John Donnelly recently spoke with Seth Berkley, founder of IAVI, about highlights in research and about his focus for GAVI.
Seth Berkley is the president, CEO and founder of the International AIDS Vaccine Initiative (IAVI), a nonprofit organization working in 24 countries to ensure the development of safe, effective, accessible, preventive HIV vaccines for use throughout the world. He is also a medical doctor specializing in infectious disease epidemiology and international health. Prior to founding IAVI in 1996, he was an officer of the health sciences division at The Rockefeller Foundation, and early in his career he was assigned as an epidemiologist at the Ministry of Health in Uganda, through the Carter Center. In August, Berkley will take up his new role as CEO of the GAVI Alliance, which is dedicated to expanding access to life-saving vaccines in 75 countries in the developing world.
John Donnelly spoke with Berkley about highlights in research and about his focus for GAVI. This is the last piece in a five-part series timed to the release of the Global Health Technologies Coalition‘s annual report, which highlights successes in US-funded global health research and development.
Q: How did you get involved in research in the first place?
A: If you look around the world, there is huge disparity not only north and south, but even between different groups of people, among stigmatized populations, or inner city populations, like what is going on now in Washington, DC, with HIV. You look at these disparities, and you look at how to resolve them. It often relates to the difficulty in accessing technology. How do you design technology for the places that are appropriate to the needs? That’s the lens I’ve been interested in-how to use science and technology in the developing world. Sometimes it’s complicated. Sometimes it’s simple. One of the simplest things ever was the discovery of oral rehydration salts for children with diarrhea. That simple understanding of mixing sugar and salt along with water increases the absorption uptake.
Q: How did you get started on AIDS vaccine research?
A: It started with my work in Uganda, and I assumed that work on vaccines was moving along. But only when I approached people and found that the vaccine effort was not going well, did I do an investigation at Rockefeller [Foundation]. The science industry was not as interested because it was tough science and it was also controversial. The activists were more focused on demanding access to treatment. But a vaccine really is the only way to end the epidemic. So in starting IAVI, we wanted to know whether this model of product development partnership could do something. Now the proof is in the pudding.
Q: What was your biggest challenge in persuading policymakers to invest in an AIDS vaccine?
A: The single hardest challenge is that most politicians think short term. It’s obvious why that is. They are in office for a short period of time, and they want to justify spending money on this problem. The hardest problem with vaccines is the timeline. You need someone to focus on this problem over a fairly long timeline.
Q: So what was your most effective argument with them?
A: If you look at AIDS, people managed to mobilize the world in an unprecedented way. The UN Security Council had a special session on AIDS. We had the President’s Emergency Plan for AIDS Relief (PEPFAR), and that and other efforts led to this incredible ability to bring treatment across the developing world. That was not thought to be the first thing you could do, but it shows what political will could do. The problem is, for every new person you added on treatment, you were getting two new infections. So you need an insurance policy, you need an end-game strategy, something to slow and end the epidemic. And really a vaccine is the only way to do it.
Q: What has been your most exciting moment at IAVI related to a research breakthrough?
A: There were a lot of moments over many years. The most interesting one involved the pursuit of broadly neutralizing antibodies. We had known for years that we had four antibodies isolated that could neutralize a range of viruses. If there were four, might there be more? We began to look a couple of years ago-it was looking for the needle in a haystack. We ended up finding 2000 volunteers who were infected for at least three years and weren’t on treatment. … We were able to isolate first two antibodies that were much potent, more broad than anything seen before. That happened a year and a half ago. Since then, IAVI has now helped to identify 15 of them. Now we are making antigens to inject in people that would include targeting these antibodies.
Q: What was the biggest challenge in starting IAVI?
A: The hardest thing was it hadn’t been done before like this. We needed to find adequate financing to move these things forward. An AIDS vaccine was seen as something a big pharmaceutical company would do. The fact that a nongovernmental organization had a role to play seemed ridiculous to people. The single biggest barrier was skepticism. Then it was money. IAVI has raised more than $850 million. At the time it started, our budget was $15 million
Q: Who were the early champions who helped you raise the money?
A: Since people didn’t believe in the idea, you needed credibility. Instead of making a fundraising board, we decided the most important priority was credibility. We got Phil Russell, from the US Army Medical Corps. We got Gordon Douglas from Merck, Jacques-Francois Martin from Pasteur Merieux, and Michèle Barzach, the former minister of health of France. They brought us credibility, and in turn that brought us funding.
Q: What’s your vision ahead for GAVI?
A: If you think about GAVI’s origainal vision, it was an umbrella alliance that included AIDS, tuberculosis, and malaria. But they decided there was so much going on in those areas it made no sense to focus on that. I would like to see a situation where GAVI returns broadly to focus on immunization across the entire spectrum. Look at what is happening with the polio eradication effort going on now. The toughest areas are the fragile states. Those are the same states where GAVI has a challenge in increasing vaccination rates. There should be an alliance that could go across different areas. The idea is to widen the tent a little bit.
Q: What are your thoughts about leaving IAVI?
A: I’m very sad about that. It was the hardest decision of my life. I founded IAVI. I hired every single person here. I loved the vision, I loved the work, but I also think it’s good for all organizations to have change. GAVI is a natural next step for me. When all these breakthroughs come, they will eventually make their way to GAVI, and then we need to make the next steps forward to get the vaccines to people.