The CGD Podcast: "Vaccines in a Changing Global Health Landscape with Seth Berkley"

Date: January 8, 2026
Host: Rachel Glenister, President of CGD
Guest: Dr. Seth Berkley, former CEO of Gavi, the Vaccine Alliance

Overview

This episode features a deep-dive conversation between Rachel Glenister and Dr. Seth Berkley about the critical role of vaccines in global health, Berkley’s new book Fair Doses, the triumphs and lessons learned from COVID-19 vaccine distribution (notably through the COVAX initiative), ongoing challenges such as vaccine hesitancy and innovation, and the difficult choices presented by shrinking global aid budgets. Drawing on decades of experience, Berkley provides an "insider's view" of the global immunization ecosystem—covering science, policy, economics, and equity.

Key Discussion Points & Insights

The Historic Success of Vaccines and Gavi’s Role

• Transformation in Vaccination Coverage

  • 1970s: Less than 5% of the world received even a single vaccine dose.
  • Today: Vaccines are the most broadly distributed health intervention globally, resulting in a roughly 70% reduction in vaccine-preventable diseases and more than a 50% reduction in under-five child mortality.

    "We've really seen this incredible change occur over time." (Seth Berkley, 03:04)

• Gavi and the Global Fight for Equity

  • Gavi’s formation was rooted in collaboration—utilizing the strengths of UN agencies, civil society, and the World Bank.
  • Gavi’s role expanded from routine childhood immunizations to the creation of COVAX as a response to the COVID-19 pandemic.

The COVAX Experience and COVID-19 Vaccine Equity

• Achievements and Limitations

  • COVAX delivered over 2 billion doses to 146 countries (06:00).
  • Despite this, stark disparities persisted: rich countries vaccinated populations faster than poorer nations.
  • Berkley offers a candid look at the behind-the-scenes challenges—political, financial, and operational.

• Key Barriers and Lessons for the Future

  • Day-zero financing was absent—a major reason low and middle-income countries fell behind in orders and access.
  • COVAX had to be created "out of whole cloth," facing skepticism, competing national interests, and logistical hurdles.
  • Lesson: Need for pre-arranged rapid financing (e.g., zero-day facilities), streamlined legal frameworks for indemnity, and early agreements on equitable dose allocation.
    • "The first and most important barrier... was no financing available on day zero." (Berkley, 06:31)
    • "If we had that money on day zero, it doesn't mean that on day zero we would have gotten the vaccines. Every political leader in the world says my job is to protect my population." (Berkley, 08:06)

• Problems with Multilateral Development Banks (MDBs)

  • MDBs like the World Bank had money in theory, but were slow, risk-averse, and hamstrung by need for guarantees of no losses.
  • MDB reluctance to lend for unapproved vaccines left poor countries unable to order early.
    • "Every time there is a pandemic, the bank says we're there... And every time they haven't been able to... It's this risk issue." (Berkley, 12:22)

• Political Dynamics

  • U.S. administration's skepticism toward WHO and specific policies (e.g., refusing to export American-made vaccines) undermined a unified response.
    • "Imagine trying to put a global effort together and saying, we're not going to work with WHO at all. It just doesn't make any sense." (Berkley, 17:39)

Reaching the Last Mile and Tackling Vaccine Hesitancy

• The "Zero Dose" Challenge

  • Remaining 10% of children globally—a "zero dose" group—are often in urban slums, with displaced or deliberately marginalized populations.
  • These communities account for disproportionate child mortality and are a surveillance blind spot for future outbreaks.
    • "50% of the child mortality is occurring in those [zero dose communities]... These are in essence dark spots in terms of health." (Berkley, 19:16)

• Vaccine Hesitancy: Emerging Crisis

  • While previously less prominent in low-income countries (due to lived memories of disease), COVID-era misinformation has increased hesitancy everywhere.
  • Disinformation, often spread with intent by both foreign and domestic actors, now severely undermines public trust.
    • "The misinformation is spreading and disinformation at the speed of light, literally because of the Internet... you end up with a situation where your local leader is trying to argue with the expertise of the greatest country in the world." (Berkley, 21:17)
    • "There's two things. There's misinformation... And then there's disinformation where people know it's wrong and they're putting it out for a political reason. That is the big problem now." (Berkley, 24:48)

Vaccine Innovation and Market Failures

• Challenges in Developing New Vaccines

  • HIV remains unsolved due to unique immunological challenges.
  • Market failures: For diseases that are rare or mostly in poor countries, there is no commercial incentive, necessitating public/philanthropic financing.
    • "So in that case, you need some other mechanism to finance the development of that vaccine." (Berkley, 28:24)

• Recent Innovations

  • Recent breakthroughs: cancer (HPV, hepatitis B), malaria, and prospects for "therapeutic" vaccines.
  • Maintenance of strong scientific infrastructure is essential, particularly in the face of falling budgets and increasing threats of new pandemics.
    • "We're in the middle of a renaissance of vaccines. Science is unbelievable." (Berkley, 29:02)

Tough Choices in an Age of Aid Cuts

• Impact of Shrinking Donor Budgets

  • WHO, Gavi, and others face existential choices about prioritization—focus on core mandates (regulation, essential vaccines) vs. broader health systems work.
  • Berkley’s defense of health system strengthening: you need functioning systems to actually deliver vaccines.
    • "Vaccines don't deliver themselves... if you kill that system's money... it's a little bit cutting your nose off despite your face." (Berkley, 34:46)
    • "For every dollar you spend on vaccines, you get a $54 benefit. It's the most cost effective intervention." (Berkley, 35:38)

• Global Security and Health: The False Tradeoff

  • Urges policymakers to recognize pandemics as national security threats—COVID-19 killed more Americans than all wars since the Civil War.
    • "Is it smart to be slashing global health money at the same time we are saying military is going to make us a secure country? I think this is not a smart thing to be doing." (Berkley, 37:39)

Institutional Models and Future Preparedness

• Institutional Architecture for Pandemics

  • Berkley is wary of constantly creating new global health institutions; prefers alliances (as in Gavi) that leverage existing agency strengths and minimize overhead.
    • "The lesson there was: don't try to make everything yourself... That would be the model I would do going forward." (Berkley, 40:20)

• What Should Governments Do Now?

  • Invest in both pathogen-specific (e.g., vaccines) and non-specific (e.g., masks, NPIs) interventions.
  • Ensure delivery systems reach marginalized populations—the "dark spots."
  • Support regional manufacturing centers rather than every country building its own.
  • Continue support for rapid research platforms like mRNA—even if mRNA isn’t always optimal, it’s fast and essential for unknown threats.
    • "It can't be every country, this is the problem. If every country wants to make its own vaccines, it's not going to happen. The supply chains will be too complicated." (Berkley, 46:35)

Are We Ready For the Next Pandemic?

• Mixed Progress and Rising Risks
  • While manufacturing capacity has improved, research, financing, and political will remain patchy.
  • The danger: complacency, aid pullbacks, growing disinformation, and neglect of key lessons.
    • "Right now we are not as prepared as we should be..." (Berkley, 49:23)

Notable Quotes & Memorable Moments

• On the fundamental problem during COVID response:

  "The first and most important barrier... was no financing available on day zero." (Berkley, 06:31)

• On political realities and pandemic response:

  "Every political leader in the world says my job is to protect my population... The challenge is do you go from zero to a hundred percent of your population or do you cover your high risk population... and then do you make sure that others in other countries have access?" (Berkley, 08:06)

• On innovation in vaccines:

  "We're in the middle of a renaissance of vaccines. Science is unbelievable. We now have two cancer vaccines for liver cancer and cervical cancer... We have our first parasitic vaccine for malaria. And... soon vaccines against cancer antigens." (Berkley, 29:02)

• On the cost-effectiveness of vaccines:

  "For every dollar you spend on vaccines, you get a $54 benefit." (Berkley, 35:38)

• On linked health & security threats:

  "More Americans died of COVID than soldiers died in all wars since the Civil War, American soldiers, all wars since the Civil War from one infectious disease." (Berkley, 37:44)

Timestamps for Important Segments

• [03:04] – Berkley's summary of Fair Doses: vaccines’ historic impact, Gavi’s evolution, and the behind-the-scenes drama of COVAX.
• [06:31] – Fundamental failures & lessons from COVAX, building day-zero financing.
• [12:22] – Challenges with multilateral development banks and why they're structurally slow.
• [19:16] – Who are the “zero dose” children and why reaching them matters for both health and pandemic preparedness.
• [21:17] – The new era of vaccine hesitancy driven by internet-fueled disinformation.
• [25:52] – The science and economics of tough-to-develop vaccines (e.g., HIV, Ebola).
• [34:46] – Aid cuts: How should Gavi and WHO choose what to protect?
• [37:44] – The case for regarding pandemic threats as national security priorities.
• [40:20] – Institutional models: avoid new silos, strengthen alliances.
• [45:58] – What governments can do now to improve equity and preparedness.

Conclusion

The episode delivers an unvarnished look at global immunization policy, equity, and innovation from one of its leading practitioners. Berkley’s framing—acknowledging both the enormous successes of global vaccination and the very real failures and vulnerabilities—is sobering but not defeatist. The call to action is clear: future pandemic preparedness and vaccine equity require timely financing, better global coordination, stronger delivery systems, and unwavering commitment to scientific truth amid rising political and informational headwinds.

For further reading:

• Seth Berkley’s book Fair Doses
• CGD’s resources on global health and pandemic preparedness
• Recommendations from the G20 High-Level Panel on pandemic preparedness