Seth Berkley’s tall order

The people and politics driving global health.

Jan 13, 2022 View in browser   By Erin Banco, Ashleigh Furlong and Carmen Paun THE BIG IDEA Workers check on boxes containing Johnson & Johnson vaccines as they arrive at Manila's International Airport, Philippines on July 16, 2021. | National Task Force Against COVID19 via AP GAVI CEO ON GLOBAL VACCINE EFFORT — As 2022 gets underway, health advocates across the world are preparing to ramp up the global vaccine campaign to reach the World Health Organization's goal of inoculating 70 percent of the world's population by July. Seth Berkley, the CEO of Gavi, the vaccine alliance and a leader of COVAX, the global vaccine equity effort, spoke to Global Pulse about preventing new, more-transmissible coronavirus variants this year. (The interview has been edited for clarity). What conversations are you having with colleagues at COVAX about how the first part of 2022 will look for global supply and vaccine readiness? What steps is COVAX taking to tackle these issues? We will, in the next week or so, announce that we've delivered a billion doses. We've allocated 1.6 billion; 1.4 billion were allocated in 2021, of which 1.2 billion were to the COVAX [Advanced Market Commitment] 91 poorest countries. Our original goal was 950 million. I'm not going to argue with anybody else that that is enough. But now, as we look at where we are in the beginning of 2022, supply is improving dramatically. We dramatically increased the number of doses going to countries. In December, we did over 300 million doses. There are between 20 and 25 countries that have been problematic on absorption, capacity and delivery. And those are getting special attention and will continue to get special attention to try to make sure that they can increase the amount of vaccine they can use and do it in a way that gets them to their own goals. Some countries have been able to absorb all the doses and scale up very dramatically during this period, places like Rwanda and Vietnam. What is COVAX doing to make sure low- and middle-income countries across the world get more shots in arms in 2022? Lots of different vaccines are making up the supply that is coming in now. And that's on top of the donations. So one of the things we're trying to manage is to get countries to have the right vaccines for the right place. You might say with capital city health care workers, Pfizer is easier to use. You might say, in the periphery, you want a temperature-stable vaccine that has a long shelf life and that might be an AstraZeneca or Novavax. You might say that in a refugee area, or an area that has instability, you want to use a Johnson & Johnson as a single dose. How is COVAX factoring Novavax into the 2022 supply calculation? [Novavax] took longer to come out. And the question now is, since it did come out late, what will the acceptance rate be? Will there be demand for it? What we'll have to do is make sure that countries are educated. We're beginning to see a lot of demand in European countries for this vaccine, which is sometimes used for boosters. It's been a very effective booster. How will continued booster campaigns and potentially fourth doses impact the race to get primary doses to low- and middle-income countries in 2022? Right now, there's no evidence that fourth boosters are required anywhere. When you talk about world production, from a public health perspective, the first priority is trying to get the high-risk groups covered around the world so that we can prevent severe disease and death and also reduce the overall spread of infections. The question that will have to be answered in 2022 is: Do you want to try to continue to vaccinate with these vaccines against infection versus severe disease and death? And if so, it is likely, though I can't say definitively, that it will require specialized variant vaccines. Once we move down that pathway, there is a worry that we end up with an inequality 2.0 where companies will want to provide those vaccines to high-income countries and not necessarily across the world. Will 70 percent of the world's population be vaccinated by July 2022? The U.S. goal is 70 percent by September. I know the World Health Organization has a goal to do it midyear. The critical issue there is that [that number] is a kind of a global aspirational goal. The critical issue is what does each country want? At the end, we will serve what the countries want. Right now, we have supply for about 40 percent of the population. And obviously, that'll depend upon what one wants. In terms of the number of doses that will exist in the world, it is possible in terms of what we have visibility on. But at the end of the day, we don't know what's going to happen with Omicron, boosters, new variants, manufacturing problems, etc. GLOBAL PULSE NUMBER 681 MILLION The number of Covid-19 vaccine doses sitting unused in the world's poorest countries, according to a calculation by the international humanitarian organization CARE, which is calling for more investments in delivery to ensure shots make it into arms. WELCOME TO GLOBAL PULSE WELCOME BACK TO GLOBAL PULSE, where one of your authors used to think Corona beer and Delta Air Lines had it bad in this pandemic, until she read about the Kovids. Global Pulse is a team effort. Thanks to editors Eli Reyes and Barbara Van Tine. Follow us on Twitter: @ErinBanco, @ashleighfurlong and @carmenpaun.   DON'T MISS CONGRESS MINUTES: Need to follow the action on Capitol Hill blow-by-blow? Check out Minutes, POLITICO's new platform that delivers the latest exclusives, twists and much more in real time. Get it on your desktop or download the POLITICO mobile app for iOS or Android. CHECK OUT CONGRESS MINUTES HERE.     THE STATE OF THE PANDEMIC A Palestinian man who works in Israel receives the first dose of a Moderna Covid-19 vaccine at a checkpoint between the West Bank and Israel on March 9, 2021. | Amir Levy/Getty Images | Amir Levy/Getty Images AFRICAN VACCINE HUB CHARTS OWN PATH: The team at the world's first transfer hub for mRNA coronavirus vaccine technology had reason to celebrate Friday. After failing to get Moderna on board to share its mRNA technology, the Cape Town hub went ahead, anyway. It has produced the drug product formulation in just more than six months since the initiative was announced. While the product is currently more of a "training batch" than the finished product, it's a starting point for Afrigen — the developer behind the hub — to tinker with. The goal: A Covid-19 vaccine based on the Moderna sequence, with comparable efficacy and safety. "But we're doing it ourselves," Petro Terblanche, managing director of Afrigen, said from her office in Cape Town's Montague Gardens. "We had no help from Big Pharma or from any tech transfer." Terblanche, her team, and a global network of experts coordinated by the WHO, hope the facility will develop a vaccine based on Moderna's shot and then train other organizations to produce it. Omicron fueled necessity: The WHO's mRNA hubs are part of an attempt to ensure that low- and middle-income countries have sufficient vaccine supplies. Before the emergence of Omicron, Terblanche thought their coronavirus shot could turn out to be not needed for the current pandemic. But vaccine developers are now racing to retool their jabs for Omicron and produce immunizations that could target more than just the current variants. It's made the work at the mRNA hub even more important as experts increasingly suggest that annual booster programs could be needed. Why Moderna? The choice of Moderna was strategic. Its preclinical comparative data was robust, the shot could be stored at a warmer temperature than Pfizer-BioNTech's vaccine and Moderna had said it wouldn't enforce its Covid-19 patents during the pandemic. The plan: This is meant to be the "pioneer vaccine" for the hub that will help poorer countries vaccinate their citizens. But the hope is also to develop a second-generation vaccine that would be more appropriate for low-and middle-income countries, such as less prohibitive storage temperatures, explained Terblanche. Ultimately, the hub is meant to live on post-pandemic, potentially producing future TB, HIV or malaria vaccines. CANADA'S FAILED PROMISES — The country that bought the most Covid vaccines per capita is so far not living up to its promises to help poorer countries vaccinate their people. Canada has so far shipped nearly 13 million surplus doses to other nations from the 200 million it promised by the end of this year, Ottawa Playbook author Nick Taylor-Vaisey writes for Nightly. Canadians fancy themselves a generous society when a crisis strikes elsewhere. But they want their boosters, and they want them now. The political price of giving short shrift to the rest of the world pales in comparison to the upheaval caused by a cupboard left bare at home. QUOTE OF THE WEEK "At a time when Covid is running rampant again across Russia, as it is in other places, and where only half the population is vaccinated, the Kremlin has to justify to the Russian people why it is stoking a potentially very bloody and costly conflict for Russia, rather than focusing on its own citizens' health and on Russia's own significant challenges in building back better." Victoria Nuland, the U.S. under secretary of state for political affairs, speaking to reporters Tuesday, ahead of talks between NATO and Russia, as the Kremlin threatens Ukraine with a military invasion if the West doesn't respond to its security concerns. WHAT WE'RE CLICKING POLITICO: The world won't be able to boost its way out of the coronavirus pandemic. Bloomberg: The lost girls of Covid. The pandemic is erasing decades of progress in young women's health, education, and independence in developing nations. New York Times: Could this 85-year-old Indian be the most boosted man in the world?   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.       Follow us

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