Dr Seth Berkley is CEO of Gavi — The Vaccine Alliance, a partner of the Bill & Melinda Gates Foundation, which works for better and more equitable access to vaccines. Gavi has helped vaccinate 760 million children in the world’s poorest countries. He was interviewed over email by The Indian Express.
How far has science travelled in the search for a COVID-19 vaccine, and what role will Gavi — The Vaccine Alliance play?
Developing vaccines is a time-consuming and resource intensive process. It typically takes up to 10-15 years from the discovery of a novel way to produce a vaccine to respond to an unmet medical need and the licensure of a vaccine for commercial use. Given the unprecedented levels of data sharing and global collaboration, with a full-scale push, we could potentially have a coronavirus vaccine — at least an investigational one for potential use in outbreaks — within 18 months to two years. That would be an incredible achievement compared to any previous vaccine development, and would require luck in terms of the approaches currently in the pipeline.
Gavi is positioned to play a key role in each phase of the development and delivery of a SARS-CoV2 vaccine. Drawing upon our experience enabling access to critical vaccines — including the Ebola vaccine — we are working closely with the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations, the industry and other partners in the R&D community to create optimal conditions for the identification of priority candidate vaccines, with a focus on potential to scale and equitable access.
Gavi’s innovative financing mechanisms are also being made available. Gavi’s ‘Vaccine Bonds’, through the International Finance Facility for Immunisation (IFFIm), will be open to additional donor commitments that can be spread over the long term but, thanks to IFFIm’s unique frontloading features, make significant funding available to accelerate vaccine candidates. Gavi will also enable its private sector Matching Fund to be rapidly deployed for quick assistance from private sector partners to scale up funding and proven technologies to fight coronavirus…
The 300,000 Ebola vaccine doses [access to which was facilitated by Gavi] were investigational doses made available through an Advanced Purchase Commitment after the vaccine was determined to be efficacious, but before the product was fully licensed… Such an effort might also be made in the case of coronavirus vaccines to help control outbreaks or protect health workers.
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Does the challenge of fighting COVID-19 end with the discovery of a vaccine?
With more than 100 candidate vaccines already in development, the response from the scientific community and industry has been unprecedented. But of course, vaccine development on its own isn’t enough. There is currently no global system to oversee the allocation of vaccine supply and many countries who have the capacity to manufacture at the required scale will also face pressure to make that supply available first to their own population. We need global access agreements before a vaccine is developed.
For me, there are two axes. The public health need — if there are out of control outbreaks anywhere in the world, it threatens not only those countries but the rest of the world… Two, there will need to be some type of agreement on priority use — health workers probably most important, followed by high risk such as elderly, those with chronic conditions and finally, the general population.
What has been Gavi’s experience in evolving access to vaccines?
Gavi’s role will be to shape markets from development to manufacturing to distribution, so that there is equitable access at scale to them. Gavi is working with partners under the leadership of WHO to help select and accelerate candidate vaccines and ensure they are managed as global public goods.
This work will build upon Gavi’s successful experience of shaping vaccine markets. This includes expanding the number of vaccine suppliers; the Advance Market Commitment for pneumococcal vaccine — which has saved 700,000 children’s lives by pre-committing incentive payments for vaccine manufacturers who have developed appropriate vaccines for developing countries; the accelerated licensing and rollout of the first Ebola vaccine in the past four years through an Advance Purchase Commitment; and managing stockpiles against outbreaks. Indian manufacturers have an important role to play in COVID-19 vaccine supply as they do in supply of high-quality vaccines globally.
Do you anticipate the COVID-19 fight disrupting routine immunisation programmes and vaccination drives?
The COVID-19 outbreak is a reminder that infectious diseases know no borders, and that the world must be prepared for the evolutionary inevitability of the emergence of novel pathogens. In countries with weaker health systems, such outbreaks can have even more devastatingaimpact — both within and beyond national borders. The importance of preparedness and early detection, meaning investing in strong primary healthcare and immunisation systems as the first line of defence against threats to global health security, cannot be overstated.
We are already seeing the impact the pandemic is having. Major Gavi-supported vaccination campaigns against polio, measles, cholera, HPV, yellow fever and meningitis have been postponed in low-income countries. These would have immunised more than 13.5 million people. The number of people missing out on vaccines is likely to rise substantially as we expect a significant proportion of planned vaccine campaigns to be postponed in the coming months, with routine immunisation programmes also severely impacted as key staff are redeployed.
How can countries mitigate such risks?
For now, the focus of governments needs to be on continuing routine immunisation as well as robust public health measures for COVID-19 and this is what they are doing. Without routine immunisation, we will face potential outbreaks of regular vaccine-preventable diseases, which will overwhelm the health system on top of the COVID-19 challenge.
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We also must remember that strong routine immunisation ensures people are protected against the spread of infectious disease and, by connecting them to health services, enables early detection of novel threats. It also means the existence of supply chains, trained health workers, data systems and, crucially, disease surveillance and in some cases basic laboratory testing…
Beyond routine immunisation, we have also recognised procuring stockpiles as an important aspect of global epidemic preparedness. Gavi funds emergency vaccine stockpiles for cholera, yellow fever, meningococcal disease and Ebola to ensure that when an outbreak does occur, we are prepared to quickly deploy vaccines to protect affected communities and limit the spread. These emergency stockpiles are a last-resort insurance policy that guarantee vaccines will always be available for rapid delivery when needed, benefiting not just directly affected nations, but the entire global community.
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