Seth Berkley, former CEO of Gavi, the Vaccine Alliance, recounts the inside story of efforts to expand COVID-19 vaccine access in his new book, Fair Doses, and lays out lessons for doing better next time.
The idea for COVAX began in Davos on January 23, 2020, when Berkley and colleagues at the World Economic Forum discussed how to ensure that any successful vaccine would be available to all countries regardless of wealth. With no funding, staff, or formal mandate, they sketched a mechanism to pre-purchase vaccine candidates and distribute doses equitably by population. That concept evolved into COVAX.
COVAX required countries to commit funds up front to buy vaccines that might never work — a risky but necessary approach in a fast-moving pandemic, backed by earlier investments in coronavirus research and the rapid promise of mRNA technology. The first COVID vaccine was authorized in the U.K. on Dec. 8, 2020; COVAX delivered its first doses to a low- and middle-income country 39 days later in India and to African nations 43 days later in Ghana and Côte d’Ivoire.
From 2021 to 2023 COVAX distributed roughly 2 billion doses to 146 countries. In the 92 poorest countries, primary-dose coverage reached about 57%, versus about 67% globally — a major improvement for many people but short of true equity. Berkley calls COVAX the fastest and most equitable vaccine rollout in history, while conceding it fell far short of its aims.
Major obstacles emerged: vaccine nationalism as wealthy countries bought large shares of available supplies; export bans and production disruptions; and strained supply chains. A pivotal setback came in spring 2021 when a Delta surge in India prompted the Serum Institute of India — a key global manufacturer and COVAX supplier — to halt exports and prioritize domestic needs. That and other disruptions left COVAX roughly 600 million doses short. Berkley argues COVAX had negotiated a broader portfolio than many critics acknowledged, and the shortages were driven largely by hoarding by richer countries and by export and production constraints.
Berkley draws several lessons for future pandemic preparedness. First, financing must be available on day one so a global mechanism can enter procurement queues and secure deals; Gavi now keeps about $500 million in capital for that purpose. Second, preparedness relies on networks — coordinating WHO, UNICEF, the World Bank, civil society and others — rather than expecting a single institution to do everything. Third, manufacturing capacity needs geographic diversification: during COVID-19 Africa produced under 0.1% of vaccines, so building local facilities is important, although local production alone does not guarantee equitable distribution across many countries.
He warns that political attention and readiness have waned since the acute phase of the pandemic. Cuts to pandemic-focused teams and foreign aid, and reductions in institutional support, have weakened global preparedness. Berkley highlights the growing challenge of misinformation and disinformation — spread not only by foreign actors but also by influential domestic figures — and says that countering it requires engagement by trusted local voices: doctors, nurses, community and religious leaders. That task becomes much harder when national leaders undermine public-health messaging.
On communication, Berkley urges a combination of science and humility. Early guidance should reflect the best available evidence while clearly acknowledging uncertainty and the reasons for changes as knowledge evolves. Transparent, consistent explanations of why recommendations shift are essential for preserving public trust.
Fair Doses is both a record of what COVAX achieved and a critique of the global responses that limited its impact. Berkley’s prescription for the next pandemic centers on sustained political will, pre-positioned financing, coordinated international networks, expanded and diversified manufacturing capacity, and clearer, more humble public communication — all aimed at making vaccine access genuinely equitable in the future.