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<~?~Insert art 027_Gate_9780593534489_art_r1> Gavi saves lives. Since its formation in the year 2000, Gavi has helped vaccinate more than 800 million children in 77 countries, with 324 million children being vaccinated in the past five years alone. We see the direct impact in the chart on the right, which shows the reduction in child deaths under age 5 over the same time period. (Gavi Progress Report 2020) The more we got into vaccines, the more I started learning about the science as well as the economics. It wasn't just that poor countries couldn't afford existing vaccines--they also didn't have the market power to demand new vaccines for diseases that primarily affected them. So the foundation started hiring people who were experts in making vaccines (and drugs). I had to learn a lot more about chemistry, biology, and immunology, I've spent countless hours in conversations with scientists and researchers from all over the world, and I've toured more vaccine factories than I can count. In short, I've spent a lot of time learning about the finances and operations of the vaccine industry, and I can say confidently that it is quite complex. That's partly because we've decided as a society that we'll tolerate very little risk when it comes to vaccines. This cautious approach makes sense: After all, you give vaccines to healthy people, and giving them a vaccine that has bad side effects defeats the purpose. (People won't take a vaccine if it's likely to have severe side effects.) As a result, the industry is highly regulated, and vaccines go through a lengthy, rigorous process of being tested and monitored. I'll explain shortly how it differs from the drug-approval process, but here's just one example of how rigorous the process is: If you build a vaccine factory, you have to meet standards that touch on