Seth Berkley: A lifetime search for equity through vaccines

Sunday August 14 2011

My lowest point was the time when serious misunderstandings took place between local and international scientists at the beginning of KAVI” Dr Berkeley

My lowest point was the time when serious misunderstandings took place between local and international scientists at the beginning of KAVI” Dr Berkeley 

By Tabitha Mwangi

As a teenager in 1970s New York City, Seth Berkley had his first major moral epiphany.

The only child of middle class parents began to feel ill at ease with his comfortable life, while around him so many people had so little. The disparities were so deeply disturbing that during secondary school, Berkley volunteered in New York’s ghetto communities, teaching children chess, swimming and lifesaving instruction.

Seth Berkley would not have known that this youthful altruism would grow into a strong desire to confront inequalities on a global scale. The 55-year-old Dr Berkley, who founded the International AIDS Vaccine Initiative, has this month taken the reins of another prominent organisation, the Global Alliance for Vaccines and Immunisations (Gavi). Though he may not have planned it this way, Dr Berkley’s entire career has been a quest to close the gap between the haves and the have-nots. Eventually, his work achieved a clearly defined focus: The realm of vaccines and immunisation.

“I believe that vaccines are the most cost-effective and powerful tools for public health,” he explains. “The excitement about GAVI is the vision to ensure that all effective vaccines are available to all who need them, whether they live in the richest or poorest country.”

Joining GAVI

Dr Berkley joins GAVI at a time when it has secured $4.3 billion of funding in addition to its existing coffers. This money is committed to GAVI between now and 2015. As a result, a lot is expected of the new CEO. But the charismatic father of two appears ready to conquer any obstacles.

The East African interviewed Dr Berkley during the Pacific Health Summit in Seattle. The annual event, sponsored by the Bill and Melinda Gates Foundation, the Wellcome Trust, the Fred Hutchinson Cancer Research Institute and the National Bureau of Asian Research, brought together key stakeholders in vaccine research and development, as well as health policy.

While sharing details of his remarkable career, Dr Berkley’s passion for his work was palpable.

While at medical school in the late 1970s, he first visited Africa and later Brazil, where his interest in understanding diseases in the developing world began. After medical school, Dr Berkley worked as a resident in internal medicine in Boston. While there, he joined a medical team that called themselves “urban guerrillas” and took health care to homes of people with chronic illnesses.

“It was where I learned how to manage teams of doctors and nurses to improve patient outcomes. What is now common practice was then very new and exciting. It was while there that I honed my skills in population-based medicine,” Dr Berkley said.

After his residency, he joined the Atlanta-based Centres for Disease Control and Prevention (CDC) and had an opportunity to return to Brazil at a time when a mysterious disease was killing children. He helped annalyse the new disease, which was named Brazilian Purpuric Fever. Later, Dr Berkley scientifically documented the great 1985 famine in Sudan.

‘The landscape of the refugee camps was dotted with the graves of children. I saw first-hand the lethal effects of repetitive measles outbreaks in malnourished children. It was an eye-opening experience,’ Dr Berkley said.

In 1987, former US President Jimmy Carter sent Dr Berkley to Uganda to work as an epidemiologist in the Ministry of Health. Dr Berkley’s job was to manage the child immunisation programmes in Uganda. While there, his attention was soon drawn to the Aids epidemic.

His team carried out the first survey in Africa to determine population levels of HIV infection. The results showed that 18.6 per cent of the population of Kampala was carrying the virus. Nationwide, 12.8 per cent of Ugandans were infected.

“When I saw the results, I thought they had put the decimal point in the wrong place,” Dr Berkley said. “Then I thought that perhaps the laboratory tests were wrong. Unfortunately, both were accurate and the enormity of the situation hit me.”

Vaccine search

Upon his return to the US in 1989, to a prestigious job with the Rockefeller Foundation, Dr Berkley was still engaged with HIV/Aids in Africa.
But he assumed that there would be a group already focused on the search for a HIV vaccine.

“I was surprised when I realised that no one was seriously seeking a vaccine. Because of the high death rate from Aids, most research was focused on finding treatment,” Dr Berkley said. “Companies were scared away by the difficulty of the science of seeking an HIV vaccine. It was also clear that the vaccine would be most required in the poorest countries in the world and was unlikely to bring in any money.”

So Dr Berkley and his colleagues at the Rockefeller Foundation created the International Aids Vaccine Initiative (IAVI) to focus attention on the creation of a vaccine for this killer disease.

IAVI was launched in 1996 with Dr Berkley as founder and CEO. Currently, it employs over 200 people in 25 countries and has 12 vaccine candidates with human trials in 11 countries in Africa, Asia, Europe and North America.

IAVI and its partners have conducted 24 HIV vaccine trials. Funding for IAVI work comes from private-public partnerships with individuals, foundations and governments donating money to the vaccine effort.

Over the past 15 years, IAVI has had its ups and downs. “My highest point was watching the African scientists at Kenya Aids Vaccine Initiative (Kavi) labs and the Uganda labs prove to the world that they can produce a quality of data as high as any in the world.

“Many people were sceptical about this and it makes me proud to prove them wrong,” Dr Berkley says.

Lowest point

“My lowest point was the time when serious misunderstandings took place between local and international scientists at the beginning of Kavi. But it was a lesson learned and IAVI now has a very strong vaccine preparedness program,” Dr Berkley added.

Dr Berkley is now the CEO of GAVI, which is reshaping the vaccine access landscape through private-public partnerships. ‘In the past, new vaccines were first available to wealthy people from wealthy countries, then they trickled down to the rest of the wealthy nation. But it would take 15-20 years before that same vaccine would be available to the developing world. If you believe in equity, that is not acceptable,” Dr Berkley said.

The vision of GAVI is that all children should be treated equally across the world. This means that vaccines should be made available to them all, whether the country can afford them or not.

GAVI focuses vaccine supply on the 72 poorest countries, and Kenya happens to be on this list.

“In my time at Gavi, I would like to see the vision of polio eradication and measles elimination come to pass. We want all the existing childhood immunisations and new generation vaccines including those for malaria, TB and HIV to be available to all children that need them,” Dr Berkley said.

Cost of immunisations

However, Gavi’s role will not be to bear the burden of supplying vaccines to poor countries forever. Over time, each country will be expected to shoulder the cost of immunisations.

Dr Berkeley’s vision for the developing countries is clear. “I would like to see developing countries take immunisations, the most life-saving public health intervention, as a priority in their budgets.

I would like to see scientists more engaged and institutions to have career structures in place and eventually some vaccine manufacture where the technology allows,” Dr Berkley said. One in every five children in the world do not receive immunisations; Dr Berkley intends to prioritise these unreached children.

“Even in developing countries, vaccines tend to be first introduced in the big cities and then slowly move out. Children in remote places tend not to be a political priority but infectious diseases don’t respect that. As long as there are pockets of infectious diseases, the rest of the country is not safe,” Dr Berkley said.