A lineup of global health leaders called upon high income countries to join the new global COVID-19 pool, saying that worldwide access to a safe and equitable vaccine is essential to beat the COVID-19 pandemic. 

Speaking at the virtual UN General Assembly (UNGA) side event on Wednesday, the leaders also said that maintaining essential vaccine services, during the pandemic, would help lay the groundwork for rollout of a COVID-19 vaccine. 

“The building back of the routine immunization program is the underlying fundamental that creates the infrastructure on which we will deliver [COVID] vaccines,” said Katherine O’Brien, of the World Health Organization. 

“Rebuilding trust in national immunization programs, maintaining essential vaccination services and ensuring safe and effective immunization campaigns will not only prevent countless deaths, but also lay the groundwork necessary for the deployment of a safe and effective COVID vaccine,” said Xavier Castellanos, under-secretary-general of the International Federation of Red Cross and Red Crescent Societies (IFRC).

The  appeals came days after some 64 high-income countries, including the 27 states of the European Union, Switzerland, Norway and Iceland, formally joined the vaccine pool – being rolled out by Gavi, The Vaccine Alliance along with the World Health Organization to bring down prices and ensure broad vaccine access. 

However, significant holdouts to the vaccine pool include countries such as the United States, Russia and China. 

And some $7.5 billion still needs to be recruited by the end of 2020 to finance the 2021 procurement  and distribution of 2 billion vaccine doses for 92 low-income countries that already participate in Gavi’s bulk vaccine procurement system, said Seth Berkley, CEO of Gavi. While that is still a huge sum, the $7.5 billion that Berkley cited as immediately needed, is still only about one-fifth of the $35 billion WHO said was the global “ask” for COVID-19 vaccines, tests and treatments.  

Keys to COVAX Success – Money & Solidarity 

“COVAX is a global insurance policy,” Berkley said. “We now have an exit plan that can help us avoid the indefensible outcome of only a few benefiting,” he said. “The probability of death from Covid-19 increases with increasing poverty, and we know if wealthy countries buy up the first two billion doses of Covid-19 vaccines instead of making sure they’re distributed in proportion to the global population, then almost twice as many people could ultimately die from Covid-19.”

Xavier Castellanos echoed Berkley’s remarks, saying that the COVAX pool represents an  opportunity “to ensure the Covid-19 vaccine will be allocated fairly and equitably,” not reserved for a privileged few.

“To end the acute phase of the pandemic, the vaccine must be available everywhere it is needed, not only where it can be afforded. None of us will be safe until we are all safe,” said Castellanos. “Ensuring fair allocation and timely delivery to all who need [a vaccine], especially the most vulnerable, is the greatest challenge that we are facing.”

Pharma needs to play role in ensuring wide global distribution 

“We need a commitment from [pharmaceutical companies] to make sure that we are able to supply globally and not just to the highest price payer,” Berkeley stressed. 

He was referring to unilateral plans by some countries, including the United States, to eschew the COVAX Facility initiative and pre-purchase large quantities of vaccines on their own. 

Participation of high- and middle-income countries in the pool is critical to increase the volume of vaccine orders and thus keep prices manageable. However, donor aid will still be required to finance the purchase of vaccines for some 92 low-income countries outright, or at greatly reduced prices.

Health Leaders Warn That Battling Stigmatization and Rebuilding Trust Also Key to Rollout 

Panelists also underlined the need to overcome the stigmatization and fear that arises from misinformation about the pandemic, and building trust in health systems.  

The calls also followed WHO/Europe warnings that the SARS-CoV-2 virus is resurging in the region, following the reopening of borders and several tourism hotspots. Countries have doubled back with even stricter quarantine and restriction measures for this second wave. Elsewhere in the world, many low and middle income countries across South East Asia, Latin America, the Middle East and Africa continue to battle against infection resurgence or steadily increasing rates.  

Questions were also raised about how COVAX would ensure that migrants, displaced persons and other non-citizens could be reached by a COVID vaccine. 

Dr. Asha Mohammed, secretary general of Kenya’s Red Cross Society, predicted that there would be big challenges in providing access to a COVID-19 vaccine to such groups; nomadic populations such as Kenya’s highly mobile pastoralists are also likely to be challenging. Cultural and religious beliefs also could pose a threat to the acceptance and access of immunization within these communities, and more broadly, she said.

Berkley said, however, that many migrants and displaced populations are already counted among the vaccine-eligible population in countries that receive subsidized vaccines from Gavi, and would be “taken care of by the advanced market commitment mechanisms.” Plans are being made to ensure delivery to such groups, even if  they are excluded from national plans, he said.  

Joyce L. Kilikpo, Executive Director of the Public Health Initiative, Liberia,  highlighted the parallels between the Ebola response in Liberia and the current COVID-19 pandemic, which has left an enormous impact on the Liberian health system. Widespread misinformation has kept families from taking their children to healthcare facilities in the COVID period. Immunization campaigns such as the one for measles have been suspended, leaving children vulnerable. There has also been a disruption in other essential healthcare services for women and children, which was exactly what she witnessed on the frontlines of the Ebola outbreak.

“We need a robust and continuous investment in the healthcare system,” Kilikpo advised. This would require investment in the health workforce, primary health care infrastructures, planning and monitoring systems.

But strong community engagement is the underlying key, according to Kilikpo.

“After all is said and done, and we have the system working, we need the community to make use of it,” she said.

Image Credits: Flickr: Jernej Furman.