The shock of a global pandemic exposed so many flaws in our current system. With that in mind, what kind of preparation and leadership do we need for the next global disaster? Dr. Seth Berkley, the CEO at Gavi, the Vaccine Alliance, joins us to shed light on the topic. He co-founded and led the organization to accelerate vaccine access to the poorest of the poor worldwide. Dr. Seth also co-created COVAX, the global emergency response and the only multilateral solution to COVID-19. In this episode, he chats with host Anne Pratt to discuss the initiatives they’ve spearheaded from the start and what they’re currently doing to keep up and prepare for what’s next. People want the virus to be over, but the virus might have different plans. Nobody is safe until everybody is safe. It’s essential to have leaders with the foresight and commitment to long-term solutions and efforts to ready us for whatever comes. Listen in to learn more about the current state of vaccinations worldwide and why we need to continue on this path to maintain global health and safety.
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Leadership Beyond The Pandemic with Dr. Seth Berkley
Are We Ready for the Next Global Disaster?
A bold leader joins us from Geneva in Switzerland, the European headquarters for the World Health Organization and the International Red Cross. He is an inspirational American medical doctor, a world-renowned infectious disease epidemiologist, and a pioneering champion of change who has worked in global public health for many years. He’s appeared on the front cover of Newsweek. Time Magazine has recognized him as one of the World’s Top 100 Most Influential Leaders and had more than 2.4 million viewers of his TED Talks.
He has served in more than 50 countries in Africa, Asia, and Latin America. He cofounded and led Gavi, a global vaccine alliance to accelerate vaccine access to the poorest of the poor worldwide. He co-created COVAX, the global emergency response to COVID-19, the worst pandemic in over a century. We warmly welcome Dr. Seth Berkley.
Dr. Berkley, thank you so much for making the time. It’s a real privilege to have you with us.
Thank you for having me.
In your life, you’ve had a remarkable career. You are a global champion of change in public health. I know you’ve spent since August 2013 at Gavi, the global vaccine alliance. Can you start by telling us a little more about Gavi, its purpose, mission, and global reach?
I was involved with getting Gavi started, which was started around the year 2000. The reason was there were exciting new vaccines that were changing the landscape, targeting some of the largest killers of children in the world, but because they were new and expensive, they weren’t getting out to the places where they could make the most difference. The idea was to create a public-private partnership that was launched in 2000.
Nelson Mandela was the first chair of the organization. It began slowly because it was a new concept of raising money and being able to engage with the industry. I joined it in 2011 as the CEO, even though I had been involved initially. I had been watching it closely and working to accelerate the activities. It vaccinates more than 50% of the world’s children. Also, it has introduced 550 new vaccines in developing countries, which has reduced vaccine-preventable diseases by 70% and has contributed to it an under-5 child mortality reduction of around 50%.
You’ve spearheaded and cofounded COVAX, which has been the world’s only multilateral solution to the global pandemic of COVID-19. Can you share with us a little about COVAX? What ignited that process? Where are we in the world with COVAX?
We were at the world economic forum in Davos, and it was about three weeks after the public identification of the virus. Later on, we found out that there were cases earlier than that. We asked the question, “Is this the big one, or is this a dress rehearsal for the big one?” I sat with a colleague, Richard Hatchett, who runs the Coalition for Epidemic Preparedness Innovations.
We said, “Look at what happened in the last pandemic, which was the flu. A vaccine was made quickly, but none of it got to developing countries quickly. Could we do something different here?” If I had known what it would take and the amount of work, I might have thought about it twice, but I didn’t. We jumped in and started in a great place. We had no money and staffing to do it. We had no mandates. We had to build that. The other interesting part was the idea of having vaccines simultaneously in rich and poor countries. We did pretty well.
After the first vaccine in the UK, 39 days later, there was the first vaccine in a developing country supported by us. We were in the process of trying to move forward. We got hit with vaccine hoarding, vaccine nationalism, and export bans. We spent a lot of 2021 disappointing people in a difficult time as there was a separation of wealthy countries having vaccines and poor countries not. We ended up asking for help, and countries began to donate doses, which wasn’t part of the original story.
Where we are is we’ve delivered more than 1.2 billion doses. We’re on a pathway toward having enough doses for countries. We’re still dealing with inequalities. Some countries with weak infrastructure and health systems don’t have high coverage rates. For those, we have to work carefully to try to understand what the problems are and solve those. We’ve done much better this time than we did in the past but it wasn’t good enough and I think everybody understands that.
You spoke about the fact that you didn’t even have a mandate and resources. I believe you’ve engaged partners and funders across 193 economies and have provided COVID-19 vaccines for 92 lower-income countries. Can you take us through what was the leadership exercise you went through to get the mandate and help secure the resources?
The challenge in doing this is we had credibility because we are the largest purchaser of vaccines in the world. With that being said, most of our vaccines are for children. They’re not for whole populations except for some epidemic diseases like yellow fever. We may do a campaign that covers different ages, but we generally provide vaccines for children. In a sense, we were logical people, but it wasn’t necessarily something that everybody would think we had to do.
We first had to begin to sell this as a concept and put together some thought processes and vision for it, but then we also had a very quick start raising money. We raised about $11.5 billion over a very short period and worked with pharmaceutical companies to get contracts for doses and work on technology transfer to developing country manufacturers.
There are a lot of processes there. You can’t do this by yourself. You need a team. One of the leadership challenges is convincing others to work with you and have them understand that together, you can do more. There’s a danger in this type of setting that you end up with many different initiatives. They don’t come together and divide rather than bring people together. We ended up with the only multilateral mechanism to move forward.
That gave us some strength in terms of working with the companies and the donors to get support. We ended up having 193 countries join us, which was extraordinary. We ended up delivering vaccines to 144 nations. Not all 193 ultimately took vaccines. Some took a little bit, but the point would be that this was the largest gathering of countries since the Paris Climate Accord. We did it without the US at the time and, in a sense, as you could argue, was a little organization pulling that together.
When you say a little organization, you’re talking about Gavi. Who were the key stakeholders you initially brought to the table in helping secure that mandate and expand the efforts? Were there critical stakeholders that you strategically targeted at the outset?
We had conversations with developing countries and some of the manufacturers. Still, it was critical to get donor resources, get our board on our side to do this, and get the board of CEPI (The Coalition for Epidemic Preparedness Innovations is a foundation that takes donations from the public, private, philanthropic, and civil society organizations, to finance independent research projects to develop vaccines against emerging infectious diseases), WHO, UNICEF, and other leaders that would join us to put together a temporary structure because we didn’t create a new legal entity to do this. We worked through Gavi and CEPI rather than creating a whole new structure. All of that was a challenge in convincing everybody to be part of that.
We had a donor conference that was planned for Gavi for our replenishment. What was interesting was we normally have 1 or 2 political leaders, but because of that moment in time and doing it virtually, we ended up with 42 heads of state, including all G-7 heads of state and 19 of the G-20 heads of state, all coming to the meeting talking about the importance of this, validating the idea of trying to do this. Not just for the world but also for developing countries. That certainly was a big help in terms of fundraising and moving forward.
I do not doubt that there must have been some pretty dark, difficult moments. Can you perhaps take us back in time to a specific time and place when you were in that moment? What was the occasion? What was the key issue? How did you feel at the time? How did you navigate out of that?
We had many dark and tough moments, but one of the hardest was I already mentioned how happy I was to say that we had in developing countries 39 days after the first doses. We had plans for hundreds of millions of doses. We had already begun to tell countries about those, and the Delta variant of the virus broke out. As you know, it was devastating in India. In India, at that point, it felt that it was doing okay and not having many problems.
Our largest supplier of vaccines at that point was the Serum Institute of India. We had done a technology transfer there. The original agreement was that 50% of those doses would go to India and 50%, particularly to the poorest African countries. What happened was India put an export ban in place. They didn’t call it that. They said, “No vaccines going out.” Suddenly, we had given countries even the first dose of vaccines. They were waiting for the second dose. They didn’t say they were stopping it, so it was delayed, and it became terrible.
We had to work our way out of that. Meanwhile, people in countries say, “We started to get protected. Now we’re not protected. What’s happening here?” That was probably our darkest moment. In a sense, the reason it was so hard is that we had set it up beautifully. The Serum Institute of India ended up producing 1.5 billion doses. They mostly got used in India. It was good for an important country but left many other countries behind.
What was the point of revelation? In that process, what was your light bulb moment? What steps did you take to try and overcome this global disappointment?
First of all, the light bulb moment that occurred to me during this process was at the end, as an infectious disease epidemiologist, when I say, “We’re only safe unless we’re all safe,” I believe that. Early on, people said it, but I’m not sure they believed it. When India occurred and then afterward, it spread around the world, people began to say, “Maybe this is true.” Later on, Omicron came out of South Africa. The hard part here was that India didn’t do the right thing from my perspective. Had they said, “We have a terrible outbreak. Instead of 50%, we’ll keep 80%, but we’ll give the rest of the world 10% or 20%,” we could have at least limped along and helped people continue their second doses.We’re not safe unless we’re all safe. Click To Tweet
What resulted from that then is a lot of anger about that. That anger led people to say, “We don’t want to buy vaccines from India anymore. We want to make our own,” which will have long-term implications because India has been the supplier of the world doing it at a great price. These are challenges that have causes.
For me, on the moral and ethical things, it makes you ask, “Let’s say the outbreak was worse. How do you create a situation where people say, ‘I know I have to take care of my friends, family, and community, but if we don’t take care of the world, it will be bad for us and the rest of the world?’” That goes against some of the ways human nature is set up. These are some of the things that I struggle with.
To that point, Dr. Beckley, it’s the idea of a virus for one is a virus for all. What has been the compelling conversation for the skeptics? How have you overcome that thinking? What have been the takeaways from your experience with that?
There are two ways to answer that question. One is this issue: We’re only safe if we’re all safe. Some say, “We should help other countries because it’s the right thing to do from a humanitarian perspective.” We also have to say that even if you’re not a humanitarian and want to protect yourself, you don’t want new variants appearing. Therefore, vaccinating the world makes sense. Trying to get that argument and have people believe it is critical. You’ve also got a separate issue, which is how you deal. This is the worst we’ve ever seen. With the partisan nature of politics at this time, your belief in science and vaccines suddenly became a political issue.
All of the sudden, we had the party you belonged to, or the state you lived in became a defining feature of whether you were vaccinated or not. Not whether you were at risk or not. That became very difficult because everybody’s connected to the internet. When rumors start in one part of the world, they move at the speed of light around the world.
We then had to dissect that and try to convince countries, individuals, and healthcare workers that a certain vaccine was safe. Those were crazy things. It didn’t have a chip in it that was tracking people. It didn’t lead to contraception. All these crazy rumors were going around and we kept having to undo those working with the social media companies and others to try to do that.
How far do you think we are in the world with that battle?
It’s interesting because, in developing countries, we tend to have much less vaccine hesitancy. Why is that? You might think it should be the opposite, but if you’re a mother or a father, you see the diseases around you. Every mother and father wants to protect their families, children, and communities from those diseases.
In the West, diseases have disappeared because vaccines are so efficient. They don’t see the need as much. Therefore, the highest level of discomfort and lack of confidence in vaccines in the world is in France, the land of Louis Pasteur. The country that had the highest belief and acceptance is Rwanda, to give you an example.
In this particular case, because of the way the rumors were going with the political nature and a lot of these technologies were new technologies and they were done rapidly because of the emergency, there was a lot more fear and vaccine hesitancy in the (global) South. We’ve had to work to try to stop that from happening. It requires different things in different countries, depending upon the origins of the problems.
Do you have one example of a country where you were able to shift that perception?
It’s never perfect, but an example would be South Sudan. It’s a very unstable country with huge political problems and is not highly educated. The question is, “Who has credibility in the community?” We worked with church leaders, not just church leaders but mosque leaders, traditional healers, and community leaders. The reason is that people tend to trust where their social networks are connected.
The idea was to try to get the information out and have them influence their populations, religious flock, or however you want to talk about that. That’s something we learned from working in the past on polio and other diseases where getting that religious or community leader engaged was a good way to have people accept something that otherwise they might be afraid to accept.
How far do you think the world has come? What do you think the risks are? Where are we? What is your perception in terms of risks, whether this global pandemic is in a manageable state or not?
Everybody wants to be done with the virus, but I’m not sure the virus is done with us. We’ve seen countries with high vaccination rates begin to say less severe, given the last variant. With less severe, there are still 60,000 people dying a week from this disease. It’s still causing a lot of deaths but less severe than some of the previous ones.
There is a sense of, “We’re over it.” It is certainly possible that this might be the last variant, or you might see a reduction in cases over time, but we’ve had a new variant about every four months. The challenge is how do we both hope for the best but prepare for the worst? How do we make sure that we continue to move to protect people who might be at high risk in case there is a Pi, a sigma, or a new variant that comes out that conceivably could be less severe or more severe? From our perspective, it isn’t over yet. We have to carefully watch what’s happening and ensure that we provide the best protection for those around the world.
Shifting to a wonderful human being whom we both greatly admire and respect, you mentioned that President Mandela, or Nelson Mandela, was Gavi’s first Chairman. I’m sure you had many moments with Madiba. Is there a particular moment that stands out for you or a place in time where Madiba inspired you in some way?
In all ways but perhaps, for me, one of the most interesting things was we would have technical meetings trying to get people interested in financing. You’d bring all these financial people and people discussing the epidemiology of diseases and the cost-effectiveness. He had a way of cutting through all of it and saying something like, “The place you are born should not define whether you live or die. These tools should be available to everyone because they can make a difference like that.”
He spoke with such moral authority with a deep voice and a strong statement that all of the people who were there arguing about the cost-effectiveness stopped and listened. That meant that they saw the bigger picture. This is a bigger picture story because vaccines are the world’s most widely distributed health intervention. 90% to 91% of people get access to at least one dose of a routine vaccine.
That means 9% to 10% don’t. Those are 2/3s below the poverty line. That’s about 50% of the under-5 mortality, which occurs in that 9% to 10% of the population. Our goal is to try to extend immunization to those populations. The idea is we’ve had such a big reduction around the world with very inexpensive tools relatively. For every dollar you invest in immunization, you get a $54 return. There’s almost nothing like that. It’s taking something that can make so much of a difference and ensuring it gets to people who need it.
Do you recall when that was? Was it at a particular board meeting?
I remember the event well, but I can’t tell you it was at a board meeting. I can tell you that because I also, in my free time, had been an expedition doctor. I did a lot of expeditions around the world. I had been in Namibia working to see if the Fish River Canyon was navigable in the rainy season. I had a horrible fall, shattered my legs, and had emergency surgery. I left, got evacuated, and got back home. I was having this meeting on financing with Nelson Mandela.
My girlfriend at the time, I got engaged on that trip, but I said, “I ought to go to this meeting.” She’s a physician, also. She said, “Anybody else would’ve said it’s crazy, but you live on airplanes.” We got right back on the airplane. I proposed on the flight out. The amazing thing is that one of the flight attendants recognized me and said, “Didn’t we evacuate you a few weeks ago?” Sure enough, I went back. I do remember the timing. It was around 2001.
You alluded to this, Dr. Berkley. There’s a very strong moral case. In the case of the skeptics, the scientific case, what do you think we still need to do from a leadership point of view to convince, persuade and inspire people in terms of the scientific case? How do we get over this hurdle in terms of helping people understand that it’s not about “I don’t care? That’s fine. There’s no more risk to me, so why should I care or worry about whether anyone’s left behind?” Are there any other examples or thoughts where you’ve been able to persuade a more skeptical audience? What does that require from you as a leader and other leaders in the world?
First of all, there is a moral-ethical thing. If I want to say something bad or lie for a political purpose, you can argue I shouldn’t do that ever anyway and live a life of honesty. You cross a line when you say things and create false knowledge that can kill people. That’s what we dealt with here. One challenge is whether people have the courage to stand up in that circumstance and say, “The Emperor has no clothes. This is not the right way to behave.”
We had several political leaders who were passing information that was known as false. The people around them also supported those falsehoods because they didn’t want to call them out. That’s a very dangerous place to be. For me, the critical issue here is having enough confidence to say, “No, this isn’t right.” Try to use that voice to make sure of influence because you never know who’s able to reverse these things, particularly if powerful leaders are saying these things.
For me, that’s been an experience. Throughout my life, I was trying to use science to drive things as much as possible. Science isn’t perfect. Sometimes we learn new things and have to change our previous things, but it’s the best thing we have. If you’re using the best science of now, then you’re in the best position to get the best outcome. That’s what we want to do here.
Do you think Mandela’s leadership is still relevant in 2022? If so, why?
It’s relevant, and some of the key things that he did. Here’s a man who spent 27 years in prison and should have emerged more radicalized, angrier, and spiteful than when he went in and didn’t. That’s history. The fact that he created truth and reconciliation commissions and tried to take the anger down a level and have people work together for a better South Africa is the type of leadership skill you need in this new world.
One of the things I think about COVAX is, “It wasn’t perfect. It was better than previous attempts we should learn for the future.” I also think about what’s the relevance of other things. If I look at climate change as an example, here’s an example of a disease that killed family members and people worldwide. If we can’t come together for that, how hard is it to come together to deal with something much slower?
It eventually will kill people and do things, but it’s a slower process. That’s why you need leadership to do the right thing and take that long-term view. It’s critical for the good of the world. We’re in time. We’re so quick and into political cycles with the internet moment. We need that longer-term leadership. That’s what’s going to be critical.
I was curious to ask you if COVID and the global pandemic addressed rehearsal for climate change.
It is. In some sense, we partially succeeded but partially failed. A virus is a good example of that. I’m in Switzerland. Switzerland vaccinated everybody, but if all the countries around it didn’t vaccinate anybody and the diseases are still moving around, you still threaten Switzerland. The same thing, if Switzerland did a perfect green environment and everybody around it was still polluting heavily, it would come to Switzerland, the climate would change, and all of that.
These are the most difficult things because to get the world in order here, you have to do some sacrifice for the greater good, but that sacrifice for the greater good is also for your greater good or your family’s greater good. It’s an issue of that timing of view. If you say, “I’m only interested in my next quarterly profits,” it’s a very different view than if you say, “I’m interested in the world my children will inherit.”
When you brought the parties together regarding COVAX, there wasn’t a separate entity set up. It was a temporary structure. Are there any lessons from COVAX and dealing with this global pandemic regarding how to organize the world in the event of climate change from a structure or a governance point of view?
There are a lot of overlapping principles. There’s a lot of innovation that’s been used. For example, we have a financing structure called IFFIm, the International Finance Facility for Immunisation. It was the brainchild of Gordon Brown (a British politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party from 2007 to 2010, the last Labour Prime Minister under Elizabeth II before her death in 2022. He served as Chancellor of the Exchequer in the Blair government from 1997 to 2007). One of the amazing things it does is it says to donors, “If you make a legal commitment to pay over time, we can go to the capital markets using those guarantees and take the money out at any point.”
It gives you complete flexibility. If somebody puts in $50 million per year for 20 years, that’s $1 billion. You can take it out on day one, more or less. There are some carrying charges and other things. What that allows you to do is front load. This turned out to be a good thing for epidemics because when an epidemic hits, it’s not like countries have money hanging around not doing anything. They may or may not have space in their budget.
This allowed countries to say, “I can take a little bit out over a longer period but allow that money to come up front.” Those types of creative instruments are important to be able to do things. We have to look at these lessons and ways of working. The hardest thing will be to get the global commons to come together and agree. Not everybody has to do the same thing, but it has to be aligned enough that we’re not going off in all different directions. That’s one of the important lessons here.Not everybody has to do the same thing, but it has to be aligned enough that we're not going off in all different directions. Click To Tweet
December 5th, 2013, was the day that Madiba (Nelson Mandela) passed away. You were the recipient of the Honorary Doctorate in Philosophy at The Nelson Mandela University in the Eastern Cape in South Africa. Can you describe that moment? What did it mean to you? Did you visit Madiba on that trip?
I did not visit Madiba on that trip, but I must say, it was incredibly inspiring to me to have this degree from the name of this great leader. In my remarks, I made that point about the role he had. Frankly, Graca Machel (Mandela’s widow) afterward continued that work. Graca allowed us to use the Nelson Mandela name as part of an immunization lecture series. I also had opportunities to work with her going forward.
This meant a lot to me. I have to say also that it meant a lot to me to be in a university and see so many young minds coming to that level of academic excellence. I didn’t go to do a seminar. They didn’t ask me to, but I saw all these people. The kids came over to me, and I said, “Can I do a seminar?” They said, “Sure.” I did a spontaneous seminar and people loved to talk and ask. I must say that’s an important part of creating the next generation of Africans.
A couple of fun facts. You grew up in New York. I believe as a child, you were interested in chemicals and worked for a wind chemical company. What got you into science and chemicals? What led to that early nine-year-old employment contract?
It wasn’t an employment contract. You’re not allowed to work at age 9. I had gotten interested. My father wasn’t a chemist. He had wanted to be a doctor, but during the depression, he had to go and work in the steel mills and never did that. He had a college chemistry textbook, and he said it was interesting. He gave it to me, and it was an older textbook. I read it from cover to cover, and I loved it. I thought it was interesting.
I found this chemical company that was near me. I had a little chemical set and went there. As I walked in and around, the owner told me that I looked like a kid in a candy store. My eyes were big, and I was looking at things. He said, “Do you want to help out in the store?” I said, “Yes.” He said, “I can’t pay you because you’re underage, but I can let you take home some equipment.” I had the best laboratory anybody could imagine in my closet. It’s a very sophisticated laboratory in my closet, and I learned an enormous amount. Chemistry remained one of my favorite subjects.
How long did you continue to visit this chemical store?
It was a few years. In the end, the store had some financial troubles. It wasn’t as ‘in’ (popular) to have hobbyists in chemistry, and it eventually closed, which is unfortunate. Occasionally, I go by that street and think fondly of those moments and what a fun thing to do. My daughter loves chemistry. I don’t think I forced her into it, but maybe it’s genetic. That’s her favorite subject. It makes me very happy to hear that.
I believe you also had a very interesting experience when doing some of your medical degrees at Brown University and working in a ghetto clinic in Jacksonville, Mississippi. What took you to Jacksonville? Is there a particular flashpoint working in Jacksonville that made an indelible impression on your career choices?
Let me take a step back though, because when I was a young boy in New York, I worked at the YMCA, The Young Men’s Christian Association. I was asked to teach chess. In the first class, I came in, many parents had enrolled their kids. They were mostly poor kids from the ghetto. It was a tough first day because these kids said, “My parents enrolled me in this. I have no interest in this. I’m not going to pay attention or do anything.” It was awful.
What was amazing is after twelve weeks of a weekly thing, on the last day, you’d see the students all watching for intent interest for a couple of hours, a game of chess, all loving it. That taught me that sometimes you have to drag somebody to give them the exposure, but once they have the exposure, people can take off. We ended up with some very good chess players and people who otherwise would’ve had no engagement in doing that. That was an important lesson for me.Sometimes you have to drag people a little bit to give them the exposure, but once they have the exposure, they can take off. Click To Tweet
Where in New York was that? Roughly, what year was that in New York?
It was the Westside YMCA on 63rd and Central Park, West. I also worked with the Bedford-Stuyvesant YMCA, Harlem YMCA, and several others over that time. It was when I was in high school. That would’ve been in the ‘70s.
Were you teaching chess at these various YMCAs?
Some of them had chess clubs as well. We did some crossover things with the students to do chess with other students. It was fun to see this. It wasn’t only an experience in my club and other clubs.
Let’s fast-forward to Jackson.
It’s Jackson, Mississippi. My Dean, who saw me as a little hyperactive and full of energy, thought he wanted to give me something of a challenge. He sent me to Jackson, Mississippi, to be an amazing physician and was a role model in my life. He was the first Black physician to get privileges in Mississippi, Robert Smith. He originally went away to medical school. He got his degree and went to the Great Northern Chicago Hospital (Northwestern Memorial Hospital) in Cook County. He worked there. He got married, settled down well, and said, “I have to go back to Mississippi.” His wife said, “I’m very happy in Chicago. Thank you very much. I’m not going to go.”
He went back to Jackson, Mississippi, and got there. He said, “I want to get privileges.” They said, “You have to join the AMA.” They said, “Sorry, we don’t allow Blacks in the AMA.” He led the first march on the American Medical Association, got the first privileges there, and became a hero to the community because he was able to work there.
I got sent down to work there. I must say it was an extraordinary experience because I arrived on my first day. I went into the Howard Johnson Hospital and changed into my little jacket and tie. I walked into the waiting room, and there were about 150, often quite heavy, people from Southern Mississippi, almost all Black. It was a different world from my New York upbringing. He brought me in and made me family. I lived with a family there. I learned about what the struggles they had were and also the type of health issues and their effects.
I was so inspired that four years later, I came back in my senior year and helped them get designated a national health service core site so they could get extra help from the federal government. He came to my medical school graduation and remained a friend. I visited him and took a trip down there, especially to see him. He’s a very inspiring leader, but I also learned what it meant to be a community doctor. Women would say only he would deliver them. I would have to with him, rush to the hospital to deliver the baby together, and then we’d go back to what we were doing because people were so dedicated to his role.
How do you think that shifted that exposure and your view of how you saw yourself in the world and the medicine you were going to pursue? Did that change your thinking and trajectory in any way?
I grew up in a lower-middle-class family, but as I was exposed to challenges in different settings, particularly in poor populations, I learned about the different problems that interested me. It made me interested in urban health, which ultimately led me towards international health, infectious diseases, and vaccines as the most effective way to deal with that. It’s not quite linear, but it was all connected.
These role models in my life were very important because they were about doing the right thing, moral leadership, and being in resource-limited settings but being able to do as much as possible. That taught me a lot about how to work in these places. I worked for (US President) Jimmy Carter and lived in Uganda for three years. I joke I got a Ph.D. in Patience when I was there because I was this hyper-energetic guy who had to slow down my pace for what was happening in that resource constraint.
That was right after (former President) Idi Amin. It was a terrible time in Uganda. I was one of the few doctors in the country. Not only did I do public health work, which is what I went to do, but I also taught at the medical school and had my ward at the hospital. I got an Honorary Doctorate from that school for that work after having helped them start a new public health school. It’s wonderful to see some of the doctors I had training as students to be senior registrars and in leadership roles in the country.
What was the pivotal moment in Uganda?
What happened was I went to help rebuild the immunization system, which was the purpose. I said, “You were the first country to talk about aids. Is it a heterosexual transmission? What’s the percentage of men and women?” People were like, “That’s a good question.” Even on my first visit, before I even decided to go, I started to collect information, and we eventually did a survey. That’s to take blood samples to see who was infected.
My girlfriend at the time was helping me with the data analysis. When I got the first results, I said, “You have the decimal place in the wrong place.” She said, “I don’t think so.” We checked the numbers, and then I went to the lab. I said, “This lab doesn’t work.” It turned out that what we were seeing was that proverbial iceberg. We saw a few cases of aids on the top, but it was all the infected below it. Although, in Africa, they say it’s a hippo with ears above the water and a big body below it.
What was important about that moment, and this is the critical thing, is President Moi on one side and President Mobutu on the other said, “We don’t have aids here. Tourists keep coming.” When we presented this to President Museveni, I did all the right things, including confidence intervals and how unsure we were about the data. Still, the next day in the national newspaper, 795,512 Ugandans were HIV-infected. This was the headline.
He said, “We have to be transparent and work. We can’t kill people. We have to do this.” That led to Uganda having an amazing effort to deal with aids, and eventually, other countries came around. That was a real leadership moment driven by data and helped by the fact that some military commanders had gone to Cuba. Castro called the president and said, “You have a problem.” I forget the number, but 50% or 60% of the military leaders were infected. It was certainly on his mind, but it was another example of a breakthrough in leadership.
At this moment, Dr. Berkley, what are the big issues that keep you awake at night? From a leadership point of view, and you have this amazing global perspective, what are the three biggest leadership challenges we are facing?
Besides Ukraine and the question of whether the leader of Russia will be rational because that’s a very scary thing given the tools in his control, it connects back to what we’re doing. What I’m scared about are infectious diseases. Decades ago, there was a stent. Infectious diseases are over. We don’t have this problem anymore. We have antibiotics, good hospitals, and good labs, but we’re only around the corner from the introduction of a new virus and disease appearing. I had an opportunity to identify my disease at one point, name it a terrible disease, and understand it.
It’s particularly poignant to me. The challenge here is how do we get people to take that seriously to prepare for it and have the tools ready to be there in case we need it? Those are the things that are scariest to me. The last thing is the issue of trust. I talked about it regarding leadership and having people be reliable in their information sources. If you don’t trust your leader, you are in a difficult situation because how do you get that contract of making some pain, as we discussed, to get good long-term things? You have to say, “This leader is doing the right thing for me, even if it doesn’t always feel like it.” If you don’t have that, it becomes very hard to make difficult decisions.
In our final few moments, are there any final thoughts you have about what the world is calling us out to do from a leadership point of view in terms of broadly shaping our future, or any final words that you think Mandela would share with the world leaders?
If he was here, he would probably be disappointed at Africa not moving more toward a more democratic norm. I’m sure he’d be unhappy about some of the disturbances that are occurring. Most importantly, what he saw and wanted, and it’s similar to what I saw with my leader in Mississippi or what I learned in Uganda or anywhere else, is everybody wants to get ahead and have a better life for their children. To do that, we need to do it more sustainably.
That’s critical in terms of a world of climate change but we also need to pay attention to the disparities. That’s the hardest thing. We have the highest disparities between the rich and the poor that have been seen, if not in history, but certainly in recent history. That’s not a good place because we know what happens when those disparities get big enough. There are a lot of resources that could help lift the world. The question is, HOW do we make that happen?
It’s been such a joy to speak with you, Dr. Berkley. I look forward to hearing more and learning more. I hope you’ll return and share more of your insights and lessons with us as we navigate a very turbulent and difficult time in the world. Thank you so much.
Dr. Seth Berkley has delivered leadership excellence and impact on a global scale that most of us still imagine or aspire to. He co-founded COVAX, which was an international emergency response to a global pandemic, a pandemic that was the worst in more than a century, and he did so with no mandate date, no money, and no staff.
Within a rapid period of time, they raised $11 billion, engaged 193 nations, distributed 1.2 billion doses to 144 countries. One may ask how in his own words that took unquestionable credibility and a tarring track record of trust. Yet the alarming users that despite these successes, the world is still unprepared or ill-prepared for the next global pandemic, or what he calls The Big One.
To date, COVID-19 has infected more than 600 million people, claimed 15 million lives, and cost global economy $11 trillion and still counting. Although many of us do say that we understand no one is safe unless everyone is safe. we still do not think, act and lead in a way that demonstrates we truly believe that. If COVID is the dress rehearsal for climate change, in this new global age where global threats transcend our national borders, my question to you is what will it take for you, your family, your friends, your loved ones to wake up, stand up, and speak out?
It is a crucial question because the world needs you to lead boldly too. Until next time, please stay safe. Take thoughtful, bold action. Sign up, share with your friends, and join our Global Leadership Movement for Change. Leading boldly is about making clear, thoughtful choices. Bold leadership is about taking bold action just one small step at a time. One small step for you, but together, one giant step for humanity. Take care and take thoughtful, bold action.
- World Health Organization
- International Red Cross
- Serum Institute of India
- International Finance Facility for Immunisation
About Dr. Seth Berkley
A pioneer in global public health for more than 35 years, Dr Seth Berkley has been a champion of equitable access to vaccines and of innovation, and a driving force to improve the way the world prevents and responds to infectious disease. A medical doctor and infectious disease epidemiologist, Dr Berkley joined Gavi, the Vaccine Alliance as its CEO in August 2011. Under his leadership, Gavi has accelerated global immunisation access in its mission to save lives, reduce poverty and protect the world against the threat of epidemics and pandemics.
During his tenure, Gavi has increased coverage of routine immunisation in lower-income countries: even during the COVID-19 pandemic, Gavi helps protect nearly half the world’s children, vaccinating more than 888 million children in just over two decades, reducing vaccine-preventable child deaths by 70% and preventing more than 15 million future deaths. He has also played a pivotal role in changing the way the world prevents and responds to global health crises, by helping accelerate the development of and access to powerful new vaccines against diseases such as Ebola; and he has led the way in ensuring emergency vaccine stockpiles for diseases of epidemic potential, including Ebola, yellow fever and cholera. Dr Berkley has taken the case for vaccine equity and placed it at the centre of the global health agenda, warning of the growing threat of pandemics in the face of global trends like climate change, urbanisation, population growth, conflict, human migration and antimicrobial resistance.