Seth Berkley and the immunisation trail

Seth Berkley (right) with AusAID’s Director General Peter Baxter. Photo: Lucy Horodny / AusAID

The introduction of rubella vaccinations in Laos. Photo: The Measles Initiative / C.McNab

by Elizabeth James, AusAID

Seth Berkley knows more about vaccines than most. He has lived and breathed them for his entire working life. First as a doctor, now the leader of the GAVI Alliance, his ambition is to have every child on earth immunised against preventable diseases.

Is this a globe-trotting health advocate living in fantasyland? Not according to those who have faith in GAVI. Since its inception in 2000, GAVI has won over an impressive number of hard-nosed donors including some of the most influential players in global health—the Bill and Melinda Gates Foundation, UNICEF, the World Bank, and a string of governments, investors, drug companies and research institutions. The Australian Government is so impressed with GAVI’S track record it has pledged $200 million over 2010–13.

That track record includes immunising more than 300 million children in developing countries in just one decade and preventing about 5.5 million premature deaths from common but life-threatening diseases such as measles, diarrhoea and pneumonia. These preventable diseases kill about eight million children a year—roughly the population of Sweden.

'Immunisation against these diseases has been around for a long time now, but mainly in developed nations,' says Seth Berkley during a recent visit to Australia. 'From 1990–2010, there have been dramatic reductions in many life-threatening diseases. My wife is a physician and worked in a training hospital in New York and she has never seen a case of measles. But if you work in a refugee camp and there is a measles outbreak, you see lines of graves of young children who have died from this terrible disease. Measles has long-term effects. If six per cent of children die from complications caused by measles when they first contract the disease, then up to 30 per cent more will die within a year and even more five years later. Measles weakens the immune systems of children.'

GAVI was set up as a public-private partnership to save children’s lives and to protect the health of people in poor countries by increasing their access to immunisation. Earlier efforts to get vaccines into developing countries often failed, mainly because drug companies believed there was no market there for their products. But there was a market—a market of 75 million children in several very poor countries. GAVI’S response was bold. It pooled this demand and started negotiating with pharmaceutical companies to drop the price of vaccines. It was a new approach and an untested one, and it worked. By buying in bulk and in massive quantities, GAVI was able to pay dramatically less for its vaccines without compromising quality. 'You don’t want to drive the price so low that the quality of the vaccines drops,' says Seth. 'We need the trust of the public.'

GAVI now works in 73 countries with per capita incomes of less than $1500. Despite their high levels of poverty, GAVI nonetheless requires these countries to contribute to the cost of the vaccines it delivers. 'We say to poor countries that they need to also pay for vaccines,' explains Seth. 'If they are really poor, then we ask them to only put in a small amount but it’s about making sure their ministries of finance come on board. Co-financing is critical for sustainability.'

The economic argument for vaccinations is convincing. Healthy children can attend school and learn effectively. They can lead longer and more productive lives. Families have less illness to deal with, fewer medical bills and more money to invest in everyday expenses. And there is something else—the demographic dividend. 'This is not often talked about,' says Seth. 'But if parents know there is a reasonable chance their children might die, they have large families. It is only when they know their children will live that they have fewer children and invest in the children they have. This is important for the world and for the environment.'

GAVI prides itself on its ability to be smart about the way it works. It seeks out new and inventive ways to raise money. One way is to issue bonds on capital markets through the International Finance Facility for Immunisation. Here, the IFFIm converts long-term government pledges into immediately available cash resources which pay for the vaccines. Government pledges are used to repay the bonds. Australia sees merit in the plan and has committed $250 million to the IFFIm over 20 years.

Despite its success in immunising children who would normally miss out, GAVI itself remains vulnerable to the fluctuating global financial markets and the ability or willingness of donors to continue committing funds to it. Yet, argues Seth Berkley, immunisation is highly cost-effective. 'With immunisation we get the most ‘bang for the buck’ because with immunisation we can get out and reach an entire population. It can get us into places that are otherwise very difficult to reach.'

The mere idea of vaccinating millions of children in some of the world’s most difficult settings would exhaust most people. Yet Seth Berkley seems energised by the challenge. He is excited by the prospect of taking the new vaccine against cervical cancer to girls in developing countries and the opportunity this presents to also educate them about contraceptives, HIV transmission, safe motherhood and other health issues at such a critical time in their lives.

That is for the future. For now, Seth Berkley is working feverishly towards GAVI’s goal of saving another four million children’s lives by 2015. And as he travels around the world generating support for GAVI, he cautions against complacency. 'There is a sense in developed countries that vaccines against common diseases aren’t as urgent as they need to be. But when people move, viruses move. We are just a few hours away at any time from having our children exposed to these viruses.'

Last Reviewed: 9 July, 2012