People I (Mostly) Admire

Episode 166: "The World’s Most Effective Public Health Intervention Is Under Attack"

Host: Steve Levitt
Guest: Dr. Seth Berkley (former CEO of Gavi, the Vaccine Alliance)
Release Date: September 13, 2025

Episode Overview

Steve Levitt has an in-depth conversation with Dr. Seth Berkley, a global leader in public health and vaccines, best known for leading Gavi—the world’s largest vaccination program. They cover the staggering impact of childhood immunizations, the economics and politics of vaccines, challenges in the field (from Ebola to COVID-19 and HIV), and the current backlash against vaccines in the US and globally. The episode also explores the collision between science and human psychology, the mechanics of pandemic preparedness, and the monumental underinvestment in new vaccine R&D.

Key Discussion Points & Insights

1. Gavi’s Work and Why It Matters

• What is Gavi?
  Dr. Berkley explains Gavi’s mission: vaccinating over 1.1 billion additional children and saving more than 20 million lives globally. Gavi also assists in building health systems and maintaining emergency vaccine stockpiles.
  [02:01]

• Staggering Impact
  Levitt underscores the significance:

  "Over a billion kids immunized that wouldn’t have been otherwise, and 20 million deaths. Absent the vaccinations, about 1 in 50 or 1 in 60 of these kids would have died."
  [02:43 - 03:23]

• Cost and Return on Investment
  Dr. Berkley details how Gavi, through bulk-buying and efficient procurement, reduced vaccine prices for low-income countries to about $24 for the full WHO-recommended suite (11 vaccines per child)—vs. $1,300 in the US.

  "For every dollar invested, you get a $21 return. If you take the broader sense of good health and less morbidity, it goes up to $54 for every dollar."
  [06:25]

2. The Economics and Politics of Vaccine Development

• Profitability Problems
  The vaccine market is less alluring for pharma compared to high-margin drugs. Levitt notes:

  "There’s been a systematic underinvestment in vaccines and R&D over the last 50 or 60 years."
  [06:57]

• Pharma's Role and 'Win-Win'
  Berkley describes convincing companies that global vaccine distribution brings economies of scale and long-term profit, even at lower margins per dose.

  "They’re able to provide it to us at 95% reduction. They’re not losing money… they end up doing good and increasing their overall return."
  [08:24]

• Malaria and Market Failure
  The malaria vaccine took decades due to limited market incentives—if malaria were endemic in rich countries, development would have likely been much faster.

  "For every 200 kids you vaccinate, you are estimated to save one life… an incredibly powerful tool."
  [09:47]

3. Scientific and Logistical Challenges

• Vaccine Development Complexity
  Most vaccine efforts fail; COVID was an outlier in speed because of prior coronavirus research and mRNA tech.

  "The previous record was four years. For COVID it was 327 days—amazing speed."
  "We say actually 7% of vaccines are eventually approved."
  [12:01, 14:23]

• Manufacturing and Cold Chain
  Old vaccines use live or killed organisms and require stable environments; mRNA vaccines need ultra-cold storage—hugely challenging for global distribution.
  [18:05]

• Stockpiling, Ebola, and Preparedness
  It’s cost-effective to maintain stockpiles—even discarding unused doses saves millions of potential lives. Yet, the development sector resists “waste,” slowing emergency response.

  "We're talking about a few million dollars for protection of the entire globe. It's an unbelievably good buy."
  [20:06]

4. Scientific Limits: HIV/AIDS Vaccine

• Why No HIV Vaccine Yet?
  The virus’s ability to mutate rapidly within each host stymies vaccine progress.

  "Within a very short period, you have millions of different viruses inside you… constantly getting around the immune system."
  [21:47]

• Cut Funding, Uncertain Future
  Berkley expresses hope but frustration at recent funding cuts and warns of possible HIV resurgence.

5. Vaccine Hesitancy and Anti-Vaxx Movements

• Is There a Scientific Basis?
  Berkley says side effects exist, but the risks from diseases are vastly greater.

  "Are vaccines safe? Incredibly safe. Do we have a good system in place to look at side effects? Absolutely… but when getting your info anecdotally from non-reliable sources, you don’t necessarily have the right information."
  [24:16]

• The Prevention Paradox
  Levitt shares a personal story: his son died from pneumococcal meningitis months before a vaccine was available.

  "Absent the horrors that come with these diseases, the vaccine works against its own acceptance by effectively getting rid of the horror… it's just a hard problem."
  [26:44]

• Psychology and Causality Confusion
  Vaccines are often blamed for unrelated developmental disorders due to timing (“post hoc ergo propter hoc” problem). Misattribution is human, but persistent.

6. Gavi’s Structure and the Gates Foundation

• Unique Public-Private Model
  Gavi bridges UN/government agencies and pharma, stabilizes demand, and enables manufacturers to scale globally.
  [30:52]

• Bill Gates’ Crucial Role

  "He put $750 million into starting a new [organization]… Now he’s about 15% of support, but he played an incredibly important role."
  [33:33]

7. COVID-19: Gavi’s Response & Lessons

• How Gavi Got Involved
  Early signals from Wuhan and past experiences led Gavi and partners (especially CEPI) to coordinate a global plan for vaccine access—Covax.

  "The best way to control an epidemic is to control it where it’s spreading and vaccinate those at risk."
  [38:23]

• Logistics of Covax

  "We were trying to purchase huge quantities of COVID vaccines that didn’t exist with a pile of money we didn’t have."
  [39:15]

• Risks and Successes
  Gavi’s COVID work could have bankrupted it. Ultimately, Covax delivered over 2 billion doses worldwide, but inequities persisted, especially early on.
  [40:06]

• Future Pandemics

  "People doing modeling suggest we have a 50% chance of a COVID-like pandemic in the next 25 years. That's a serious number."
  [41:24]

8. Underprepared for the Next Pandemic

• Public Health Lags “War Mentality”
  Unlike the military’s constant readiness, public health lacks ongoing rapid-response infrastructure.

  "The military, we’re on constant alert… that mentality has not caught on in public health."
  [44:08]

• Science Undermined by Politics
  Berkley laments science’s loss of authority in public discourse, especially after politicization during COVID:

  "What changed in COVID was the unbelievable partisan behavior… science became a political issue, and that became a tragedy."
  [51:24]

• Trump Era and U.S. Vaccine Science

  "The NIH has canceled support of mRNA vaccine research. One of the scientists I work with described that as the stupidest science decision he’s ever heard."
  [53:40]

• The Real Consequence

  "We are destroying the institutions… If you are a young person, do you really want to go into science knowing you’re not going to get money, not going to have a good career?"
  [56:00]

9. Personal Inspirations and Advice

• Purposeful Careers

  "If you really want to make a difference in the world, you have to go where the problems are."
  [56:40]

10. Key Takeaways

• Vaccines are the single most cost-effective global health intervention.
• Political attacks and funding cuts are undermining future preparedness.
• Human psychology and misinformation create dangerous complacency.
• Major breakthroughs (HIV, pandemic preparedness) depend on the very investments under threat.
• There is an urgent need for ongoing, proactive scientific and logistical readiness for future pandemics.

Notable Quotes & Memorable Moments

• On Gavi's Impact:
  "Since Gavi was set up, it’s vaccinated over 1.1 billion additional children. It’s credited now with having saved more than 20 million lives." – Seth Berkley [02:01]

• On ROI of Vaccines:
  "For every dollar invested, you get a $21 return. If you take the broader sense… you get a $54 return." – Seth Berkley [06:25]

• On the Science vs. Psychology of Vaccine Hesitancy:
  "The challenge with prevention is giving these innocent little babies a bunch of injections… you have to understand and believe you’re doing something good for your kid. And if you don’t believe that, then that’s a breakdown in communication, not in science." – Seth Berkley [27:19]

• On COVID Vaccine Development:
  "The previous record [for vaccine development] was four years. For COVID it was 327 days—amazing speed." – Seth Berkley [12:01]

• On Systemic Underinvestment:
  "On a dollar-for-dollar basis, our failure to prepare for the next pandemic may be the single worst policy mistake of our time." – Steve Levitt [57:29]

Important Timestamps

• 02:01 – Seth Berkley explains Gavi’s mission and impact
• 06:25 – The economic return on investment in vaccines
• 14:23 – Only 7% of vaccines attempted become reality
• 20:06 – Cost-effectiveness of stockpiling vs. “wasted” vaccines
• 24:16 – Addressing anti-vax arguments: risk and side effects
• 26:44 – Levitt’s personal story of losing his son pre-vaccine
• 30:52 – How Gavi’s public-private partnership model works
• 33:33 – Bill Gates’ role in founding Gavi
• 38:23 – How Gavi responded to COVID and Covax creation
• 41:24 – Modeling risk of future pandemics
• 51:24 – Politicization of public health during COVID
• 53:40 – NIH’s withdrawal from mRNA research
• 56:40 – Career advice for purpose-driven young people
• 57:29 – Levitt’s conclusion and warning on preparedness

Episode Tone and Language

The discussion is frank, data-driven, and empathetic—unflinching about failures and political realities, but rooted in the optimism of science and the humanitarian power of public health. Levitt and Berkley maintain a personal, at times emotional, tone, using both hard numbers and human stories to illustrate the stakes.

For anyone who wants to understand the stakes and mechanics of global vaccination—what works, what’s threatened, and why vaccines’ success creates its own peril—this episode is essential listening.