Seth Berkley, former CEO of Gavi, the Vaccine Alliance, recounts the global effort to expand COVID-19 vaccine access in his book Fair Doses. Now a global health consultant after stepping down from Gavi in 2023, Berkley describes how leaders tried to make vaccines a shared global good, what succeeded, what failed, and what the world must fix before the next pandemic.
The idea that became COVAX was sketched at the Hard Rock Hotel in Davos on January 23, 2020. Reports of a novel virus in China were emerging and, although many details were uncertain, Berkley and colleagues at the World Economic Forum treated the risk seriously. Along with Richard Hatchett of CEPI and others, they proposed pooling purchasing power to buy vaccine doses in bulk from manufacturers and allocate them by population need rather than by countries’ ability to pay.
COVAX produced mixed but important outcomes. Between 2021 and 2023 it delivered about 2 billion doses to 146 countries, enabling some of the fastest vaccination rollouts in low- and middle-income settings on record. After the U.K.’s first COVID shot on December 8, 2020, vaccines supported by COVAX reached India 39 days later and Ghana and Côte d’Ivoire 43 days later. In the 92 poorest countries, primary-dose coverage reached roughly 57% versus about 67% globally — not perfect equity, but measurable progress.
Yet COVAX also faced major obstacles. Vaccine nationalism was a central problem: wealthy countries hedged their bets by buying multiple candidate vaccines, absorbing much of the early supply. Export restrictions, supply chain disruptions, and production bottlenecks made matters worse. In the first year of the pandemic, only about 1% of people in the poorest countries were vaccinated.
A critical setback came in spring 2021 when the Delta wave overwhelmed India. The Serum Institute of India (SII), the world’s largest vaccine maker and a key COVAX supplier, stopped exports to focus on domestic demand. Earlier in the pandemic India had sent donated doses abroad, which critics highlighted once Delta struck. With SII exports halted, COVAX fell roughly 600 million doses behind schedule. Berkley says diplomacy, engagement, and even legal avenues were tried, but those doses could not be recovered.
Berkley disputes the notion that COVAX relied on a single supplier. The initiative contracted with many manufacturers and held one of the broadest portfolios of vaccine candidates of any global program. Still, when richer nations locked up supplies, COVAX lost bargaining power and faced constraints it could not overcome.
From these experiences Berkley draws several practical lessons for future outbreaks:
– Ready financing on day one: Money must be available immediately to buy into manufacturer queues and secure supply. Gavi now maintains about $500 million in capital for this purpose.
– Clear, collaborative architecture: Pandemic response should be coordinated across institutions—WHO, UNICEF, the World Bank, civil society, national governments—each with defined roles and shared planning, rather than expecting any single body to do everything.
– Broader, dispersed manufacturing: Expanding vaccine production capacity in more regions reduces vulnerability to export bans and supply shocks. For example, Africa accounted for less than 0.1% of global vaccine production during COVID; building regional facilities helps access but doesn’t automatically guarantee even distribution within continents.
Berkley is frank about current readiness: he believes the world is less prepared now than it was before COVID. Political attention and funding have waned, and misinformation and disinformation from a mix of foreign actors, domestic politicians, and high-profile individuals have severely complicated public health communication. When national leaders publicly cast doubt on vaccines or call for unfounded changes to immunization programs, it becomes much harder for health authorities to correct the record.
He also warns that meaningful preparedness infrastructure has been eroded. Berkley points to cuts in U.S. foreign aid and health programs, reductions in pandemic-focused staff at the National Security Council and the CDC, and pauses in U.S. funding to Gavi. He estimates these shifts could leave tens of millions of children unvaccinated and contribute to a large increase in preventable deaths.
To counter misinformation, Berkley reiterates a longstanding public health approach: enlist trusted local voices—clinicians, nurses, faith and community leaders—to share evidence and context. That strategy becomes tougher when misleading messages originate from high-level figures, but local engagement remains essential.
His closing advice is straightforward: trust science, communicate uncertainty honestly, and practice humility. In the early days of any outbreak facts are incomplete; experts should give clear guidance based on available evidence while openly acknowledging what they do not yet know. That transparent approach builds public trust and helps people understand why recommendations change as new data arrive.
Fair Doses offers an insider’s account of the push to treat COVID vaccines as global goods and a pragmatic, cautionary framework for strengthening international readiness for the next pandemic.
