The Life Scientific: Seth Berkley

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0:30Seth Berkley:at Whole Foods Market. How did a boycott Jimmy become a billionaire from posting videos? On Good Bad Billionaire, we're going to find out how the world's most popular YouTuber, Mr Beast, made his fortune. He's buried himself in a coffin for days. Counted to 100 ,000 on camera. And even recreated Squid Games, all in an attempt to go viral on the internet. But it all started when he gave a homeless man$10 ,000. So is he a philanthropist reshaping capitalism? Or is he just the king of the attention economy? Find out on Good Bad Billionaire. Listen on BBC.com or wherever you get your podcasts. Hello, from building a makeshift chemistry lab in his wardrobe as a child, and years later setting his own shattered leg after a climbing accident, to more recently raising billions of dollars to help vaccinate the world during the Covid pandemic, Dr Seth Barclay has never been one to do things by halves.

1:23Seth's career as an epidemiologist has revolved around one big problem, that vaccines save lives, but only if people can get them. His four decades in the field have taken him around the world, from helping to build Uganda's first HIV surveillance system and founding the International AIDS Vaccine Initiative, to leading Gavi, the vaccine alliance, for more than a decade, overseeing the immunisation of hundreds of millions of children worldwide. And when COVID-19 struck, Seth founded COVAX, the global initiative designed to stop wealthy nations monopolising vaccines. So it's no surprise that he doesn't pull his punches when it comes to calling out misinformation and believes public health messaging has to get back to the science.

2:07He says we need to care about this. People must understand that vaccinating the world is self-interest as much as humanitarian. It's a strong message. Whether it's getting through to the right people remains to be seen. But we'll get to that. For now, Dr. Seth Barkley, welcome to The Life Scientific. Thanks for having me. Now, Seth, I think we have to start by acknowledging that this is a particularly strange time in vaccine science. There's a huge amount of anti-vax propaganda and disinformation floating about. How have we got to this point? It really is crazy because on the one side, we're in a renaissance of science and amazing new tools are becoming available.

2:47We're tackling new diseases. And that's the exciting part. The bad part is there's been this incredible politicization of vaccines. And we saw this during the pandemic where many leaders called on their followers not to get vaccinated. And we saw death rates shift where people, you know, following that advice had higher death rates. And we also saw intentional disinformation, which spreads literally at the speed of light, given social media. And the combination of that has made people lose trust in governments, lose trust in vaccines, lose trust in health workers. And it takes a long time to build trust.

3:23Pretty easy to lose. Yeah. If you had to make a case for vaccines in just one sentence, what would you say to the skeptics? I mean, we have to start off by saying the natural situation of life is for children to die. Lots of them. The mortality rates before public health was 300 out of a thousand. Today, in the best countries, it's about one and a half. And for me, vaccines are a way to have a parent never have to go through that horrible thing of losing a child, to know that if you have a child or two children, that they are likely to grow up, live, and in fact, today have about 40 years of extra life.

4:02That is because of these advances, as well as sanitation, clean water, etc. Right. Well, of course, on a more positive note, we have seen some amazing success stories around vaccines in the past few decades. You've been involved with several of them. Is there any single example that stands out for you? For me, what's really exciting is shifting from traditional infectious disease, which is the problem we just discussed, to now having vaccines that work against cancer and even vaccines that are working now against parasitic diseases. If I use an example of cancer, the HPV vaccine, human papillomavirus vaccine, you get this shot and you're prevented for the rest of your life of getting this horrible, slow, painful killer of people in the developing world.

4:48And it is now the most impactful vaccine that Gavi uses. Well, Seth, I mentioned in the introduction that you built a lab in the wardrobe of your childhood bedroom. Tell me how on earth that came about. So I got a chemistry set. I thought it was really fun. And then it turned out there was a chemical company not far from my house. And I went there as a young boy. And I was apparently looking around with big eyes like a kid in a candy shop. And the owner actually saw me and said, you know, do you want to help? I can't pay you because you're underage. How old were you at the time? It was about nine, I think, or ten.

5:26And he allowed me to help in the place. and I got to take home chemicals and laboratory wear. And so I had the best equipped closet anywhere. And of course, as a young boy, I was not just doing experiments, but making explosives and doing all kinds of things. Health and safety be damned. Yes, health and safety be damned. Well, certainly those early home experiments stood you in good stead. You ended up going to study medicine at Brown University. And in the summer of 1978, as a young medical student, And you went to get some hands-on experience at a clinic in Mississippi, which ended up being a formative time for you.

6:04Yeah, I mean, it wasn't by chance I went there. I was peripatetic, and my dean of my medical school thought it would do me good to be thrown into a system. So I worked with an iconic civil rights physician, and he had studied at the best institutions in the north, went back to Mississippi, and tried to get privileges. and they said, you have to join the American Medical Association. And he went to do that. And they said, we don't allow blacks. And so he ended up leading a march on the AMA, creating the Medical Commission for Human Rights. So he was the first kind of licensed black physician, and therefore he was really powerful.

6:42So I ended up living with a local black family, working in this clinic, and really beginning to understand what it was like to be in a place that still had a lot of discrimination and how that affected their health care. And it was an amazing experience. Well, after qualifying in 1981, Seth, you did your residency in Boston at Harvard University's teaching hospital, Beth Israel. Then you took a job as a medical epidemiologist at the US Centers for Disease Control and Prevention. Yes. And I was actually lucky to get placed in special pathogens, which is where the really exotic and interesting and new diseases appear, and actually had an opportunity to travel around the world, find interesting diseases, including novel ones where I got to discover a new disease and actually name it.

7:33So it was a really extraordinary experience and helped build up the type of skills that I was able to use later. You remain focused on finding a way into global health. And in fact, during your next role as a state epidemiologist in Massachusetts, you got the opportunity to work briefly in Sudan. That was an incredible story. They asked for a team to go to document a famine that was underway in Sudan. And I went with a colleague of mine, Dr. Mike Linan, who's a very experienced guy. And the two of us had to figure out how to get out there. And it became rainy season. It was impossible to get out there.

8:10We ended up renting a camel train. And actually, we had to buy a camel train. Sorry, not renting it. And that was crazy. Imagine putting that on your expense report later. But we went out and we documented the worst famine ever documented in human history, 93 % severe and moderate malnutrition. And we saw waves of deaths going on, but including measles deaths in children where you'd go out in the morning and count the graves that were there. So a really extraordinary moment. And all of that had to do with poor logistics. It wasn't that there wasn't food available or funds available. It was getting it there and having the political will to be able to do that.

8:51And that was the tragedy. And of course, there was a measles vaccine. Yes, absolutely. So it was a case that Sudan couldn't get hold of it or couldn't get hold of enough to... Well, I mean, again, this is the political question because you have these tools that are so fabulous that everybody should get. And you have a situation where it doesn't get there. And it might be because they're out. But, you know, it also might be because somebody didn't want to let it through or somebody destroyed the clinic that had the cold chain to store it or didn't have a syringe available, etc, etc. So it really is you have to have each piece working.

9:26And that's why the goal should be to vaccinate everybody in the world. Mm hmm. Speaking of measles, and let's bring this up to date for a moment. Many listeners will know that at the start of this year, the World Health Organization revoked the UK's measles elimination status, along with that of several other European countries, after multiple outbreaks here. There's a similar situation unfolding in the US. As we're recording, it still technically has this elimination status, but the latest statistics suggest it will lose that in November when the next official assessment takes place. What's gone wrong here?

10:00And in your view, is there a simple way to fix it? Well, there's a lot of things have gone wrong. The U.S. is a unique situation because it has, as a secretary of health, a known vaccine skeptic. And so there's incredible disinformation, misinformation that's being spread there. Now, you know, it's hard to say that's the reason you're having it here in the U.K., but the disinformation and misinformation is being spread by social media. And it certainly is part of the problem now that is spreading around the world. And how do we get back to a place where people understand that you can't say things on social media that ultimately will kill people?

10:38You go into a movie theater, you yell fire. That's not free speech. You can get held accountable that I don't understand how you can do that and mislead people into avoiding vaccines that are lifesaving. Well, Seth, back to your story. In 1987, you were offered a job with the Carter Center in Uganda. That's the nonprofit health organization set up by former U.S. President Jimmy Carter. And of course, the fact that it became the early epicenter of the HIV AIDS epidemic in Africa meant that that then became your focus, didn't it? Well, I started out, I mean, I was sent there to actually work on rebuilding the immunization system and started out working in that area.

11:14But we started doing some studies and we ultimately did a national serosurvey. survey. That's taking blood randomly from around the country to figure out what the infection rate is. And when we first got the result back, it showed that about 12 % of the adults were infected and close to 20 % in the capital city. And this is, of course, the little tip of the iceberg out and the body that's below. Or in Africa, we talk about the hippo with the hippo's ears up and the body that's below. But it was a clear public health emergency. And what was amazing about it is when we presented the results to President Museveni.

11:50We did it with wide confidence intervals, all the challenges that were there and, you know, things we missed. And he had published in the national newspaper 790 ,512 Ugandans are HIV infected. I was horrified from a public health point of view, but he just knew that this was a problem. He began to work on it and the countries came to his aid and set up the state-of-the-art AIDS control program. Well, after two years in Uganda, you moved back to the US to join the philanthropic Rockefeller Foundation, managing global programs in epidemiology, vaccination and AIDS. But a couple of years in this job led you to a stark realization that the global HIV vaccine effort had stalled.

12:38Yes, HIV was, of course, incredibly important. It at this point had really spread and was spreading in the developing world. And the challenge, of course, was we needed a vaccine. And it turned out that the vaccine effort wasn't focused on the developing world where the widest diversity of strains were. And so we decided to put together a new initiative to try to help drive that work forward. So this is with the foundation support. In 1996, you established and became CEO of the International AIDS Vaccine Initiative, or IAVI, where the core mission was to drive HIV vaccine development. How did you manage to do that?

13:15Well, we had some big successes and interesting fundraising. So ultimately, we ended up taking lots of novel vaccines forward. We ended up creating research facilities around the world, which was really important because it meant that we could do the trials in Africa, do them in Asia, do them in Latin America. And the program is still going on, although recently has had some really tough moments. And yet still no HIV vaccine. Did you ever despair? Yeah. It was hard because, you know, you start out saying people have always asked you, when's it going to happen? And you say, we don't know, but it's at least 10 years away.

13:52But, you know, as the joke was, all right, it's always 10 years away. It is the hardest organism to create a vaccine for why when you inject or get injected, it's one or two viruses that get taken. And those viruses make mistakes when they reproduce. And you end up after a month or two having, you know, billions of different strains in your body. That's the challenge. It's not the immune system can't fight it, but the immune system's trying to fight it, but it's constantly changing and adapting. Right, right. And eventually it isn't able to do it. And one of the things we've learned since is that some people can make antibodies that neutralize a large amount of the strains.

14:31The question is, how do you turn that into a vaccine? And that's something that IAVI is still working on, unfortunately, with the crazy cuts in funding in the US, you know, that work after 25 years has really gotten cut. And that's unfortunate because progress was really being made. Back to your early days with IAVI, you were still occasionally acting as an expedition doctor on various international trips to keep up your clinical skills. In 2001, on a trip to Namibia, you had a terrible accident. Yeah, that was not my best days. I had with me a full surgical kit and medical kit. But of course, you know, I was the one that got injured.

15:11I was carrying a pack with medical stuff in it, and my leg got caught between two rocks, and I had a slow, twisting fall. I had to set my own leg in the field, but I actually injured my other leg as well. And we ultimately were able to get a helicopter to evacuate me and to have emergency surgery, which I stayed awake and watched because I was nervous. I didn't want to have anybody to hang blood on me, given that the infection rate in Namibia at the time was about 25%. percent. And so it really changed my life in many ways because I was at the time a marathon runner and triathlete. And I had to change and adjust my sports.

15:50Yeah, because this was more than just a twisted ankle. You underwent five operations. You spent six months in and out of a wheelchair. As you say, you're a marathon runner, triathlete. Did that all end? It really did because the operations I had meant that my flexibility in my ankle is not great. So I had a shift to, you know, and now I can bicycle ride and I can use the elliptical. But you know, it changes things. The reason, right, it's not that you love running, but all the traveling I was doing, it's the one thing you can do anywhere in the world. Well, it's probably a good thing then you had various sporting stress outlets, even if it wasn't running marathons, because life was about to get extremely busy for you.

16:28In 2011, you joined Gavi, the Vaccine Alliance, as CEO. So for anyone who isn't familiar with this organization, maybe you can briefly set out what it does. So the concept, there had been a set of efforts to try to get vaccines out. And if you go all the way back to 1974, less than 5 % of children in the world received even a single dose of vaccine. Not all of them, just a single dose. And so a set of efforts had lifted that number up, but it was kind of stuck around 60%. And there were all these new vaccines that science was bringing forward. And so Gavi was born in the year 2000 out of the World Economic Forum.

17:07Bill Gates was an important supporter of it. And the concept was bring industry, bring everybody together and try to drive forward now new and underutilized vaccines. And it's been an amazing success in that they've introduced about 800 new vaccines in the poorest countries in the world, have immunized more than 1.2 billion additional children with these vaccines, saved more than 20 million lives, and really taken immunization to the place where it is now the most widely distributed health intervention in the world. So, you know, a little over 90 % of people in the world have access to a routine vaccine.

17:49That obviously means, by the way, that 10 % don't. And that's still now critical to reach because that's where about 50 % of the under five child mortality exists in that 10 % of kids and two thirds of them live below the poverty line. And this isn't only about helping those countries, because when you have eliminated measles, as you in other countries, then it has the opportunity to come back. So what you really want to do for your own situation is to make sure that these diseases are not circulating in other countries. Yeah. And the same argument, I remember, was made during the COVID pandemic, that you vaccinate other far off countries because ultimately it benefits the whole globe.

18:34Yes. And people initially, I don't think, believe that, but I think the epidemic taught them that. Yeah. Well, for your job at Gabby, Seth, you and your wife, Cynthia, moved your young family to Switzerland. And one of your big early tests was in the 2014 Ebola outbreak in West Africa. Tell me about that. What happened was there was a vaccine and actually a few vaccines. But the reason there were vaccines was because after September 11th and the anthrax attacks, George Bush set up a program to try to deal with biodefense. And on the list, they put Ebola. And so a number of places started making Ebola vaccines.

19:11And then they decided, well, it's Too dangerous, too difficult, not a biohazard. And they just shelved those vaccines. So the vaccines never went all the way to licensure. And so our role in this was really to, first of all, have them dusted off, have them tested in a clinical trial, and then to put a set of incentives in place to say to the company, you've got to take it all the way to licensure, to manufacturing, and to create a stockpile. And to do that, we'll set up an advanced purchase commitment so that you can go to your shareholders and others and say, it makes sense, somebody will buy it because the risk was no marketplace, it wouldn't happen.

19:48And that became a really important tool that we later on used for COVID and other diseases. As you say, it really did turn out to be important groundwork because in late 2019, there were rumblings of a new super virus coming out of China, which is when you, Gavi and various other collaborators swung into action to launch COVAX, an initiative to ensure equitable access to COVID vaccines. How did that come about? We had no mandate to do it. We had no money. We had no people. But we thought it was the right thing to do. So we were sitting in Davos with Richard Hatchett, who is the CEO of the Coalition for Epidemic Impairedness and Innovations.

20:29My wife, Cynthia, was with us. And, you know, we were discussing the rumors we were hearing. At that point, it was still not known whether it was person-to-person transmission. But President Trump was down the street saying, it's nothing, we've got it completely under control. And we weren't so sure at that point. And we thought, is this the big one? Or is this a dressed rehearsal for the big one? But either way, we should try to get prepared. Because what we knew was that if this was going to be a pandemic, that even if there weren't yet known vaccines, wealthy countries would go to companies and put pre-orders in like had happened in the previous pandemic flu, where countries had bought up all the doses and none were available for the rest of the world.

21:12So that's what we were trying to avoid. Well, what you achieved in that strange period of lockdowns and anxiety all around the world was actually quite remarkable, wasn't it? It was incredible. It was the fastest rollout of vaccine in history. So the first dose of a vaccine outside of a clinical trial was done here in the UK. And 39 days later, we had a dose of vaccine in a COVAX country. And it took 43 days after that because WHO had to do their regulatory stuff and they weren't moving very quickly. But before we had doses in Africa and 42 days after that, we had doses in 100 different countries.

21:49And ultimately, we delivered 2 billion doses of vaccine. And coverage rates in the developing world were 57 % in the 92 poorest countries. That's about half of the world's population. That compares to about 67 % in the global number. So not perfect equity, but closer than it's ever been before. So it really was an extraordinary effort. And you were still CEO of Gavi, but after a decade, you decided to step down in 2023. How did it feel to walk away after such an intense period? I mean, the Gavi work was intense and something I loved, but even more intense was Kovacs. So I was actually pretty tired at the end of that.

22:33And it's one of the reasons I made a decision not to jump right into another CEO role, but rather to do a portfolio of activities and write a book. But I am still committed to the work that I did at Gavi, and I'm trying to, in essence, drive some of the same things from different angles now, from the private sector, from biotech companies, from new technologies that will make a difference. Well, as we've already discussed, Seth, it's a very different world today compared to when you started your career. We've spoken before on this program about how misinformation and distrust are undermining global vaccine efforts.

23:11In fact, a major study, partly funded by Gavi and published in The Lancet last year, found that routine vaccination coverage globally had actually stalled and even reversed. How would you like to see that tackled? I think, first of all, it needs to be seen as a problem. So for the people who are still out there saying we shouldn't have vaccines, that vaccines aren't safe, they are contributing to the problem. So we need to make sure, one, that we get good and truthful information out there, information based on science. Without science, we are lost. And second is really about dealing with the disinformation machines that are out there.

23:50We have to understand that when you attack a specific vaccine, people may not remember that vaccine, but they remember an attack on vaccines suggesting maybe that vaccines in general are problematic. So we really need a change in mindset. And the loss of trust in governments and in science is a broader problem that is influencing that here. You mentioned a loss of trust in science. Of course, last year, US Health Secretary Robert F. Kennedy Jr. announced that the government was halting funding for Gavi because the organisation was, and I quote, ignoring the science around vaccines. He didn't offer any evidence to support that claim.

24:28And you've since called his remarks a mix of misinformation and some disinformation. How do you feel about statements like that coming from such a position of power? It's a real challenge because from the beginning of vaccines, there has been vaccine hesitancy. The first smallpox vaccines done here in the UK, there were wood carvings of people with cow horns growing out of their heads because they got, you know, the cowpox vaccine. And so that's always been a problem. But you could deal with it using local leaders or religious leaders or, you know, nurses or doctors. Or all of a sudden, when you've got political leaders, when you have presidents, when you have secretaries of health providing disinformation, misinformation, it's a real challenge because a lot of people say, what do they know that I don't know?

25:17And that's a problem because it's very hard then to convince people to do otherwise. And it's very labor intensive. You know, you need that extra time to work with families to help answer their questions, have them understand that, in fact, these vaccines are good for them and for their children. Yeah. As you mentioned, you recently wrote a book, Seth, Fair Doses, an insider story of the pandemic and the global fight for vaccine equity. I hope this doesn't count as a spoiler. But at the end of the book, you say, if we start now, we'll be much better prepared for the next pandemic, because it's an evolutionary certainty that there will be one.

25:57So what would your advice be then to be as prepared as possible for whatever health challenges around the corner? Well, the most important thing is building strong health systems. The health system is where when a disease appears that's novel, it will be a health worker saying, I see something strange and reporting people. So having good health systems is important. But also, we delivered during COVID three times the number of vaccines that had ever been delivered before. And, you know, it wasn't pretty, it wasn't easy, but the health workers were the heroes that did that. And building those systems to be stronger and better is the way to prepare for the future, in addition to making sure there's adequate manufacturing, there's good supply chains, there's going to be money.