Devex sat down with the former head of Gavi to discuss the difficult times ahead as the foreign aid landscape drastically changes; what this could mean for the health of the world's population, and where priorities should lie.

The health of the world’s population exists on shaky grounds amid widespread cuts in foreign aid and the U.S.’s withdrawal from global cooperation.

Berkley served as head of Gavi from 2011 to 2023, and now works in advisory roles for organizations, such as the Serum Institute of India, in areas such as vaccines, and other interventions for diseases impacting low- and middle-income countries.

His tenure at Gavi included a tumultuous period where there was extraordinary need for international solidarity and cooperation: The COVID-19 pandemic. This cooperation was present in some ways as countries banded together to create COVAX, the world’s attempt at vaccine equity — which Berkley led. But in other ways, it fell completely flat, including when wealthy countries hoarded vaccines.

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Dr. Craig Spencer, a Brown University School of Public Health professor, discusses the greater implications of Elon Musk's DOGE cuts in the health sector.

Now is the time to continue the momentum towards achieving African vaccine sovereignty. We must work to both increase the continent’s vaccine manufacturing capacity and then develop strategies to promote their uptake.

Five years to the day after the World Health Organization first referred to Covid-19 as a pandemic, the US National Institutes of Health slashed grant funding for projects that aim to understand vaccine hesitancy and promote vaccine uptake. The Covid-19 pandemic and more recent outbreaks of mpox, Marburg and Ebola underline the importance of regionalised vaccine manufacturing to ensure access to vaccines for people in Africa. Yet, without research to inform strategies to improve trust in vaccines and promote their uptake, the gains in manufacturing will not translate to lives saved.

Defunding research that aims to improve vaccine uptake is another historic mistake in what has become a sad litany of health science reversals by the Trump administration. In January 2025, before the funding cuts were announced, leading vaccine researchers from around the world published an article calling for countries to measure the social and behavioural reasons that people choose to get vaccinated or not and to use this information to design approaches to improve vaccine uptake. Heeding this call is now more important than ever to ensure that the vaccines produced in Africa are taken up by those who can benefit from them – otherwise what is the point?

We must work to both increase African vaccine manufacturing capacity and develop strategies to promote their uptake once they are made. Currently, only 1.1% of Africa’s vaccine supply is produced locally. This overdependence on foreign vaccine supplies leaves African people vulnerable. This challenge is heightened by the inequity in access to foreign supplies, a disparity that became especially evident during the Covid-19 pandemic. While the Covid vaccination campaign was the largest and fastest in history, Africa faced significant challenges in access and distribution. By November 2022, almost two years after high-income countries began vaccinating their citizens, only 25% of the people in Africa had been fully vaccinated against Covid-19.

At the beginning of the pandemic, initiatives such as the Covax facility, a global Covid-19 vaccine procurement mechanism, signalled positive steps towards global solidarity for equitable vaccine access. Although this effort was highly commendable, the reality was very different. Gavin Yamey, the director of Duke University’s Center for Policy Impact in Global Health who was involved in the early discussions about Covax, declared that “rich countries behaved worse than anyone’s worst nightmares”. Wealthy countries were first in line to receive vaccines because they were able to place orders for multiple candidates in their early stages of development. Hoarding of these vaccines led to what World Health Organization (WHO) director-general Tedros Ghebreyesus called “vaccine apartheid”, as booster doses of the Covid-19 vaccine were widespread in high-income countries before people in low-income countries had even received a first dose.

Once vaccines are available on the African continent, how can policymakers be sure that the regulatory process for their approval, technical expertise to run clinical trials, and health workforce to administer vaccines are in place to be able to ensure that vaccines reach those who need them? For example, the response to the current mpox public health emergency of international concern has been plagued by delays in authorisation for the vaccine and limited data on the effectiveness of these vaccines in children.

The ongoing challenges with vaccine access in Africa continue to cause preventable loss of life even though it is well established that early access to vaccines in an outbreak can stop a virus in its tracks. Strengthening vaccine manufacturing capacity on the continent will ensure long-term health security across the continent. Promising efforts are already under way that must be supported and expanded, particularly in light of uncertainties surrounding US funding for global health. As of late 2024, there were five African vaccine suppliers in four countries – South Africa (Aspen Pharmacare and Biovac), Senegal (Institut Pasteur de Dakar), Morocco (Marbio) and Egypt (Vacsera) – with scaled facilities that are close to commercialisation. A further 20 suppliers across the continent are in development or awaiting technology transfer.

In 2021, the African Union announced its goal of supporting the African vaccine manufacturing industry to produce more than 60% of the vaccine doses required on the continent by 2040. The Partnerships for African Vaccine Manufacturing was created under the Africa CDC in 2021 to achieve this goal and was expanded in 2024 to include all health products under a new name, the Platform for Harmonized African Health Products Manufacturing. As of June 2024, there are 25 active vaccine projects across the continent. Initiatives such as the WHO’s mRNA technology transfer hub and those supported by the Coalition for Epidemic Preparedness Innovations (Cepi) also have been working to increase African vaccine manufacturing, and fostering vaccine sovereignty.

In 2024, major African-led initiatives were launched to accelerate African vaccine manufacturing. The African Vaccine Manufacturing Accelerator received a $1.2-billion investment, through reallocated Covid-19 funds from other country’s governments and philanthropies, to expand vaccine manufacturing on the continent, Afreximbank pledged $2-billion in support of African Health Products Manufacturing, and regulatory bodies from seven African countries signed a memorandum of understanding to promote a strong, harmonised regulatory system on the continent.

Countries including Rwanda are also setting a strong example. Leveraging a tremendous amount of preparation and partnerships with the private sector and global public health organisations such as Cepi, just 10 days after the outbreak was declared, Rwanda implemented clinical trials of the Sabin mpox vaccine.

Achieving self-reliance in vaccine production in Africa is possible. In combination with continued efforts to understand and promote vaccine uptake, we need whole-of-government approaches that support the growth of vaccine manufacturing on the continent. The ministries of health and finance must work together to develop strategic approaches for preferential procurement practices of regionally produced vaccines. There needs to be harmonisation of the regulatory bodies on the continent with the WHO’s prequalification process – an approval process required for vaccines to be bought by UN agencies such as Unicef – so that safe and effective vaccines can reach populations in need and at scale.

Now is the time to continue the momentum towards achieving African vaccine sovereignty. These efforts will save lives if people have the confidence and trust to take them. DM

Margaret Dunne is a doctoral candidate in the Department of Epidemiology; Thokozani Liwewe a medical doctor and global health professional working with the Ministry of Health, Malawi, and a Game Changers Fellow; Alice Im is a research assistant; Andrea Uhlig is a research associate; Carly Gasca is a project director; and Wilmot James is a professor and senior adviser – all at the Pandemic Center in Brown University’s School of Public Health, Providence, Rhode Island.

The CDC has historically been the backbone of US public health, delivering essential resources, guidance, and disease surveillance to state and local health departments. However, as the agency faces workforce reductions and funding cuts, public health experts warn about the unsettling future of infectious disease preparedness, response efforts, and access to vital health care programs. The consequences of these changes could be catastrophic, jeopardizing our safeguards against outbreaks and public health crises.

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Bird flu is sweeping through egg-laying chickens in the United States at an unprecedented rate. So far in 2025, 30 million layers, as they’re known, have been culled, close to the 38 million killed throughout all of last year: Nearly 10 percent of the country’s annual number of egg-layers have been wiped out. But one of the big questions, as egg prices become a potent political football, is this: Are these shocking infection rates and cull tallies to blame for skyrocketing prices? Or is something else going on?

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Masking up. Distance learning. Social distancing. No one could have predicted the profound changes that followed the World Health Organization’s declaration of COVID-19 as a global pandemic five years ago Tuesday.

Dozens of essential care workers and advocates gathered outside the State House to remember Rhode Island’s nearly 4,500 victims of the pandemic and address the ongoing challenges their field still faces.
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When the virus that caused the COVID-19 pandemic first emerged, many scientists thought it would evolve slowly, like other coronaviruses.

But that was one of the first big surprises from the virus dubbed SARS-CoV-2. It evolved like crazy.

"SARS-CoV-2 so far has probably been even faster than influenza virus, which is really remarkable," says Jesse Bloom, who studies viral evolution at the Fred Hutch Cancer Center in Seattle. "I thought it would undergo some evolution, but the speed at which it's undergone that evolution and the ability it's shown to undergo these big evolutionary jumps is really remarkable."

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On Monday, the Director of the Pandemic Center Jennifer Nuzzo presented a lecture titled “Pandemic-Proofing the Future” at a Presidential Faculty Award Lecture. Five years after a state of emergency was declared for COVID-19 by the World Health Organization, Nuzzo discussed ways we can better prepare for future pandemics.

President Christina Paxson P’19 P’MD’20 opened the event and Nuzzo was introduced by Francesca Beaudoin PhD’16, the academic dean of the School of Public Health.

Nuzzo, who is also a professor of epidemiology, opened her lecture by recognizing the devastating “failures” of the American health care system after nationwide shutdowns left cities, such as New York City, desolate.

“I don’t want to imply that New York was wrong to (shutdown),” Nuzzo told The Herald in an interview after the event. “The fact that it had to come to that was a failure.”

Bird flu has been spreading in North America since late 2021, but recently the situation has taken some concerning turns.

In January, the first person in the US died from bird flu. In February, two more people were hospitalized, and officials detected two new spillovers into cows, indicating the virus is here to stay among livestock and farm workers. The price of eggs has also skyrocketed as bird flu moves through egg-laying chickens.

“The past couple of weeks, it’s all been new plot twists in the H5N1 story,” said Meghan Davis, an associate professor of environmental health at the Johns Hopkins Bloomberg School of Public Health.

People who work closely with wild and domesticated animals should take precautions, such as washing their hands, wearing a face mask while handling sick or dead poultry and cleaning their litter, and monitoring symptoms after contact with animals.

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