Trump’s funding cuts will deprive 75 million kids of vaccines, lead to a less safe world: Dr Seth Berkley

Professor at Brown University School of Public Health and former CEO of Gavi, the vaccine alliance, Dr Seth Berkley championed equitable access to vaccines and co-founded Covax during the pandemic. In an interview with Sunday Times, he warns of the repercussions of abrupt fund cuts. Excerpts:

It is well recognised that there should be reforms at the agency and efficiency could be increased, but withdrawal does not serve the interests of the US or those of the world as it will reduce its ability to do critical work. The sudden cessation of funding has meant that many places, relying on long-standing programs for drugs, vaccines, diagnostics, health system strengthening and technical assistance will be shut down resulting in loss of lives, spread of infectious diseases, lack of control of epidemics and further spread of antimicrobial resistance. It is for the US govt to decide what to fund but the sudden nature of this change would make it difficult for any program to sustain its activities. As this is occurring in some of the poorest countries, the effects are devastating. Normally, other countries might be able to step in to moderate some of the effects but the broader geopolitical changes that are underway has meant that many countries are shifting their finances to deal with these priorities and there may be less funding available.

Gavi provides vaccine support to about 50% of the world’s children in the poorest countries, as well as vaccinating more than 1.1 billion additional children in the last 25 years. It has been an incredibly successful public-private partnership, driving down the cost of vaccines by more than 90%, introducing more than 700 new vaccines and reducing vaccine preventable disease deaths by 70%. For every dollar invested, we get a $54 return when we take into account broader societal benefits. Finally, Gavi keeps the global stockpiles for ebola, yellow fever, cholera and meningococcal meningitis — which are available to stop epidemics in their tracks when outbreaks occur. The US currently provides about 13% of Gavi’s support. If they were to stop funding Gavi, the current estimate is that 75 million children would have to go without vaccines, leading to increased numbers of deaths, disabilities and outbreaks. It may also mean that new vaccines such as the first malaria vaccines or new meningitis vaccines specifically targeted to strains of meningitis spreading in Africa may not be able to be introduced. Obviously, the effects will only be known if funding is stopped and then we see what other donors and countries can support, but it is clear that this would lead to a less safe world.

Climate change will have a very large impact on epidemic events. The movement of people due to climate emergencies and the changing patterns of disease spread due to the increasing ranges of insect and animal vectors and human encroachment on wildlife areas will lead to new infectious diseases (about 70% of new pathogens come from animal sources). General use of antibiotics without diagnostic testing further increases risk of antimicrobial resistance when an outbreak occurs. This will lead to many more outbreaks which is why it is critical for the world to invest more in outbreak identification and mitigation. Having medical countermeasures—and the ability to rapidly create ones for novel pathogens—will be critical to keep outbreaks from becoming epidemics and pandemics.

Malaria is currently one of the largest killers of young children in Africa where 94% of the malaria deaths occur. The introduction of malaria vaccines as a new tool to be used alongside these other effective interventions has the possibility to dramatically reduce these deaths. It is estimated that for every 200 children vaccinated in high-incidence communities, one life will be saved. The SII vaccine is 60 per cent cheaper than the other available malaria vaccine and can be made in very large quantities so has the possibility to be a game changer, but only if it is introduced and used. This will depend on having adequate finance in place which is under threat now.

India has been the world’s vaccine producer. Unfortunately, during the Covid crisis, it stopped exporting its vaccines suddenly leaving many countries without access which eroded trust in Indian manufacturers as reliable vaccine providers for these countries. Many countries moved towards local production which may be good for their self-sufficiency, but small-scale production may be less cost-effective and reliable. It will be critical to ensure that the vaccine manufacturing ecosystem remains focused on quality and there remain adequate and multiple producers of critical vaccines going forward.
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It is difficult to make alternative plans when programs are defunded suddenly. Stopping HIV treatment is particularly bad, as it doesn’t take long for drug resistance to develop and for immunosuppression to return as viral loads rise.