This interview is part of COVID-19 vaccines: The road to recovery and beyond, a series that includes a broad array of voices leading the historic global effort to develop, distribute, and provide equitable access to COVID-19 vaccines, including the Africa CDC; CEPI; Gavi, the Vaccine Alliance; Moderna; and Pfizer.
As long as COVID-19 is out there, it’s a threat. Unless vaccine supplies are shared more equitably, it’s estimated that the world’s poorest countries will not be able to reach a vaccination rate of 60 percent until 2023 or later.1 In many ways, the impacts of that timeline could be more devastating than the immediate crisis. With disproportionate global vaccine distribution and growing concerns over the emergence of more contagious COVID-19 variants, the required protection becomes much harder to reach—very possibly extending the length of the pandemic.
Dr. Seth Berkley is the CEO of Gavi, the Vaccine Alliance, which was built to help low-income countries obtain vaccines. He knows better than most, from decades of work on vaccines, that closing immunity gaps globally is a Herculean task. But he also sees progress and a renewed cooperation and collaboration among his partners to deal with vaccine distribution more equitably. Gavi co-leads (with CEPI and WHO) COVAX, which supports the research, development, and manufacturing of a wide range of COVID-19-vaccine candidates and is the biggest global effort in history to get vaccines to developing nations.2
Gavi is in a unique position to address inequities in COVID-19-vaccine access. As the secretariat of an alliance comprising UNICEF, WHO, and the World Bank, along with other leading global health agencies, vaccine manufacturers, and the private sector, it has spent two decades funding vaccines for lower-income countries. But one of the most important strategies for making real headway in a crisis of this magnitude is to evolve the working relationships among the alliance’s flagship organizations to heighten the core immunization measures.
Dr. Berkley talks with McKinsey’s Michael Conway and Lieven Van der Veken about how he is reactivating private and public resources toward one of the biggest societal challenges in history. What follows is an edited excerpt of their conversation.
McKinsey: Gavi’s mission is to secure vaccines for developing countries. How are you doing that with the COVID-19 vaccines?
Seth Berkley: Historically, vaccines don’t get to the poorest nations. Over the past 20 years, Gavi’s public- and private-sector collaborations have provided close to 50 percent of the world’s children with vaccines and have been able to launch more than 495 new vaccine introductions and campaigns all across the world.
In 2020, given the importance of the COVID-19 outbreak, we helped launch a partnership called COVAX to accelerate the development and manufacturing of COVID-19 vaccines and guarantee fair and equitable access to them for every country in the world. So far, 193 countries and territories have come together to be part of this initiative. Through the COVAX Facility, the alliance went on to secure two billion doses of COVID-19 vaccines for the second half of 2021, with the goal of having every healthcare worker in the world immunized.
The hardest part at the beginning was not being able to move the deals as quickly as we’d like and not being able to deliver as quickly as we’d like. But comparing the work of this crisis to the pandemic in 2009, we were two-and-a-half times faster and went to four times the number of countries with more than seven times the number of doses.
We still have a ways to go. More than 3.47 billion vaccine doses have been administered globally, but while 49.6 percent of inhabitants of high-income countries had received at least one dose of the vaccine as of July 14, only 1 percent of those in low-income countries had.3 We set up COVAX to try to get equity firmly on the agenda. We knew that had not happened in previous epidemics. We also had hoped to stop bilateral deal making as much as possible because we know that it’s not an efficient way to deal with the distribution of products equitably. We’ve done very well—not necessarily getting us to equity but at least having that as part of the conversation.
Concerning bilateral deals, there was excitement for a multilateral mechanism. People came together to work on it, but when the new variants appeared, some high- and low-income countries made additional purchases. This has led to the type of supply constraints that we knew were going to be there.
McKinsey: Can you expand on the challenges of ongoing supply constraints and what can be done to quicken equitable vaccine distribution for COVID-19 and other vaccine-preventable diseases?
Seth Berkley: At first, the challenge we had was getting the financing and the vaccine approvals. We initially moved forward with two different deals: one with AstraZeneca, and the other with the Serum Institute of India.4 The latter covered distribution to the poorest 60 countries, and the former covered the rest of the world. In early 2021, we began to deliver on both of these plans. It was a little slow at the start because of the magnitude of the effort, but then it started to take off.
But we knew this wasn’t a fait accompli. There are new challenges that emerge every day during a pandemic of this scale, like the rise of new variants that test the efficacy of current vaccines, vaccine hesitancy in some countries over risk concerns, and the terrible surge of infections in India. These challenges impose additional stress on an already strained supply chain for delivering vaccines to developing countries.
There are new challenges that emerge every day during a pandemic of this scale .... These challenges impose additional stress on an already strained supply chain for delivering vaccines to developing countries.
The entire world was producing about five billion doses of all types of vaccines per year prior to the pandemic. Estimates reveal a further ten billion to 14 billion doses will be needed to include COVID-19 vaccines.5 That’s a tripling of volume. Serious challenges with the supply chain will need to be dealt with.
So far, we’re still seeing routine vaccines being supplied at about the same pace as they were before the COVID-19 pandemic. But considering the current global shortages, the production is likely to slow down. In some places, a lack of routine vaccine distribution could lead to additional complexities. There’s a study that suggests that due to the efforts in preventing just one COVID-19-related death, there could be 84 deaths from other vaccine-preventable diseases.6 We want to avoid that type of trade-off. An outbreak of a vaccine-preventable disease would also compound the problem by doubly overwhelming the healthcare system and healthcare workers.
Over the longer term, we need to solve for building a more equitable manufacturing system for vaccines and make sure they are produced in different regions across different countries. We clearly need more localized capacity, but it also has to be economically viable for those regions.
McKinsey: Gavi has always relied on strong partnerships. What has been the impact of the COVID-19 pandemic on your collaborations? Has there been an upside?
Seth Berkley: One of the advantages that Gavi has is that it’s an alliance. We have working relationships with WHO, the World Bank, and UNICEF, as well as civil society and vaccine manufacturers. We’re working together every day with all of these different groups. We can bring those existing relationships together in a network-type operation versus a more siloed approach. In April 2020, this way of working resulted in the Access to COVID-19 Tools Accelerator, which supports the development of all the tools needed to fight the disease—not just the vaccines but the diagnostics, treatments, and therapeutics needed globally as well.7
This network approach is how both the surge capacity and the ability to work in different ways can be done best. For example, initially, in the year 2001, we only worked with five private-sector companies, and four of the five were in wealthy countries. Today, we have 17 suppliers, and the majority of those are in developing countries. We not only had to work with some of the same manufacturers of the past but also had to introduce new competitors in the mix, and those manufacturers were under enormous pressure to deal with high-income governments.
And so the challenge has been to help lead these companies to balance their engagements in both developed and developing countries. That was very hard at the beginning. But through more cooperation and collaboration, this way of working provides faster and stronger decision-making powers across a whole range of institutions to respond quickly and focus on specific challenges as they arise and try to solve for those.
This “network wave” is the wave of the future. If you look at the big problems in the world, they are not going to be solved by just one group, whether it’s the private sector or governments. They’re going to be solved by interesting collaborations between the private and public sectors and different groups and institutions working together. That’s how we’ll get the balance of being both agile and representative: taking into account the politics but not being consumed by it and unable to move forward.
McKinsey: The COVID-19 pandemic has been a very difficult and dynamic period. What lessons have been learned from it? Which do you think will last?
Seth Berkley: The world has to be prepared. It is evolutionarily certain that we will have more outbreaks. What was quickly evident to me as we began this systematic approach was the number of things that were not in place.
The most trivial example was how we label the vaccines. Are they labeled for each individual country or region in different languages? Do we have a pandemic label? There were also more complicated examples. Do we have the system set up to deal with the issues of indemnification and liability and no-fault compensation? Do we have regulatory harmonization—are countries willing to accept, for example, WHO prequalification or emergency use authorization as a way forward?
Now that we’ve systematically put all of these measures in place, I think the challenge for us is, how do we keep them in place going forward? How do we take the existing organizations that are working in these spaces and build the surge capacity and financial ability but also keep the lessons learned? That way, the next time there is a pandemic, we can just jump right in and use the tools that have been put in place.
McKinsey: In the area of innovation, what do you see as most promising in the fight against COVID-19 and other diseases?
Seth Berkley: First of all, on the vaccine side, it’s been unbelievable. As somebody who’s worked in vaccines for decades now, I was asked early on how long it takes to produce a new vaccine, and the fastest vaccine before this was produced in four years. The Ebola vaccine took five years. And here we are, 327 days from the time the genomic sequence was done until we had a vaccine. That is extraordinary innovation. And not just one vaccine: there are 15 COVID-19 vaccines that have been approved for widespread use.
The Ebola vaccine took five years. And here we are, 327 days from the time the genomic sequence was done until we had a vaccine. That is extraordinary innovation.
Our hope is that some of these innovations can be pivoted to other diseases, whether they be regional diseases—like Marburg or Congo hemorrhagic fever—or whether the innovations are for diseases where we need a universal vaccine—like influenza—or better work—like HIV or tuberculosis. I’d also like to see new tools to deliver vaccines. Can we use patch technologies? Can we use nasal or oral administrations that can make it easier to work in difficult settings, and ideally not at –80°C? How do we achieve temperature stability?
Beyond vaccine innovation, we need to take advantage of the digital world and the ability to track and trace. We could use barcodes to follow vaccine distribution, with identifiers that allow us to get real-time data that can help us manage stocks and the process better. This pandemic has been an opportunity to test new systems and develop them for future use on routine vaccines and other health commodities.
We also have to think about how we innovate on the financing side, which has been an important part of what we’ve done. It’s brought us into areas like innovating in insurance, which is not our normal strength but was really important. For example, we were able to create a no-fault compensation scheme for the 92 poorest countries. That had never been done before.
McKinsey: What are three things you want to see happen differently concerning the COVID-19 vaccines?
Seth Berkley: The first thing I would like to see is COVID-19-vaccine doses freed up for the poorest countries. We are just not there yet concerning this critical issue of equity. Many countries are now donating back surplus doses, and I expect more will follow.
Second, I want to see the volumes increase everywhere so that we can take into account domestic needs at the same time that we look at global supply.
And last—and I think this is beginning to happen—people need to understand that we are only safe if everyone’s safe. It’s a natural response for people to say, “I’m worried about my family, my community, my country.” But when you see a pandemic moving globally as fast as this one is, mutations occur. If there are large parts of the world that are unprotected, there’s potential risk not just for those countries but for the whole world. So how do we move to a world that, in those circumstances, doesn’t think nationally but thinks globally? That’s a critical part of the future vision of where we need to go.
McKinsey: What advice would you give other leaders with regard to leading in crisis?
Seth Berkley: The most important thing is to be bold—be willing to take the risks that are there. It’s really important to reach out for as much help as you can get during those moments because these are really difficult challenges.
And when I say reach out for help, I mean in terms of asking experts to give advice, looking at other models that have worked in the past, not being egocentric, and making sure to take advantage of what science and technology have to offer to be able to move things forward. It’s about being humble and understanding that when you deal with something like this, there’s going to be lots of unknowns. And you need to bring people together as best as possible to tackle them.
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