Some of the $2.6 billion that remains in a COVID-19 vaccine delivery scheme, COVAX, could be redirected into investment into investigational vaccine candidates for Marburg Virus Disease (MVD) and Ebola Sudan strain virus, as well as over half a dozen other vaccine programmes that were suspended due to the pandemic or delays in product development, a spokesperson for the Global Vaccine Alliance (Gavi) told Health Policy Watch. COVAX is a COVID vaccine initiative jointly run by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI) co-sponsored by WHO and financed by donations from high-income countries. 92 low- and middle-income countries can participate through COVAX Advanced Market Commitment [AMC], a financing instrument launched by Gavi.

Pilot trials for new MVD and Ebola vaccines were among a series of new investments  approved by the Gavi Board last week, in part with the support of the surplus funds from unused COVID vaccine delivery to low-income countries. 

The board also approved new investments into a hexavalent vaccine which will offer protection against six diseases–- diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenzae type b, and the inactivated polio vaccine (IPV). However, the Board remains committed to making COVID-19 vaccines available to high-risk groups in eligible low-income countries until 2025, a Gavi press statement underlined. 

Restarting programmes in new vaccinations 

The agency is also taking advantage of the lull in COVID vaccine demand to restart programmes introducing approved vaccines against hepatitis B, DTP boosters, a post-exposure prophylaxis for rabies, maternal RSV, and a multivalent meningococcal conjugate vaccine. 

“Decisions taken by our Board will help countries fight disease more cost-effectively, be better equipped to fight back against emerging threats and continue to protect those most at risk from COVID-19,” said Professor José Manuel Barroso, chair of the Gavi Board. He said the decisions will bolster Gavi’s record as “an innovator and a disrupter in global health.”

“The next steps in this process are to continue working with Alliance partners, particularly the WHO, UNICEF and countries to create timelines, technical guidance for introduction of these new products, and outline the parameters of these new programmes,” the press statement added. 

In its meeting, the Board also approved a long list of vaccines to be considered in the agency’s next vaccine investment strategy, which is expected to be finalized in 2024.

Those include licensed or pipeline products against hepatitis E, Mpox, dengue, COVID-19, tuberculosis, group B streptococcus, chikungunya and shigella. 

Investment in the global stockpile of vaccines

The Gavi board described its allocation to global stockpiles of vaccine candidates against MVD and Ebola Sudan virus as a  “time-limited investment”, pending recommendations by “scientific expert groups”.  

“The concept of Global Virtual Pool Inventories (GVPIs) is to establish small reserves of investigational vaccine candidates, which would be ready for use [condition] in the event of an outbreak,” the press statement said.

Opportunities to jumpstart a clinical trial of vaccine candidates for Ebola Sudan Virus were missed late last year because it took time to get the vaccines into place in Uganda, at which point the outbreak was already in decline, and was finally declared over in early 2023.

In early 2023, 2000 doses of MVD vaccine candidates were made available for administration as part of a planned “ring trial” among those diagnosed with the disease during the recent outbreak in Africa. 

However, the WHO couldn’t proceed with the trials due to lack of sufficient participants, followed by the eventual declaration that the MVD outbreak was over in late March. 

There are no global stockpiles of vaccines for MVD and Ebola Sudan virus at present, partly because the vaccines have not been approved by regulators. But experts have emphasized that having stockpiles available and ready for more rapid deployment could facilitate trials that demonstrate vaccine efficacy – or lack thereof. 

Image Credits: WHO.