Okonjo-Iweala: Access To COVID-19 Vaccines ‘Not Just Moral Imperative – It Is A Strategic And Economic One’ Medicines & Vaccines 09/02/2021 • Madeleine Hoecklin Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Ngozi Okonjo-Iweala – poised for election next week as Director General of WTO. In her first major public statement since the United States signaled that it would approve her candidacy for Director-General of the World Trade Organization (WTO), Ngozi Okonjo-Iweala highlighted the need for rich countries to step up their financial contributions to ensure equitable access to COVID-19 tools. Okonjo-Iweala was the keynote speaker on Tuesday at the fourth meeting of the Access to COVID-19 Tools (ACT) Accelerator Facilitation Council, where a new burden sharing agreement to recruit more funds from donor countries to fill a $27 billion funding gap was announced. The Council needs the money to rollout key components of the ACT’s flagship project, COVAX, the global vaccine distribution facility, as well as parallel initiatives to ensure global access to COVID-19 tests and treatments. Okonjo-Iweala’s appointment as the first woman and first African DG of the WTO is likely to be confirmed next week; WTO members are now set to reconvene Monday – following the shift in the US position, which had been the sole outstanding obstacle to her election last December. As she takes over the helm of the WTO, Okonjo-Iweala will have to negotiate a thorny course in a heated COVID-related debate among trade delegates. Low- and middle-income countries, led by South Africa and India, are seeking WTO approval for an “IP waiver” on all COVID-related health products, for the duration of the pandemic – while rich countries that have opposed the move. In her comments before the council, Okonjo-Iweala, steered a middle course during the meeting, calling for greater equity in vaccine distribution and more donor funding to support the global COVAX facility and other ACT Accelerator initiatives co-sponsored by WHO and a range of other UN agencies and public-private partnerships. Okonjo-Iweala is currently the WHO Special Envoy for the ACT Accelerator, which was established in April 2020. Echoing the message conveyed by Dr Tedros Adhanom Ghebreyesus, WHO Director General, in his opening remarks, Okonjo-Iweala emphasised the current inequity in the global vaccine rollout, with people in over 60% of high-income countries being vaccinated, while only a handful of low-income countries have received doses so far. The COVID-19 vaccination doses administered globally per 100 people, as of 8 February 2021. “If we want to stop this pandemic from spreading and mutating, we need to change the way this map looks as fast as we can,” Okonjo-Iweala said, referring to the map of the administered COVID-19 vaccines per 100 people in the population. We Cannot Delay The Rollout Of Tools “We cannot delay the rollout of tools around the world. Equitable access to COVID-19 tools is not just a moral imperative, as Dr. Tedros said, it is a strategic and economic one as well. Global solidarity is the fastest, most effective way to defeat the pandemic,” declared Okonjo-Iweala. She praised the the ambitious ACT Accelerator initiative as the “fastest, most coordinated and successful global effort in history to develop these tools to fight the disease.” However, the initiative is plagued by “persistent underinvestment in global solutions and increasing bilateral action,” which undermines the ability of the COVAX facility to procure vaccines for participating countries, including the world’s poorest countries, at an affordable price, she noted. “Governments everywhere are under immense pressure to secure doses for all of their citizens. Many cannot afford the bilateral deals, others are still seeking them, and some have secured more doses than their populations require. Solving these problems requires all of us to come together to find solutions,” Okonjo-Iweala said. “Given the contraction in available official development assistance, many more countries will have to bite the bullet and find sustainable ways to finance and co-finance COVID-19 tools, including through multilateral development banks,” she added. Countries participating in COVAX are prepared to begin receiving doses and COVAX is prepared to start distributing the vaccines, having already released an interim distribution forecast for the first and second quarter of 2021, however, adequate supplies of the vaccines may not be available to meet the needs of countries. “The ACT Accelerator’s COVAX vaccines facility is poised for the fast track distribution of two plus billion doses of internationally recognised safe, effective, and quality assured vaccines across 109 participating countries and economies. And countries are ready…However, there are challenges,” said Okonjo-Iweala. “Countries, manufacturers, regulators, civil society, and actors in the multilateral system all have a role to play to ensure that vaccines reach people in all countries, prevent infection and end this pandemic everywhere….This is why we’re here today,” Okonjo-Iweala added. Pharmaceutical Companies Dedicated to Ensuring Equitable Access to Vaccines Meanwhile, the CEO of AstraZeneca, Pascal Soriot, also appearing at the meeting, said he believed the company’s vaccine can remain a critical anchor of the global COVAX effort to roll out vaccines in low- and middle-income countries – despite the poor initial showing the AstraZeneca vaccine has made in stopping mild and moderate disease from a SARS-CoV2 virus variant that first emerged in South Africa. “Our commitment as a company to supply COVAX, together with our collaboration with the Serum Institute of India, who are developing the vaccine together with us, means that over 300 million doses of the vaccine could be made available to 145 countries in the first half of this year, subject to regulatory approval,” said Soriot. The AstraZeneca vaccine is one of the backbones of the global initiative, with the largest commitment of vaccine volumes to COVAX so far. Pascal Soriot, CEO of AstraZeneca, at the ACT Accelerator Facilitation Council meeting on Tuesday. “Our supply to COVAX means that on average 3% of people in these countries will receive the vaccine. And I’m really proud to say that 61% of our projected supply for COVAX during this period of time is due to go to low and middle income countries,” said Soriot. On Sunday, however, the vaccine’s image in Africa suffered a major blow as South Africa announced that it was putting the rollout of the Oxford/AstraZeneca vaccine on hold due to data showing low efficacy against the B.1.351 variant that has been spreading in the country. Soriot stressed, however, that the vaccine still should be able to protect against severe disease. A recent study in Great Britain has also been encouraging, suggesting that the AstraZeneca vaccine may not only prevent disease in those who are immunised, but also reduce virus transmission to others by as much as two-thirds. “Right now it is essential that vaccines continue to be administered to as many people as possible,” as the benefits of vaccines far outweigh the risks of their potential lower efficacy against the new variants, said Soriot. “We will never fully stop COVID-19 until everyone everywhere has access to an effective vaccine. The need to bring COVID-19 vaccines to the world equitably has become even more pressing in recent weeks as we see more infectious strains of the virus emerge in multiple countries and spread rapidly across the world,” said Paul Stoffels, Chief Scientific Officer at Johnson & Johnson, who also appeared at the meeting. While pausing the rollout of AstraZeneca, South Africa is accelerating its plan to vaccinate people with the J&J vaccine, which showed reasonable efficacy against the B.1.351 variant in recently reported Phase 3 trial results. “Since day one of our program we have been committed to bringing an affordable COVID-19 vaccine on not-for-profit basis for emergency pandemic use,” said Stoffels. Paul Stoffels, Chief Scientific Officer at Johnson & Johnson. As part of the Johnson and Johnson commitment, the company has pledged to provide up to 500 million doses of its single-dose vaccine to low income countries through COVAX in an agreement signed with GAVI, The Vaccine Alliance, in December of last year. “Beating COVID-19 will require constant surveillance, continued innovation, including potential boosters development, and all the new vaccine strategies and close partnerships between government and vaccine makers. Only through innovative collaboration fueling new ideas, well planned implementation of equitable approaches, as well as constant vigilance and a sense of urgency will the world beat COVID-19,” said Stoffels. Council Discusses New “Burden Sharing” Arrangement To Prod Donors To Fund Budget Gap Meanwhile, the Council discussed the refined financing framework, which included a burden sharing mechanism, and the updated priorities and strategies for the ACT Accelerator for 2021. In light of the successes in the development of vaccines, diagnostics, and therapeutics, as well as the evolving knowledge about the necessary measures to combat COVID-19 globally – informed by the spread of virus variants and the increasing fragmentation of international collaboration – the ACT Accelerator launched its ‘refreshed’ strategy on Tuesday. The four new strategic priorities for the ACT Accelerator in 2021. For 2021, the four core priorities of the ACT Accelerator are: rapidly scaling up the doses available for vaccinations, particularly for the COVAX facility; bolstering R&D to address the virus variants; stimulating the uptake of tests and therapeutics in low- and middle-income countries; and ensuring a robust supply pipeline is established to deliver essential tools to low- and middle-income countries. In addition, new and existing financing sources were evaluated through the Council’s finance working group to develop a robust financing framework to ensure the promise of ACT Accelerator is realised. The funding commitments to the ACT Accelerator currently total US$6 billion, with the United Kingdom, Canada, Germany, and the Diagnostics Consortium for COVID-19 contributing the most. An additional US$4 billion is projected in funding. The ACT Accelerator is facing a US$27.2 billion funding gap, of which US$19.2 billion is needed from high-income and upper middle-income countries to fully finance the initiative, according to John-Arne Røttingen, Ambassador for Global Health for the Norwegian Ministry of Foreign Affairs and a member of the Council’s finance working group. “We are gravely concerned that the current ACT Accelerator’s funding gaps will impede global equitable access to these products and ultimately delay the end to the crisis everywhere,” said the Council co-chairs, Zweli Mkhize, South Africa’s Minister of Health, and Dag-Inge Ulstein, Norway’s Minister of International Development, in a statement released in December. The new financing goals and needs to close the funding gap for the ACT Accelerator, presented at the Council meeting on Tuesday. To recruit funding to fill this gap, a burden sharing framework was developed to determine contribution based on GDP and the level of openness of the economy, with a greater proportion of income paid by richer countries. Countries are then categorised into different ranges of contributions. A preliminary illustration of what this grouping of countries may look like was introduced at the meeting. While the burden sharing mechanism is not yet fully developed, officials hope it could lead to a rise in contributions. The grouping of countries under the new burden sharing mechanism proposed by the financial working group of the ACT Acceleration Facilitation Council. “This is a joint responsibility. We really need to have a framework for splitting the bill responsibly…not based on an old model of donations from a few, but on a new model of collective contribution from a much larger group of countries,” said Røttingen. “This is solidarity in action.” “We really hope that now countries, hopefully, will increase the contributions in the weeks and months to come [and] they will actually link this to a framework of fair financial contributions from everyone,” he added. Member states were largely supportive of the financing framework launched on Tuesday. “We are currently considering additional contributions and urge all partners, especially other G20 countries to step up their support for ACT A,” said Germany’s delegate. “In addition, we would welcome stronger involvement of the private sector…We have to work together to close this acute funding need.” “From the UK, we welcome the new and prioritised strategy and the budget for 2021 and we must continue to optimise international and domestic resources,” said the UK’s representative. “For the UK’s G7 presidency, we are going to work with fellow G7 nations to drive an ambitious health agenda that exactly reflects these principles…on equitable and affordable access.” Similarly, Italy, which will hold the G20 presidency in 2021, “stands ready to mobilise the political support needed for the ACT Accelerator and the COVAX facility to deliver concretely on the commitments undertaken within the G20 almost a year ago,” said Italy’s delegate. Bruce Aylward, Senior Advisor to the WHO Director General and lead for the ACT Accelerator, thanked member states for their “strong endorsement for the vision…in the strategic plan and budget for 2021. It sounds like that plan is right, the priorities are right and the budget is necessary,” he said. Bruce Aylward, Senior Advisor to the WHO Director General and lead for the ACT Accelerator. Aylward also expressed gratitude to Japan for its announcement of additional contributions, and to the “UK and Italy, who committed their presidencies of the G7 and the G20 respectively to take forward the ACT A agenda.” Success of ACT Accelerator and COVAX Threatened Meanwhile, Dr Tedros warned of the significant challenges and threats to both the ACT Accelerator and the COVAX facility. “We have created a dose-sharing mechanism, set up rapid processes for the emergency use listing, set up indemnification and no-fault compensation mechanisms and completed readiness assessments in almost all AMC countries,” said Dr Tedros at the Council meeting. However, while progress was made, the success of COVAX and the ACT Accelerator is threatened by the $27 billion financing gap, countries signing bilateral vaccine deals that compete with COVAX contracts, and current disruptions in vaccine manufacturing processes. Tedros called on countries to donate vaccines and share doses instead of vaccinating lower-risk groups and called for pharmaceutical companies to establish partnerships to develop manufacturing capacities and deal with production obstructions. “We need an urgent scale-up in manufacturing to increase the volume of vaccines. That means innovative partnerships including tech transfer, licensing and other mechanisms to address production bottlenecks,” said Dr Tedros. Dr Tedros Adhanom Ghebreyesus, WHO Director General. Brazil’s delegate followed up on Tedros’ point and called for the Council to “move beyond principles and…talk about how to make vaccines available to everyone everywhere,” by expanding local vaccine production using licensing and coalition building. Norway also expressed its support for using technology transfers and voluntary licensing to increase the global production capacity and stressed the importance of the equitable pricing of products. “We call on pharma companies to implement pricing strategies that take countries’ different levels of ability to pay into account. Companies should agree cost plus prices with the COVAX facility for the countries eligible for the advanced market commitment,” said Norway’s delegate. Additionally, taking a step to address the funding gap, Tedros “call[ed] on OECD and DAC countries to commit a proportion of stimulus financing to close the funding gap, and to take measures to unlock capital in multilateral development banks.” Shift in US Role On Council The United States announced at the Council meeting that it would shift its role from observer to participant in the Council, making a commitment to multilateralism that follows its decision to rejoin the WHO and take part in COVAX. This move was widely acknowledged and well-received by member states. “As President Biden expressed on his first day in office, the United States will partner with the WHO and the entire UN system to respond to COVID-19, improve global health and health security, and build a better future for all people,” said the US’ delegate. I welcome the United States of America to the @ACTAccelerator. We’re glad to have your support and involvement, and we look forward to your partnership in ensuring that all countries enjoy #VaccinEquity, diagnostics and therapeutics against #COVID19. #ACTogether https://t.co/MVddmvodlx — Tedros Adhanom Ghebreyesus (@DrTedros) February 9, 2021 “I would like to begin by welcoming the United States of America to the ACT Accelerator,” said Dr Tedros in his opening remarks. “We’re glad to have your support and involvement, and we look forward to your partnership in ensuring that all countries enjoy equitable access to vaccines, diagnostics and therapeutics against COVID-19.” Image Credits: World Bank Photo Collection, WHO, Our World in Data. Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. 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