Title: Pandemic Preparedness Alert

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Coming up later in the hour, a call-in for anybody who's still undecided about any election in our area this year or any ballot question. You could be undecided, let's say between two candidates or you can be undecided between one candidate and not voting at all, as I know some people are. That's coming up. Now we turn to our health and climate segment of the week. Every Tuesday, we make sure to cover some of these stories that might otherwise get drowned out by other big headlines.

Today we're on the health side with a very consequential guest who's here to take us behind the scenes of the COVID vaccine rollout. We're going to go back to that, as well as to talk about some current issues. He's definitely going to reflect on some of the lessons learned from that pandemic before another one begins and given all the changing vaccine politics right now. It's Dr. Seth Berkley, an infectious disease epidemiologist. He's an adjunct professor and senior advisor through the Pandemic Center at Brown University. The former CEO of Gavi, that's the Vaccine Alliance, co-founded COVAX, which was dedicated to vaccine equity around COVID in particular.

Founded and served as CEO of the International AIDS Vaccine Initiative. We'll ask about that. There is no AIDS vaccine yet. He's got a new book called Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity. Yes, we will talk about the changing vaccine politics and the health implications for sure, but more than that in this segment. Dr. Berkley, welcome to WNYC.

Dr. Seth Berkley: It's great to be with you, Brian.

Brian Lehrer: Your book begins in January 2020. You're at Davos at the World Economic Forum surrounded by world leaders, including President Trump, who, I gather your report, dismissed pandemic concerns at the time, but a lot of people did. It was just January. What do you remember from that moment?

Dr. Seth Berkley: Well, the interesting thing, of course, we didn't really know this was going to be a pandemic. We had heard about the cases in Wuhan, and we thought those coming from this wet market, it could have been just a point exposure. There began to be rumors of what looked like person-to-person transmission. Of course, that gets us nervous. The conversation there was, is this the big one, or is this a dress rehearsal for the big one? Of course, given what we know can happen, we decided that we would begin to plan as if this was the big one and get ready for it.

Brian Lehrer: In a matter of weeks, as we know, COVID-19 had circulated around the world. For listeners who don't know, you led Gavi, which is essentially the bulk purchasing system that makes vaccines affordable for poor countries and vaccinates about half the world's children. Then, during COVID you created COVAX, which tried to do the same thing on an emergency timeline for that particular spread of disease. In hindsight, was that realistic, or what kind of a report card do you give it now?

Dr. Seth Berkley: It's an interesting question because what we knew-- if you go back to the previous pandemic of avian flu, we knew that a vaccine was made, but that vaccine was bought up by high-income countries and virtually no vaccine got to developing countries until after the pandemic when people were finished in high-income countries and some vaccine was donated. That's what we were trying to prevent. We knew, of course, that there would not be perfect equity, but at the end, this was the fastest and largest rollout of vaccine in history.

We ended up with developing countries, the 92 poorest countries, which is more than half of the world's population, having a primary vaccination of about 57%, which was compared to 67% globally. Not exactly equitable, but obviously better than we've ever done before. Of course, lots of problems, slower rollout there, lots of export bans, vaccine diplomacy, et cetera.

Brian Lehrer: Can you talk about vaccine hoarding? You saw wealthy countries like the United States and the UK ordering more doses than their population needed. How did you address this discrepancy while other countries were going without?

Dr. Seth Berkley: First of all, we have to remember at that time we weren't sure that a vaccine could be made. Second, if it could be made, we didn't know which vaccine would work. It is a completely rational thing if you have money to go ahead and buy not one type of vaccine, but buy two, three, four, five, six of them. That's what the wealthiest countries did: Is bought lots of doses of all different types of vaccine. Of course, what that does is tie up the supply for the rest of the world. We started out wanting to buy vaccines for developing countries because we think that's the right way to move forward.

Of course, we had no money, we had no people, so we had to build everything, which made us slower in terms of being able to move forward. The Critical thing was, as soon as those vaccines that countries had bought began to move towards expiration, then countries were like, "Wow, we don't want these to expire. We bought all these vaccines, let's just give them away." It turned out to not be so simple. We didn't have a donation mechanism. There were liability issues. If a country had bought them and sat under their liability system, it had to be transferred to us and our liability system, et cetera, et cetera. These are some of the important lessons were there.

At the end, we were able to take about 50% of the vaccines we delivered. We delivered 2 billion doses of vaccines to 146 countries, and about 50% of those were ultimately donated doses, which was, of course, good because they didn't get wasted.

Brian Lehrer: Listeners might be thinking on this vaccine hoarding question-- some listeners, that it's only fair that countries that contribute more financially to the vaccine development process get first dibs. I guess in a way, it comes down to the old foreign aid debate. Can you make the case for why a New Yorker listening in should feel responsible for vaccination rates in, I don't know, Sierra Leone, for example?

Dr. Seth Berkley: Absolutely. It's a very important point. There is obvious humanitarian philosophy here, but when we think about a pandemic, what we're trying to do is stop transmission as best as possible. That not only protects other countries, but it also protects your own country, whatever that is, in this case, the US. What we would like to see in a pandemic is, of course, the first thing that a leader's going to do is vaccinate their own people. That's what they're there for. That's what they should do.

Once they cover the highest risk populations, which in this case were healthcare workers, the elderly, people with comorbidities, then they should vaccinate those people in other countries, because at the end, what you're trying to do is stop that spread. It's estimated that about a million people died unnecessarily because of vaccine hoarding. That's the message we were trying to get out, is let's try to operate this as efficiently as possible, protecting each individual country, but also making sure that we deal particularly with healthcare workers in other countries, because if they die and there's not as many healthcare workers in poor countries per population, then we're really going to have a problem, which, of course, we did in terms of the global spread.

Brian Lehrer: Listeners, if you have a question for our guest, Dr. Seth Berkley, who's been one of the leaders of global vaccine efforts on a number of levels and now has a book, Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity. We welcome your questions or stories for him. 212-433-WNYC. Call or text. 212-433-9692. I'm curious with the global involvement that you had with COVID vaccines, if you saw different rates of vaccine skepticism in different countries, and if that affected ultimately vaccine uptake rates and disease rates.

Dr. Seth Berkley: It's a great question, Brian. Vaccine skepticism has existed since the first vaccine, which was the smallpox vaccine, that were wood carvings that showed people having cow's horns growing out of their head after they got the vaccine. This is a longstanding problem.

Brian Lehrer: Tell our listeners that that's an interesting part of your book that you trace the history of vaccine hesitancy back to the 1850s, right?

Dr. Seth Berkley: Yes, that's correct. The issue here is that we used to be able to deal with vaccine hesitancy. We worked with community leaders, thought leaders, experts, whether it's the village chief, or whether it's the doctor, or nurse, or it's the community leaders, that's how you dealt with it. It was pretty not easy, but it was doable. What's changed now, of course, is really a couple of things. One is, we have social media, which, of course, moves literally at the speed of light. You've got this not only misinformation, but disinformation.

The difference there is misinformation is what your aunt might tell you because she's ill-informed, but doesn't mean any harm. Disinformation is intentionally giving the wrong information. We had Russian bots, and North Korean bots, and Chinese bots, and by the way, the US government providing misinformation during this period as well. Then the other big thing that happened was we had this incredible partisan behavior, and that was tragic. More Republicans per capita died than Democrats did because they didn't get vaccinated. Of course, we're fighting a virus; there should be no politics here. We should be trying to give people the best advice.

To your answer, we ended up with lots of disinformation, and it made countries reject vaccines that they had already asked for. This really was a tragedy. We're still feeling this today because the disinformation is continuing. It's been used to really work on trying to destabilize democracies by providing positive information and negative information at the same time. This is a real ongoing problem.

Brian Lehrer: Was it different in the United States because we have such an individualistic culture, the last 250 years? There was all this adamance in certain corners that "I'm not going to let the government tell me what to do." The vaccine mandates that were supposed to stop the population spread by requiring something of every individual or most individuals. I wonder if just the cultures of other countries were different in ways that that kind of thing didn't spring up as much.

Dr. Seth Berkley: You're absolutely right. The thing we're living with now is a pushback on mandates in general. Not just vaccines, but on closing schools, on mask wearing, on lots of other issues. Of course, there's a long history of providing mandates. What's interesting about vaccine hesitancy is that it used to be that the worst vaccine hesitancy was actually in high-income countries. Why is that? Because we don't see these childhood diseases anymore. You talk to an average physician, they've never seen diphtheria, measles, tetanus, because vaccines work so well.

Whereas if you're in developing countries, of course, you know auntie down the road has had a child that died. You see people who are disabled because of these diseases. People understood and wanted to protect their families from it. During the pandemic, people pushed back on these mandates, but the purpose of mandates, of course, is to try to protect the whole population. We ended up not having herd immunity. Herd immunity is the concept that if you vaccinate a whole herd of people, or in animals, in the case of veterinarian, even if one animal doesn't get a take or get vaccinated, they're protected because everybody else is protected and it can't be transmitted.

We couldn't do that with COVID because of the variations, but the original idea was to try to get that coverage up to protect everybody, including those who couldn't get vaccines.

Brian Lehrer: RFK Jr feels like the elephant in the room here. What are your biggest concerns about his leadership at Health and Human Services if another pandemic were to take root during his tenure, specifically with respect to vaccines, if one could be developed?

Dr. Seth Berkley: First of all, we've disbanded a lot of the systems that are in place to deal with pandemics. I'm obviously worried about that. If I had to list, my biggest worry in a pandemic, you start off knowing nothing. What do you want to do? You want to turn to experts to give the best sense from what we know about other viruses at that moment in time. Then you want science to go forward, and you want to make sure we have truth. Now, during the pandemic, people would ask questions, "Where did 6 feet come from? Why is it not 5'11' or 6 foot 1 inch in terms of numbers?"

The answer is 6 feet was an expert opinion on what might be a reasonable safe distance. What you want over time is that to get better. Science doesn't change, but the information that comes from science. My worry now is we've put in place advisory mechanisms that have known anti-vaccine people on it. We're not following science anymore. Without science, we are just lost. There's some discussion now of breaking MMR vaccine into three separate vaccines. There's no science for that. Of course, at the beginning, there were three separate vaccines. That meant six shots for kids, and now it's down to two shots for kids because they're combined.

Doing those types of things create uncertainty in parents and worry, and are not based on science. That is really the worry. The same thing with attacking mRNA products, and frankly, pulling the funding for Gavi, the Vaccine Alliance, which is the distribution system for most of the world, which ultimately protects US population because it stops the spread of these diseases around the world.

Brian Lehrer: On the history of the pandemic, or a point from the history of the pandemic, listener writes, "Can Dr. Berkley say why Gavi, which he led, decided to put all its eggs into the Indian vaccine manufacturer? As a result of the export ban in India, vaccines never made it to Africa when they were needed." Is that accurate?

Dr. Seth Berkley: Not quite. It's a great question, though. The nuanced answer for that briefly, is the following. We ended up with the largest portfolio of vaccines in the world. We had 11 different vaccines that we had in the portfolio, a range of different types. We started out trying to buy a range of different vaccines. As I said at the beginning, we had no mandate, no money, no staff. We built that up. We raised $12.5 billion, and we were able to do that. Early on, we technology-transferred vaccine to the Indian manufacturer, the Serum Institute of India, which is the largest vaccine manufacturer in the world, and they were able to get vaccines out quickly.

Of course, what happened was they had the Delta wave in India. Severe infections, funeral pyres burning everywhere. The government, which had access to no other vaccines, stopped exporting it. Now that did make a big difference in where we are, but we were getting that vaccine from the manufacturer of it, AstraZeneca. We were also beginning to get small doses of mRNA vaccines, and later on, the J&J vaccine, some of the Chinese vaccines, a range of different vaccines, until eventually Serum came back.

In an ideal world, you don't want to have all your eggs in one basket. We tried not to do that, but of course, mRNA vaccines in the beginning were really only going to high-income countries, and that was something that, over time, we worked to change.

Brian Lehrer: You do deal in the book with conflicting incentives of vaccine companies in the race against the virus. Maybe that's part of where, for some people, vaccine hesitancy comes from or distrust. We hear from the left as well as from the right, and previously more from the left for many good reasons, "Don't trust the big pharmaceutical companies," and then we're being told to trust the big pharmaceutical companies.

Dr. Seth Berkley: I think the reason we have governmental agencies is to do a check on what's happening by these companies. That's the role of, say, an FDA and regulatory systems is to make sure that the products that they are making are safe, that they've been evaluated, and there's continuous monitoring to try to look for side effects or problems or contaminations in them. It's not a trust, or if it is a trust, it's trust and verify. I think that's what we want to do.

Brian Lehrer: It's trust in the government agencies that do the verification. I guess some people worry that those agencies have been too infected by people from the corporations who get appointments in the revolving door.

Dr. Seth Berkley: This is something we hear, but let's be clear, these vaccines have been used in 200 countries around the world. They've been looked at not just by one regulatory agency, but by literally hundreds of regulatory agencies. We have a pretty good understanding of what's there. I think skepticism is okay, but again, disinformation is the problem because we're hearing things that just aren't accurate. That's a problem because it scares people, and it means they won't do the right things. The conversation right now about autism, the idea that circumcision is being talked about, and things like Tylenol and a range of other things.

Again, without the scientific data behind it, that just confuses people. That's the real problem.

Brian Lehrer: You're a vaccine specialist, but also with infectious diseases generally. I don't know if this is on your beat or in your expertise exactly, but there is a story this morning about the State of Texas suing the manufacturer of Tylenol over these concerns about autism risks for babies born after pregnant women take Tylenol, which I keep reading there's no science to support. Do you have anything on this?

Dr. Seth Berkley: First of all, I think you're absolutely right. There isn't the science to support it. Even more important, and this is critical for people to understand, is that if women get high fevers in pregnancy, there is an increased risk of autism. You take Tylenol, it actually reduces the risk of autism from those high fevers. Of course, autism is a complex disease with many different factors in it. By the way, this type of misinformation is the same thing with vaccines. There are side effects for vaccines, which you always have to compare what are the side effects of the natural disease versus that of the vaccine?

Brian Lehrer: Risk versus risk. Do you think it could be a good thing that this lawsuit is filed, and maybe the science will be played out in a courtroom, and it will be a slam dunk, and then all the world will see it? I don't know if they have cameras in the courtroom at whatever jurisdiction this would be heard in, but could it be a good thing?

Dr. Seth Berkley: Personally, I prefer to not have things decided in courtrooms in that type of adversarial environment. I much prefer to have a proper scientific discussion with transparency of that data and the ability for people to understand it and follow-- understand where the advice come from and feel comfortable with it. If at the end of the day we're in a situation where we don't have that from the federal government and you're seeing now people spring up with state review professional societies like the Pediatric Society or the Infectious Diseases Society of America beginning to have recommendations, then so be it. Maybe it needs to happen that way.

That's not a good way because if we're litigating, have every single piece of disinformation, it takes a long time, and that misinformation and disinformation spreads.

Brian Lehrer: Asante in Brooklyn, you're on WNYC. Hi, Asante.

Asante: Hey, Brian. Spoke to you before. I had a comment and a question just for background. My sister's an epidemiologist, infectious disease expert, and I lost family members during the pandemic, and it made me very irritated. I remember asking her like I don't understand how the communication doesn't put across that the science doesn't change, like your guest said, but what we know about it may change. I asked her a historical example. Gregor Mendel is the father of genetics. During his lifetime, he didn't get any credit for all his work on peas.

I remember asking her, "Why can't we tell people to look in their freezer at peas and understand that all we know about genetics and our cousins and our hereditary is through Gregor Mendel?" It was devastating for me personally that all my family members or quite a few of them, they were so skeptical. That's it.

Brian Lehrer: Thank you, Asante. Thank you for telling that story. What are you thinking listening to him, Doctor?

Dr. Seth Berkley: First of all, Gregor Mendel was very important at the beginning, but the science since then has been exquisite, and we really understand not only how the genetics mixes, but we actually can get right down to the DNA and what's happening. This is why we're in the midst of this amazing renaissance in science that will ultimately create vaccines for tumor antigens and be able to treat chronic diseases and treat cancers. I think the point is science moves forward, and people have to understand it as much as they can and believe in it.

The other thing I'd say is that COVID is still with us, and it is still killing people. There was a recent study that just came out by the VA, looking at vaccine effectiveness from September to December of 2024, 160,000 people. They showed a 64% protection against deaths, 39% against hospitalization, 29% against emergency room visits. All of the negative conversations about vaccines hide the fact that it's still a disease that's important and still should be treated as such.

Brian Lehrer: I'm glad you brought that up. In fact, I think the last stats I saw, tell me if this is accurate, if you know, COVID in the last couple of years, which we consider post-pandemic, generally, in casual conversation, COVID is still in the top 10 causes of death in the United States. Is that true?

Dr. Seth Berkley: That is correct. Obviously, infectious diseases continue to be there. We've seen not only at the federal level now, but we're seeing there are 350 anti-vaccine bills that have now popped up at state level, 26 have been enacted in 11 states. We have to worry about all of this negative information, because if you go back in history, basically about 350 out of 1,000 kids died, and that was from infectious diseases. We've dealt with it with vaccines, with sanitation, with better housing, et cetera. If we don't clean water-- if we don't continue to use these tools, we can go backwards and start seeing polio and measles, which, of course, is now in the worst spread since it was eliminated in 2000.

That's an example where if it's spreading in the developing world, it can come back here and kill our children.

Brian Lehrer: We have one minute left. I have to ask you, since you used to be CEO of the International AIDS Vaccine Initiative, if we were able to develop a COVID vaccine at warp speed, as they called it, why, after all these decades, haven't people been able to develop an AIDS vaccine?

Dr. Seth Berkley: The challenge with AIDS is that you get infected with one single virus or a couple of viruses, that's it. Those viruses make so many mistakes because it's a retrovirus, that you end up with billions of different strains. In essence, the strains keep changing as your immune system fights it until it exhausts the immune system. That's what's happened. There have been advances that can make vaccines that conceivably could protect against all strains. Unfortunately, the slashing of research at USAID and at NIH and others have dramatically reduced that research, which had been going on slowly over time.

I feel terrible about that because it's something I invested a lot of my life in. I do believe in the power of science. I think eventually there will be a vaccine. As you know, there are now long-range treatments you can take to prevent the disease. It's not the same as a vaccine. I hope we get there. I hope those get reinstated for this important disease. By the way, we're going to see HIV spreading much worse, given the cuts that have occurred.

Brian Lehrer: Dr. Seth Berkley, now at Brown, is now author of the book, Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity. Thank you for sharing it with us.

Dr. Seth Berkley: Thanks for having me, Brian.

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