"The scope of anti-vax involvement is unprecedented," notes epidemiologist Dr. Seth Berkley.

During the COVID-19 crisis, public health leaders endeavored to supply vaccines impartially across the globe. Dr. Seth Berkley contends that although they progressed significantly, they could achieve even more in the times ahead.(Image credit: Peter Dazeley via Getty Images)

Within a few weeks of the initial accounts of an “enigmatic ailment resembling pneumonia” surfacing in Wuhan, China, public health authorities assembled to gauge the danger and bolster infrastructures to lessen any forthcoming conceivable harm. This endeavor commenced several months before the formal declaration of COVID-19 as a pandemic.

Dr. Seth Berkley — a noted disease specialist focused on infectious diseases and the previous head of Gavi, a worldwide body focused on boosting youngsters’ entry to vaccines — was a crucial character in the drive to guarantee forthcoming COVID-19 vaccines would be allocated to the world’s most deprived countries. Berkley’s recent publication, “Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity” (University of California Press, 2025), chronicles these pandemic-period attempts and ponders what succeeded and what didn’t.

Live Science conversed with Berkley regarding the book and the understandings we ought to convey into the next major worldwide outbreak — the emergence of which, Berkley maintains, is an issue of “when,” not “if.”

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This carries considerable weight. We’ve also witnessed the control of several infectious ailments: the abolishment of smallpox, the nearly total curtailment of wild polio, the management of measles across numerous nations, among other accomplishments. However, the current trend is to draw back from these endeavors even as risks posed by infectious conditions linger — and, as recently seen in the U.S., we’ve had significant measles occurrences.

The U.S. had indeed achieved the status of eradicating indigenous measles infections, signifying that new cases originated externally. Now, the U.S. risks forfeiting that distinction. This underlines the importance of a global perspective, as increases in measles infections abroad, coupled with population movement, will inevitably lead to cases in the United States if vaccination levels recede, which they are.

We are encountering circumstances where experts are discredited, and individuals lacking expertise but possessing preconceived notions on vaccines are appointed. They allege to boost confidence; however, I see little evidence of this. Furthermore, the U.S. is currently fractured. Most recently, we see states consolidating efforts to release their guidance. Professional organizations are issuing advisories instead of a unified set. In conclusion, I question whether this increases confidence.

NL: Do you attribute these shifts in the U.S. to an escalation of an existing issue, or to a more contemporary concern?

SB: It embodies both aspects. Vaccine hesitancy can be traced back to the first vaccine developed in the 1700s for smallpox, soon after its effectiveness was demonstrated. There were illustrations portraying individuals with cow horns sprouting from their heads — because the vaccine originated in cows — among other similar depictions. So, this isn’t a novel issue.

What distinguishes this era is the intense politicization — the concept that a particular political group holds these beliefs and responds accordingly, resulting in distinct vaccination coverage levels based on political affiliation. And, ultimately, you see government leaders propagating conspiracy theories and challenging the credibility of scientific institutions and frameworks designed to ensure the highest caliber of science attainable.

During COVID, we saw Russian and Chinese automated accounts disseminating false information, which inevitably spread rapidly. Moreover, to my knowledge, the U.S. government, specifically the Department of Defense, released disinformation to discredit the Chinese vaccine. These activities constitute a form of warfare that yields devastating consequences. … This represents an unparalleled level of anti-vaccine activity.

Logically, resources should first be devoted to preventing illnesses before addressing their treatment — yet such logic is not inherent to humans.

Dr. Seth Berkley, Brown University

NL: It is commonly argued that the effectiveness of vaccines has lessened people’s apprehension about vaccine-preventable conditions. Do you see this as valid?

SB: Observing this emerging age of disinformation — as I mentioned, there has always been vaccine misinformation. However, the distinction lies in this: If you live in a country with high vaccination coverage, and therefore the diseases are effectively nonexistent, it becomes simpler for a parent to reason, “I don’t wish for my child to be injected with something. … I’m unfamiliar with these conditions. I’ve never encountered them. How damaging can they truly be?” So, that’s one point of view.

Alternatively, those living in developing countries where these diseases remain extant witness the complications experienced by children and the paralysis resulting from polio. They observe individuals who become blind or deaf due to rubella. As such, the benefit-harm analysis differs in these different populations. And it falls on science to determine the benefit-to-cost relation of these items?

The other problematic aspect stems from our lack of exposure to these conditions, which prevents us from comprehending the severity of potential adverse consequences. In measles, there is subacute sclerosing panencephalitis, a rare condition wherein the child’s brain deteriorates, leaving no recourse.

The task is to prevent continual apprehension, yet every parent seeks to avoid this outcome for their children. It’s about striking a balance between raising awareness and informing individuals about the consequences of these conditions, encompassing even uncommon events. This represents our present task. In my perspective, information stands as the sole remedy.

NL: The book also accentuates a route toward global vaccine equity. In your judgment, what are the greatest impediments to reaching that objective?

SB: Firstly, the ideas we’ve discussed are related to understanding the value of immunization, which is essential to individuals everywhere. It’s also imperative to retain that understanding regardless of how rare the diseases are.

The next fundamental matter involves having accessibility to vaccines. By combining the purchasing capabilities of many nations, Gavi could decrease the price [of regular vaccines] by 98% compared to prices in the United States, rendering them cost-effective. Although vaccines are financially viable even at higher costs, affordability is certainly preferable. As such, ensuring the products’ availability and ensuring production matches necessary quantities is essential.

The third portion requires having distribution mechanisms available, which is where we see challenges. As noted previously, vaccines are the most commonly issued health intervention, and approximately 90% of families worldwide gain entry to routine vaccines. … Reaching [the final 10%] by the established system serves not only in offering vaccines but also in delivering health access, and it builds an alert system to guarantee the provision of health workers for all. This facilitates monitoring outbreaks or emerging unusual diseases and reporting those findings.

Finally, I believe it is imperative to have comprehensive monitoring of new infections worldwide. Emerging outbreaks and pandemics are evolutionarily inevitable, and that alert system is crucial for everyone in the world. Establishing this cost-effective prevention system is worthwhile and a matter of giving prevention the needed priority.

NL: I wish to revisit the thought that epidemics and pandemics are unavoidable. Understanding this, how ought we prepare?

SB: Epidemics are definitely unavoidable. The initial step involves preparation for known events such as the flu, COVID, and hemorrhagic fevers, all of which can be treated by currently available interventions. How do we assure global readiness by creating a network of laboratories, maintaining vaccine stockpiles, and having scalable production potential?

Sadly, much of this infrastructure is being disassembled. [The United States] is currently laying off employees at key health agencies, withdrawing from the World Health Organization, and modifying development assistance by cutting scientist training programs. We are tearing down the existing systems that are vital in managing known threats, which poses a serious issue.

Transitioning to the “unknown unknowns,” we also want the related science prepared in advance. The choice to abandon mRNA vaccines is a recent instance of this. [HHS has recently ceased funding mRNA vaccine research and development.] mRNA vaccines are not necessarily optimal or even appropriate for every condition; nevertheless, these platforms enable rapid development because of their quick genome-based creation. Subsequently, vaccines can be, in essence, “printed” and increased in scale efficiently.

In scenarios involving pandemics with elevated mortality rates, the optimal response entails constructing an mRNA vaccine for management. We shouldn’t cease advancing and refining the mRNA platform, but, instead, the ongoing elimination of research seems exceptionally unwise to me.

NL: To further discuss mRNA, do you think vaccine speed is the highest priority in an outbreak setting? Or can the mRNA platform provide other advantages?

SB: The greatest advantage is its speed. Remember, COVID had a mortality rate near 1.5% to 2%. Other conditions that might emerge could present mortality rates within 20% to 50%. In a case like that, involving a respiratory disease that has a high mortality rate, time will be of the essence.

The mRNA procedure is the most efficient. … Subsequent to creating mRNA vaccines, it is plausible to transition toward other types of vaccines that could yield prolonged protection or enhance immune responses [in relation to a specific pathogen]. These latter types, however, can’t be developed at the same speed, therefore, it becomes a handoff process.

A concern that emerged with COVID entailed the construction of over 200 vaccines; nevertheless, given mRNA’s quick output, other vaccine types couldn’t gain widespread use. Novavax, a protein-based vaccine, experienced limited circulation despite its safety, reliability, and possibly prolonged safeguards.

How do we introduce rigorous comparative science to find the most effective products in that setting? The pharmaceutical division is disincentivized from performing head-to-head studies; thus, these tasks will have to be delegated to global bodies or governments.