What Happens to GAVI with America’s Withdrawal?

Ashish Jha: 00:00:06

Hey, everybody. Ashish Jha here from Providence, Rhode Island, with another episode of a moment in health where we talk about one data point, we discuss one study, and then we answer one question. And you may have heard something a little different today, you may have heard a different theme music. Very excited to announce that Katherine Beggs, Brown, class of 2022 composed that it's an original composition for this podcast, and I am deeply grateful for Katherine work on this. Thank you very much, Katherine, for for that terrific composition that will now be the theme song, the theme piece of a moment in health. All right, this week I want to get going by talking about a data point. It's actually from a somewhat older study. The data point I want to talk about is 76.5%

Ashish Jha: 00:00:55

three quarters, 76.5% what is that number? It's from a 2016 study that showed that insured workers, people, workers who had health insurance, on average, missed 76.5% fewer work days than uninsured workers. Turns out, having health coverage is good for your health and it's also really good for economic productivity. I have an op ed coming out in the Boston Globe that lays out why I believe, and I think we all should understand, that health is one of the enabling features of freedom in our country. It allows us to pursue our unalienable rights to life, liberty and pursuit of happiness. One of the things it does is that allows people to be more productive, to live healthier lives, longer lives, and that we should be doing everything we can as a society to enable more health. So your data point 76.5% is the benefit of being insured and missing far fewer work days. Okay,

Ashish Jha: 00:02:02

I want to move on now to talking about a study. And the study comes from this month's Journal of called vaccines. And the study is entitled, lower risk of dementia with ASO one adjuvanted vaccinations against shingles and RSV infections. All right, so let's talk about what this study is. The study looks at people who got the shingles vaccine. Now that study has there's been a previous version of this that's been done showed that people who got the shingles vaccine were less likely to develop dementia. They also looked at people who got the RSV vaccine and find a relatively similar effect and somewhat of a bigger effect if you got both, compared to people who got the flu vaccine. This is an interesting study, and what it shows is a couple of things. First, it seems to suggest that potentially both shingles and RSV may play a role in developing dementia, and if you can be protected against those two viruses, they may be part of what's going on in reducing dementia rates. There's a second potential explanation, which is both of those vaccines, compared to influenza, is adjuvanted. There's an extra adjuvant added to the vaccine called ASO one, which helps boost the immunologic response. And the authors speculate that ASO one may be playing a role in reducing dementia as well, and that may be what's going on. All right, so how do I interpret this study, and what does this all mean? Well, first of all, if the question is, should you go out and get an RSV vaccine or a shingles vaccine in order to prevent dementia? I would say that is not where the evidence is so far, this evidence is suggestive, and in my mind, it might reduce the risk of dementia. I think that evidence for shingles is a bit stronger than it is for RSV, but this is just suggestive information. You should go out and get the shingles vaccine if you're over 50, because you want to avoid shingles. It's incredibly painful and awful. And you should get if you're over 60, and certainly if you're over

Ashish Jha: 00:04:09

75 should get the RSV vaccine because you don't want to get RSV because it can kill people, especially as they get older and become more immunocompromised. So those are the primary reasons for getting those vaccines. But there is now this increasing evidence that these two viruses may also be playing a role. Last point I want to make on this is again a point I have made before, but I want to reiterate, which is this mental model we have that there are chronic non communicable diseases like dementia and cardiovascular disease and multiple sclerosis, and then there are infectious diseases like flu and RSV. It's probably a false dichotomy. We know that HPV, the human papillomavirus, is the primary cause of cervical cancer and other types of cancer. We are seeing increasing evidence that a lot of viruses are maybe contributing to dementia, and that the split between infectious diseases. And non infectious diseases. It's probably a false dichotomy, and we've got to be managing all of this together in one broad category. So that's your study. More evidence suggesting that ASO one adjuvanted vaccines against shingles and RSV may contribute to lower rates of dementia among older people,

Ashish Jha: 00:05:28

all right. And now for the one question of the week, and for this, I have a very special guest all the way from Switzerland joining me, my friend and colleague, Seth Berkley, who is a senior advisor to the pandemic Center here at Brown but really one of his major accomplishments was he led Gavi, the Global Alliance on vaccines, for about a dozen years. And so I'm very pleased to have Seth here today. And Seth, my question for you is, this week, we heard RFK Jr basically saying the US government is going to pull back its support for GAVI. I think a decision that all of us think is just incredibly misguided and harmful. So the question for you is, how do you think GAVI moves forward with a vacuum from the US government, and before we even go there, if you don't mind, just take 30 Seconds to explain to people what GAVI is, how it works. And then if you could get into how you see the current challenges, but really where you see the future.

Seth Berkley: 00:06:26

So thanks Ashish and GAVI just finished its replenishment effort, which is why this is timely right now. So GAVI is a public, private partnership. It started in 2000 and the goal was that there were new and powerful vaccines that were being made and being used in high income countries, but weren't getting to the poorest countries where those disease burdens were perhaps even greater, given the, you know, the situation on the ground with the health systems, etc. And so GAVI began then, and it's been a remarkable success. It's vaccinated 1.1 billion unique children. When I say unique meaning many children get many, many vaccines, but these are individuals, and it's gone from having six vaccines originally now to covering against 19 diseases. The other thing that's happened during this period is it's built up a program to deal with epidemics and keeps global stockpiles, so when there are outbreaks anywhere in the world, people can have access to those as quickly as possible. The last part of it, which is interesting is this is about giving a hand up and not a handout, because every country contributes something, and if you're very poor, you contribute a little bit. As you get richer, you contribute more, until you eventually graduate out of Gavi, 19 countries have graduated out. They've continued their vaccinations, and so this really is some of the best development aids you can do to help countries when they really need it, but to also protect the world against outbreaks. Now, the US has been a supporter from the beginning. It has been there and has slowly grown over time. The US is a 13% of GAVI support, so a major amount, but not over its weight in the global economy. So this is one where the burdens are shared. In the previous administration, there was an approval for a pledge for the next four year period. Normally it's a five year pledge. US doesn't do that, but they did a four year pledge, and that was approved. And so

Seth Berkley: 00:08:31

as far as GAVI was concerned, they were receiving money, but then a decision was taken. It was an unusual decision, because normally money for GAVI comes out of the State Department, and therefore would be under the control of the Secretary of State. But in this case, there was a video yesterday from the Secretary of Health and Human Services, Robert F Kennedy Jr, and he said that they would not be supporting GAVI. There is now an effort to rescind the support that has already been approved. And in that video, he talked about the power of reducing prices, but he also talked about the fact that some of the vaccines that were being used were not the same vaccines in his United States, and there were some accusations of safety issues, et cetera, and that was really quite harmful and unfortunate, because, of course, GAVI follows the safety standards of the world on the particular vaccine that was discussed was a Pertussis vaccine. Pertussis is a disease whooping cough that that actually kills like one in 200 kids that are infected with it. It's about 13 million deaths have been inverted since this vaccine has been available. And the challenge with this is there are two versions. One is a acellular version, and that's a version that's used in the US. Why? It has a little bit less reactogenicity. It doesn't give quite as strong an immune response, and in the US, that's okay. Because you can get boosters easily if you need it, and we've seen, in fact, an increase of infections because this vaccine is not as strong as the wholesale one. The wholesale one does give a stronger reaction and can cause fevers, soreness, occasionally even febrile seizures. But everybody who's looked at it has said it's a much more effective vaccine, particularly for use in these countries. So it was really misinformation that was unfortunately combined with this. Now, what does it actually mean? It means that about 25 sorry, 75 million children during this five year period

Seth Berkley: 00:10:36

will not receive vaccines, and that should directly lead to 1.2 million children dying in low and middle income countries, unless that money is replaced. And I just want to finish by saying that, you know, vaccines are the most cost effective intervention. For every dollar you spend, you get $54 in return. So this is an amazing investment in protecting children around the world. We've seen a 70% reduction in vaccine preventable disease deaths, contributing to a 50% reduction in children's deaths around the world. This is really important stuff, and the idea that that the US, as the largest development donor in the past, as the leader in science and technology, would walk away from this science and technology seems to me to be something that is not in the best interest of the US or of the world.

Ashish Jha: 00:11:36

Wow. First of all, thank you. That was extraordinarily helpful. Let me ask just a couple of quick follow on questions. I mean, it seems like just on the pure facts and on the science, this is a mind bogglingly foolish decision on the part of the United States government. In my mind, on my opinion, you don't have to agree or disagree on that, but I just it does sort of boggle the mind, how this is the thing we would walk away from. But on some level, not totally shocking, given RFK is 2530 year history, campaign against vaccines. Do you see others stepping up? That's sort of one part of a kind of a follow on on this. And what do you think this means for American standing in the world on critical issues where there is just pretty much broad consensus across the world that these are the right things to be doing. When America walks away from something this obvious and this useful, what impact do you think it has on American leadership and American standing in the world?

Unknown: 00:12:35

Well, I mean, the first thing to say about it, we just came from the replenishment, and so all the US did make this statement. There was a video that was shown at the replenishment on this, by the way, rebutted by the editor of The Lancet because the science that was called in the video wasn't accurate. But you know, more importantly, there was broad support from many other countries, and that includes not just high income countries, but developing countries who have stepped up and put their own money in as well. Now the challenge, of course, is that given the massive cuts in development aid that have occurred, there is a big stretch to deal, not just with vaccine related diseases, but also with AIDS, TB, malaria, other activities as well. And so there's not a lot of free money around. So in terms of others stepping up, there's also been a call for having increased defense funding, and the world has responded to that as well, given the uncertainties that are there. And so the combination of all of that has meant that we're living in very, very tight times. But to your point, this is the most effective spending you can do. And even if you said, I don't care about those people living in the rest of the world, if you just care about the US, we will have outbreaks in the US, because these diseases have been eliminated, many of them in the US. And so, for example, measles was eliminated in the US, we now have a big outbreak going on in the US by definition, that is coming in from people outside of the US, and we'll see the same with pertussis. We'll see the same with other diseases. So it is not good for the US from its own self interest point of view. But lastly, you know, the thing I think you have to worry about is that countries will look to other countries for this type of support and help, rather than the traditional engagement by the US and it and it really hurts our standing, because countries will scramble, children will die, and as a

Unknown: 00:14:33

result, people are going to say, Well, why did this happen? Why did it happen so suddenly? Because there's not enough time even for countries to plan out these changes that are occurring right in front of us.

Ashish Jha: 00:14:46

Yeah. Yeah. As you said, it really is part of this broader pattern of abdication of American leadership that in the long run, I think yes, it'll hurt kids, yes, it'll hurt poor people, but it will really hurt the United States. States and its standing in the world, and it's it, and people sense that it is a reliable partner on critical issues. So anyway, Seth, first of all, thank you for coming on and really explaining all of that as brilliantly as you did. And more importantly, thank you for your more than a dozen years of leadership of Gavi, but also all the work you're doing right now to continue making the case for these important global health investments. I really appreciate it. Thanks for coming back. It.

Unknown: 00:15:23

Thanks for coming back. Thank

Ashish Jha: 00:15:31

you. All right. So there you have it. Another episode of a moment in health where we talked about one data point 76.5%

Unknown: 00:15:38

fewer work days missed for insured versus uninsured. Workers making a case for insurance coverage, for for boosting productivity, the economic case for expanding coverage. Uh, supports employers investing in health benefits. Of course, the health benefits of being insured, it goes far beyond missing work days, but that is another piece of data worth thinking about, the study where we talked about the lower risk of dementia with ASO one adjuvanted vaccinations against shingles and RSV, a reminder that viral infections probably are playing an important role in dementia, and that while you should be getting these vaccines if you're eligible for the primary Reason of preventing infection, there may, in fact, be important secondary effects as well. And then last, but certainly not least, we heard from my friend and colleague, Seth Berkley, physician, brown grad, who ably ran GAVI for 12 years, talked a lot about what GAVI is, this Global Alliance, a public, private partnership that has vaccinated literally billions of kids around the world, saved millions and millions of lives, and has taken issues around vaccine safety quite seriously. And this week, this past week, the health secretary of the United States accused GAVI of not being a serious organization when it comes to taking vaccine safety seriously, and more importantly, withdrew funding, which I think is a terrible, terrible decision. Ultimately, it will harm kids around the world, but it will really undermine us standing as a global partner, incredibly self destructive. So Seth did a very nice job, I think, of laying all those issues out. And last, but certainly not least, I want to mention that this is the first episode where we got to hear music by Katherine Beggs, a Brown alum who composed this originally as an original piece for our podcast, a moment in health. So thank you again, Katherine, and thank you to all of you for listening to a moment in health, and I'll be back next

Unknown: 00:17:36

week with another episode. Thanks so much. You.