Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity Seth Berkley Univ. California Press (2025)
Most people don’t like getting vaccines, much less seeing their children have needles poked into their thighs and arms. But context can change that. Besieged by terrifying outbreaks of paralytic polio and the spectre of iron-lung respirators, many parents were happy to see their children receiving the first polio vaccinations in the 1950s. Similarly, when I got my first COVID-19 vaccine, it instantly relieved the sense of existential dread that I had felt for almost a year as the death toll rose.
The radical plan for vaccine equity
Traumatic memories from the pandemic are waning for many. But infectious-disease epidemiologist Seth Berkley thinks the prospect of future pandemics means that it is imperative that we do not forget about the powerful impact of the COVID-19 vaccine. In Fair Doses — a fascinating account of the race to distribute the drug around the world — he attempts to provide readers with a ‘booster shot’ to restore public-health awareness.
Berkley is ideally positioned to tell the story. In 2020, he was the chief executive of global-health organization Gavi, the Vaccine Alliance. In the early months of the COVID-19 pandemic, Gavi, along with the Coalition for Epidemic Preparedness and Innovations and others, co-founded COVAX — a worldwide initiative to access, purchase and deliver billions of doses of safe and effective COVID-19 vaccines to those living in low- and middle-income countries (LMICs). The author rightly spends little time on the science of the vaccine or the disease itself. Instead, his aim is to describe the complex and interwoven financial, legal, practical, ethical and political issues involved in securing and equitably distributing vaccines to more than 140 territories.
These complexities led to a series of challenges for COVAX leaders. As Berkley recalls, “I thought that this time, because of COVAX, we could tackle a pandemic with a meaningful, global commitment to equity. How wrong I was.”
A gargantuan effort
COVAX’s goal was wildly ambitious, especially given the world’s abject failure to distribute influenza vaccines equitably a decade earlier during the 2009–10 flu pandemic. With those flu vaccines, Berkley notes that LMICs were left “at the back of queue”. As he highlights, the drugs arrived too late to prevent a substantial burden of disease — and in some countries, essentially didn’t arrive at all.
Learn from COVID: Gates’s pandemic prescription
By contrast, COVAX was, in many ways, a success. By the end of 2021, more than one billion COVID-19 vaccine doses had been distributed, and two billion had been distributed by the end of 2023. More than half (57%) of the population in the world’s 92 lowest-income countries ended up receiving the one or two doses required (depending on the brand of vaccine) for initial protection, as compared with the global average of 67%. Doses supplied by COVAX are estimated to have averted 2.7 million deaths in low-income countries by the end of 2022.
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