The World Health Organization aims to raise a whopping US $31.3 billion to fund the ambitious goals of the Access to COVID-19 Tools (ACT) Accelerator; a multi-stakeholder initiative that aims to develop and deploy diagnostics, drugs, and vaccines to control the virus.

But so far, only $US 3.4 billion has been pledged towards the initial goals. And US $13.7 billion is ‘urgently needed’ in order to cover immediate needs, according to an investment case released by WHO on Friday.

The funding will go toward:

• Scaling up development and delivery of 500 million diagnostic tests to low- and middle-income countries (LMICS) by mid-2021
• Delivering 245 million courses of treatments to LMICs by mid-2021,
• Delivering 2 billion vaccine doses, of which 50% will go to LMICs by the end of 2021.

“It’s clear that because all people are at risk of COVID-19, all people should have access to all the tools to prevent, detect and treated, not only those who can afford to pay for them,” said World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus at a Friday press briefing. “We have made the principle of equitable access a simple thing to say, but a complicated thing to implement.”

More than 9 million people have been infected, and nearly half a million have so far lost their lives to the virus. The investment required in the Accelerator is less than a tenth of the loss the global economy is facing every month due to the pandemic, according to International Monetary Fund estimates.

“The cost of inaction now is quite important to take into consideration,” said Philippe Duneton, executive director of UNITAID, working with the Wellcome Trust on the therapeutics pillar of the project.

A good portion of the immediate investments will go towards preparing markets to absorb new COVID-19 technologies, setting up demand, manufacturing, and country capacity to roll out any new diagnostics, vaccines, or drugs.

Four Investment Pillars Require Urgent Funding

The ACT Accelerator operates under four main pillars – diagnostics, therapeutics, vaccines, and the health systems connector.

The diagnostics pillar, co-led by FIND and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, aims to avoid 1.6 billion further infections by scaling up access to diagnostics. The pillar requires US $6 billion in the next year, but US $2 billion is urgently needed to begin deploying tests now. Ultimately, 10,000 healthcare workers will be needed.

“The real strategy towards containing the epidemic is through testing, tracing, isolation; and the starting point for that is a very rapid rollout of very large numbers of tests,” said Peter Sands, executive director of the Global Fund. “To underscore the urgency for many lower middle income countries, lockdown is not sustainable. Households don’t have the wherewithal to continue without working, and governments don’t have the ability to compensate for lost income, coupled with the fact that clinical care facilities are extremely limited.”

The therapeutics pillar will focus on accelerating the development and deployment of effective treatments. While no drugs have yet been tapped, the pillar aims to provide 250 million courses of treatment to LMICS in the next 12 months. Some US$11.6 billion is needed in the next year, while US $3.8 billion is needed immediately.

“Of course, as soon as we have a medicine, the situation at the country level will also be a challenge,” said Duneton. “The access to oxygen, for example, is not the same in all countries.”

But “the only way to prevent further transmission [of the virus] and to break that cycle, would be to have an effective and safe vaccine available to people,” said WHO Chief Scientist Soumya Swaminathan. 

The vaccines pillar has an ambitious goal of delivering 2 billion doses by the end of 2021. Seven candidates are currently in clinical trials, but none have yet received regulatory approval. So far, the fastest vaccine to move from lab bench to approval for human use was the Ebola vaccine – which took five years to develop.

“In general, it takes 8 to 10 years for a vaccine to move from when the research begins to when it gets into people. We want to shorten that timeline as short as possible – 12 months, 18 months maximum,” said Swaminathan. “That would be unprecedented, and can only happen through global collaboration.”

The Coalition for Epidemic Preparedness Innovation (CEPI), and Gavi, the Vaccine Alliance, will lead the vaccines pillar alongside WHO, which will provide oversight of regulation, policy and allocation. Some US $18.1 billion is required to safely deliver the vaccine to people in need.

Gavi, through an advanced market agreement under its COVAX Facility, aims to pool purchasing power from nations of all income levels to secure low vaccine prices. Some 950 million doses must be procured by self-financing, upper-middle and high income countries, in addition to the 2 billion doses set aside for lower income countries.

A final pillar, the health systems connector, aims to strengthen the infrastructure and community networks required to deliver tools to people in need. Led by the World Bank, and the Global Fund, the pillar aims to build lab capacity, train staff to safely manage COVID-19, and to use new tools as they are deployed.

Image Credits: Flickr: IAEA Imagebank/Natalia Khurtsidze, PR Manager of the Clinic.