Organizers say they have no plans to “sunset” the support they offer countries through the Access to COVID-19 Tools (ACT) Accelerator, the global partnership to facilitate equitable access to COVID-19 tests, treatments, and vaccines.

The ACT-A, however, will undergo a “transition” when its strategic plan and budget ends in September, according to the World Health Organization’s (WHO) Dr Bruce Aylward, who represents the global body at the ACT-A.

Its COVID-19 response will likely be incorporated into the usual work of key ACT-A partners, including Gavi, the global vaccine alliance, which is a co-leader of COVAX, the vaccine arm of the ACT-A.

COVAX also is co-led by WHO and the Coalition for Epidemic Preparedness Innovations (CEPI), alongside key delivery partner UNICEF.

Aylward told a media briefing on Wednesday that ACT-A’s work to enhance equitable access to COVID-19 tools will continue, since the pandemic hasn’t ended.

“As countries are moving from managing COVID-19 as an acute emergency to integration into longer-term disease control programmes, the ACT-Accelerator partnership is adjusting its ways of working,” he said.

A Gavi spokesperson told Health Policy Watch that COVAX partners and other ACT-Accelerator organizations, mindful of the need to prepare the global health response for future pandemics, “are looking at how to transition temporary emergency response structures into an integrated approach that builds COVID-19 and pandemic preparedness and response capacity into existing global health architecture”.

Though WHO hasn’t changed its designation of COVID-19 as a pandemic, Dr Mike Ryan, WHO’s head of health emergencies, described it as more of “a series of national epidemics” and stressed that the real work needed to take place at the national level.

Globally, COVID-19 cases have increased by at least 30%, driven by variants BA.4 and BA.5 in Europe and the US, while a new sub-lineage of BA.2.75 is rising in India, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing.

ACT-A transition plan

Aylward indicated there is little appetite among ACT-A partners to develop another strategic plan.

Therefore the focus is on a “transition plan,” he said, to “make sure that this extraordinary collaboration that we’ve put together can continue to operate but in a mode and in a manner that allows us to make sure the core business of the [partner] organisations also gets attention”.

The pandemic’s strain on nations’ resources, financial markets and global supply chains have caused setbacks in key global health programmes, particularly childhood vaccinations and tuberculosis diagnosis and care.

“The ACT-A agencies will not sunset their support to the countries that rely on them for equitable access to these tools,” stressed Aylward. “What we will do is make sure that we work efficiently and effectively to deliver right across our mandates in the longer term.”

At the ACT-A’s Council Meeting, also held on Wednesday, some countries offered their views of what form this transition could take. India’s Dr Vinod Paul, for example, called for ACT-A to become “a long-term institutional mechanism to support countries in future health emergencies”.

Indonesia and South Africa called ACT-A’s evaluation to feed into international discussions on pandemic preparedness. France’s John Valadou, meanwhile, called for an assessment of ACT-A before any decisions were made about its future.

“We should avoid two risks when it comes to global governance,” Valadou said. “We shouldn’t make the existing architecture too complex, and secondly, we should not weaken the central role that should be played by WHO.”

Dr Fifa Rahman, a civil society representative on ACT-A, told the council that her sector looked forward to seeing the transition plans. She endorsed Germany’s call for “some kind of mechanism for coordinating and evaluating the global risk response to COVID”, describing this as essential.

Rahman also called for resources to build more resilient health systems, including community health systems, pointing out that only 14% of community health workers in Africa were paid, while health workers in many countries were grossly underpaid.

She also called for transparency in government procurement of COVID-19 goods during this transition phase. 

Norway’s Ambassador and ACT-A council co-chair John-Arne Rottingen closed the council meeting by noting that “members support a gradual transitioning” of ACT-A.

“We cannot go back to where we were before the pandemic,” he said. “We need to continue coordination and collaboration across the implementing agencies and ACT-A actors. And we also need to use the evaluation and other learning efforts to learn for the future both on the countermeasure side as well as long-term strengthening of health systems, primary health care capacities and supporting the health care workforce.”

Goodwill COVID-19 support does not mean equity

Reflecting on ACT-A’s future, Aylward said “what we’ve learned in this pandemic is that goodwill alone is not enough to get to equity”, which is why a pandemic accord or instrument is important.

And to address future pandemics, he said, more financing is needed to prepare so that low-and middle-income countries can purchase what they need, manufacturers are included, and supply chains keep flowing with the free trade of raw materials and finished products.

“All of this needs to be captured under something like a pandemic accord,” Aylward said. “This is not charity. This is not handouts. This is in everyone’s interest to end pandemics, like the one we’re in the midst of now has been going on much longer than it should have given the science that we had so early in this in this pandemic.”

Image Credits: UNICEF, Gavi .