Apr. 16 2018

Commencement Speaker Seth Berkley Thinks Big

Despite enormous progress in vaccinating children around the world, the 2018 Mailman School Commencement speaker is determined to reach "the missing child."

Not many organizations can stake a claim to numbers like these: Since its inception in 2000, Gavi, the Vaccine Alliance, has supported the immunization of more than 640 million children in low-income countries and, as a result, prevented more than 9 million deaths. Yes, the results are impressive, says Seth Berkley, Gavi’s CEO and the 2018 Mailman School Commencement speaker, but they aren’t nearly enough as long as one child is left behind.

Partnering with governments and the private sector, Berkley and Gavi work to bring down the price of vaccines, strengthen the supply chain, and much more. By 2020, he aims to immunize another 300 million, saving some 5-6 million additional lives. “Now we’re focused on the missing child,” he says. “We want to increase coverage and increase equity by finding the areas we haven’t been able to adequately reach, including some middle-income countries that are lagging behind.”

Throughout his globe-spanning career, Berkley, a physician and epidemiologist by training, has modeled a tenacious approach to addressing large-scale problems—for example, with the Centers for Disease Control and Prevention, identifying the bacterium behind deadly Brazilian purpuric fever, or with the State Department, traveling by camel through rebel-controlled territory in Darfur, western Sudan, to document the worst famine ever evaluated in history.

A Wakeup Call for AIDS

In 1986, working as an epidemiologist in Uganda through the Carter Center, Berkley helped organize the nation’s first HIV serosurvey. The results were a total shock: about 800,000 Ugandans infected—12 percent of the country’s population. “I couldn’t believe the numbers,” he remembers. Until then, AIDS was largely thought of as a “gay plague” affecting the West. The survey suggested it had become something much bigger. “It was a turning point for me, and for the epidemic,” he says.

In the 1990s, Berkley continued working on AIDS and other global health problems at the Rockefeller University. He also taught infectious disease epidemiology at the Mailman School; he calls the late Dean Alan Rosenfield a mentor. Then in 1996, Berkley founded the International AIDS Vaccine Initiative (IAVI), believing as most experts did, that their goal was possible within a reasonable period.  

While an AIDS vaccine continues to be a work in progress, delayed by continued scientific hurdles, in many important ways, Berkley’s work with IAVI has already paid dividends. Advances in the laboratory have made other vaccines possible, including recently, one for Ebola. Arguably even more importantly, IAVI pioneered a model of partnering with industry, academia, and developing country scientists that has paved the way for others, including Gavi. 

Shaping Markets, Saving Lives

Marshaling an annual budget of around $1.6 billion, Berkley and his Gavi team negotiate lower vaccine prices for the 73 countries it supports. In the U.S., it costs around $950 for all the necessary vaccines for one child; by aggregating demand, Gavi purchases the same for just $35. “We work to create a healthy market for vaccines,” Berkley explains. Gavi also helps countries become self-sufficient; so far 16 countries have “graduated” to fully self-finance all vaccines introduced with its support.

But price isn’t everything. Another pillar in Gavi’s “market shaping” strategy is encouraging competition between manufacturers to fuel innovation. Berkley who counts tech titans like Gates, Sheryl Sandberg, and Sergey Brin as friends, believes technology will play a key role in reaching the “missing child.” (Brin, the Google co-founder, once profiled Berkley for Time Magazine’s list of the “World’s Most Influential People.”)

One Gavi priority is the crucial “cold chain” that keeps vaccines within a safe temperature range as they travel to remote areas, often on dirt roads by foot, bicycle, or motorcycle. Temperature sensors and innovative refrigeration technologies have improved reliability. Soon motorcycles could be replaced by drones, which are now being tested in Rwanda, as part of a nationwide service that is now delivering blood and other medical supplies. The infrastructure for childhood immunization programs reaches 86 percent of the world’s children. Strengthening it, says Berkley, will also provide an avenue for underserved communities to get nutritional supplements, contraception, and all manner of public health interventions. “Vaccines are a starting point for universal coverage,” he says.

Berkley makes clear that a bold vision is necessary to solve big problems. But to graduating Mailman students and all aspiring public health professionals, he adds another set of professional attributes which he looks for in the people he hires—an entrepreneurial outlook, the ability to take data seriously, and most importantly, an openness to new ways of thinking. Graduation isn’t the end of your training, he says. “You need to be continuously learning.”