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Access to COVID-19 Tools Accelerator

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The Access to COVID-19 Tools Accelerator (ACT Accelerator or ACT-A), or the Global Collaboration to Accelerate the Development, Production and Equitable Access to New COVID-19 diagnostics, therapeutics and vaccines, is a G20 initiative announced by pro-tem Chair Mohammed al-Jadaan on 24 April 2020.[1] A call to action was published simultaneously by the World Health Organization (WHO) on 24 April.[2] As of January 2022, it was the largest international effort to achieve equitable access to COVID-19 health technologies.[3]

Definition

The ACT Accelerator is a multinational collaboration, and multistakeholder initiative including the World Health Organization, the Coalition for Epidemic Preparedness Innovations (CEPI), FIND,[4] GAVI the Vaccine Alliance,[5] the Global Fund, UNICEF, Unitaid, Wellcome, the World Bank and governments, to raise financial support of accelerated research and development, production, and globally-equitable access to COVID-19 tests, therapies, and vaccines.[6][7] It is a framework for collaboration, not a new organization or a decision-making body. In March 2020, G20 leaders had called for a cross-discipline support structure to enable partners to share resources and knowledge and in April 2020 it was launched by WHO, European Commission, France and the Bill & Melinda Gates Foundation.[8] On 24 April 2020 pro-tem Chair Mohammed al-Jadaan announced it,[1] simultaneously to the WHO.[2] Sir Andrew Witty and Dr Ngozi Okonjo-Iweala accepted to act as Special Envoys to the ACT Accelerator from the WHO.[9]

The ACT Accelerator comprises four pillars, each managed by two to three collaborating partners:1) Vaccines (also called "COVAX" pillar), 2) Diagnostics, 3) Therapeutics and 4) Health Systems Connector.[10] Diagnostics are the most important medical technology available to monitor and control the spread of COVID-19,[10][11] to avoid repeated lockdowns, which threaten economies and ways of life.[11] Testing supports healthcare services to be managed and COVID-19 transmission to be suppressed.[10][11] The therapeutics pillar is a research effort to discover and develop promising COVID-19 drug development for COVID-19 infection and illness. It involves monitoring over 1,700 clinical trials, and was part of the effort to provide dexamethasone for up to 2.9 million patients in low-income countries and facilitates future access to monoclonal antibody therapies in low- and middle-income countries.[10] The pillar for health systems analyzes needs and resources in some 100 countries to identify problems, capacity, and requirements for access to and implementation of COVID-19 tools across world regions.[10] The COVAX pillar has the goal of facilitating licensure of several COVID-19 vaccines, influencing equitable pricing, and providing equal access for up to 2 billion doses by the end of 2021 to protect frontline healthcare workers and people with high-risk of COVID-19 infection, particularly in low-to-middle income countries.[12][13]

Coalition for Epidemic Preparedness Innovations

In 2017, a multinational organization named Coalition for Epidemic Preparedness Innovations, CEPI was formed. It is working with international health authorities and vaccine developers to create vaccines for preventing epidemics.[13]

Over 2020 throughout the pandemic, CEPI funded the development of nine COVID-19 vaccine candidates in a portfolio deliberately made diverse across different vaccine technologies to minimize the typically high risk of failure inherent in vaccine development.[14][15] As of December 2020, CEPI supported the vaccine research organizations and programs of AstraZeneca/University of Oxford (AZD1222), Clover Biopharmaceuticals (SCB-2019), CureVac (Zorecimeran/CVnCoV), Inovio (INO-4800), Institut Pasteur (MV-SARS-CoV-2), Moderna (mRNA-1273), Novavax (NVX-CoV2373), SK bioscience (GBP510), and Hong Kong University.[14][16][17] CEPI is an observer of the Global Research Collaboration for Infectious Disease Preparedness (GLoPID-R) which was working closely with the WHO and member states to identify priorities for funding specific research needed for a COVID‑19 vaccine, coordinating among the international funding and research organizations to maintain updated information on vaccine progress and avoid duplicate funding.[18]

Timeline

On 10 September, 2020 the UN and the European Union co-hosted the inaugural meeting of the Facilitation Council of the ACT-Accelerator, which had received $2.7 billion of the $35 billion necessary to secure the 2 billion COVID-19 vaccine doses, 245 million treatments, and 500 million tests that the initiative deemed necessary to end the pandemic and speed economic global recovery.[19] In September 2020, ACT Accelerator partners committed to provide 120 million COVID-19 rapid tests for low- and middle-income countries.[10]

Although the Trump administration of the United States had withdrawn its financial support of the WHO and ACT Accelerator in 2020,[20] the United States reasserted its support of the WHO and COVAX on 21 January 2021 following the inauguration of President Joe Biden.[21]

By December 2020, more than 10 billion vaccine doses had been pre-ordered by developed countries. The manufacturers of three vaccines closest to global distribution – Pfizer, Moderna, and AstraZeneca – predicted a manufacturing capacity of 5.3 billion doses in 2021, which could be used to vaccinate about 3 billion people (as the vaccines require two doses for a protective effect against COVID-19).[22] Due to the high demand in preorders from rich countries for 2021,[23][24] people in low-income developing countries may not receive vaccinations from these manufacturers until 2023 or 2024, increasing the use of the COVAX initiative to supply vaccines equitably.[22][25] Emphasizing the need for broad distribution of safe, effective vaccines against COVID-19, especially across developing countries, GAVI uses the slogan, "No one is safe until everyone is safe."[26]

During 2020, major changes in the overall effort of developing COVID‑19 vaccines were the increasing number of collaborations of the multinational pharmaceutical industry with national governments, and the diversity and growing number of biotechnology companies in many countries focusing on a COVID-19 vaccine.[27] According to CEPI, the general geographic distribution of COVID‑19 vaccine development involves organizations in North America having about 40% of the world's COVID-19 vaccine research, compared with 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.[27]

Financing

In May 2020, the WHO had a telethon which raised US$8.8 billion in pledges from forty countries to support rapid development of vaccines.[28]

As of May 2020 CEPI organized a US$2 billion fund in a global partnership between public, private, philanthropic, and civil society organizations for accelerated research and clinical testing of nine COVID-19 vaccine candidates, with the 2020–21 goal of supporting several candidate vaccines for full development to licensing.[27][14][29] By early May 2020, the United Kingdom, Canada, Belgium, Norway, Switzerland, Germany and the Netherlands had already donated US$915 million to CEPI.[28][30] The Gates Foundation, a private charitable organization dedicated to vaccine research and distribution, was donating US$250 million in support of CEPI for research and public educational support on COVID‑19 vaccines.[31][32]

In December 2020, the Gates Foundation donated another US$250 million to the ACT Accelerator to "support the delivery of new COVID-19 tests, treatments, and vaccines, particularly in low- and middle-income countries" during 2021, making the Foundation's total donation of US$1.75 billion toward the COVID-19 response.[33][34]

As of December 2020, US$2.4 billion had been raised for the overall ACT Accelerator, with nine vaccine candidates being funded by COVAX and CEPI – the world's largest COVID-19 vaccine portfolio – with 189 countries committed to the eventual deployment plan.[14][35] See table above.[36]

National governments contributions

In May 2020, France announced a US$4.9 million investment in a COVID‑19 vaccine research consortium via CEPI involving the Institut Pasteur, Themis Bioscience (Vienna, Austria), and the University of Pittsburgh, bringing CEPI's total investment in COVID‑19 vaccine development to US$480 million by May.[37][38] Belgium, Norway, Switzerland, Germany, and the Netherlands have been major contributors to the CEPI effort for COVID‑19 vaccine research in Europe.[30]

On 4 May 2020, the Canadian government committed CA$850 million to the WHO's live streaming effort to raise US$8 billion for COVID‑19 vaccines and preparedness.[39] On 18 May 2020, China had pledged US$2 billion to support overall efforts by the WHO for programs against COVID‑19.[40]

On 22 July 2020, China announced that it planned to provide a US$1 billion loan to make its vaccine accessible for countries in Latin America and the Caribbean.[41]

On 24 August 2020, Chinese Premier Li Keqiang announced it would provide five Southeast Asian countries of Cambodia, Laos, Myanmar, Thailand and Vietnam priority access to the vaccine once it was fully developed.[30]

Controversies

Inequities

COVAX is designed to assist vaccine purchases and distribution for poor and middle-income countries unable to compete in the open market and avoid inequities for vaccine access.[6][7] However, by December 2020, more than 10 billion vaccine doses had been preordered mostly by high-income countries comprising only 14% of the world's population like the United Kingdom, Canada, and the United States.[42][22] poorer countries, such as South Africa, had difficulty obtaining vaccine deliveries, despite having a factory for making COVID-19 vaccines within the country.[25] Half of South African citizens live in poverty, and may receive a vaccine only by participating as volunteers in clinical trials.[25]

The COVAX administration, governments, and vaccine manufacturers have been criticized for lack of transparency and accountability over fair pricing and equitable allocation of COVID-19 vaccines to developing countries where financial and vaccination resources are limited, and government corruption may exist.[24][25]

Limited transparency of roles and accountability

In examining the founding principles of participation, transparency, and accountability, one study found lacking clarity on the roles and responsibilities of the stakeholders, questions about potential conflicts of interest, unclear accountability with no ACT-A wide accountability framework and receding role of governments.[3]

References

  1. ^ a b "G20 launches initiative for health tools needed to combat the coronavirus". 25 April 2020.
  2. ^ a b "Access to COVID-19 Tools (ACT) Accelerator" (PDF). World Health Organization (WHO). 24 April 2020.
  3. ^ a b Moon, Suerie; Armstrong, Jana; Hutler, Brian; Upshur, Ross; Katz, Rachel; Atuire, Caesar; Bhan, Anant; Emanuel, Ezekiel; Faden, Ruth; Ghimire, Prakash; Greco, Dirceu (29 January 2022). "Governing the Access to COVID-19 Tools Accelerator: towards greater participation, transparency, and accountability". The Lancet. 399 (10323): 487–494. doi:10.1016/S0140-6736(21)02344-8. ISSN 0140-6736. PMID 34902308.
  4. ^ "Home". FIND. Retrieved 28 January 2022.
  5. ^ GAVI the Vaccine Alliance
  6. ^ a b "What is the ACT Accelerator?". World Health Organization (WHO). 2020. Archived from the original on 25 September 2020. Retrieved 29 August 2020.
  7. ^ a b "What is COVAX?". GAVI. 1 September 2020. Retrieved 11 December 2020.
  8. ^ "What is the ACT Accelerator".
  9. ^ "WHO Director-General's opening remarks at the launch of the Access to COVID-19 Tools Accelerator". World Health Organization (WHO). 24 April 2020.
  10. ^ a b c d e f "The ACT-Accelerator: frequently asked questions (FAQ)". World Health Organization (WHO). 2020. Retrieved 16 December 2020.
  11. ^ a b c "Investing in diagnostics to manage the course of the COVID-19 pandemic" (PDF). World Health Organization (WHO). 1 May 2020. Retrieved 16 December 2020.
  12. ^ "COVAX: CEPI's response to COVID-19". Coalition for Epidemic Preparedness Innovations (CEPI). 2020. Retrieved 15 December 2020.
  13. ^ a b "New vaccines for a safer world". CEPI. 2020. Retrieved 15 December 2020.
  14. ^ a b c d "Our portfolio: partnerships to develop vaccines against COVID-19". CEPI. 2020. Retrieved 15 December 2020.
  15. ^ Nick Jackson (28 September 2020). "Why we need a "portfolio approach" to COVID-19 vaccine development". CEPI. Retrieved 15 December 2020.
  16. ^ "CEPI's COVID-19 vaccine portfolio". CEPI. 2020. Retrieved 15 December 2020.
  17. ^ "CEPI and SK bioscience extend collaboration to develop 'next generation' COVID-19 vaccine". CEPI. 9 December 2020. Retrieved 15 December 2020.
  18. ^ "GloPID: Novel coronavirus COVID-19". glopid-r.org. Archived from the original on 2 May 2020. Retrieved 2 May 2020. GloPID-R Members and other major players involved in infectious disease outbreaks worldwide reacted rapidly to this emerging epidemic, working closely with WHO to identify the specific funding research priorities needed to tackle the disease.
  19. ^ "Leaders pledge 'quantum leap' towards fully funding COVID-19 vaccines and treatments". UN News. 10 September 2020. Retrieved 11 September 2020.
  20. ^ Rauhala, Emily; Abutaleb, Yasmeen (2 September 2020). "U.S. says it won't join WHO-linked effort to develop, distribute coronavirus vaccine". The Washington Post.
  21. ^ Stephanie Nebehay (21 January 2021). "U.S., staying in WHO, to join COVID vaccine push for poor nations: Fauci". Reuters. Retrieved 21 January 2021.
  22. ^ a b c Asher Mullard (30 November 2020). "How COVID vaccines are being divvied up around the world Canada leads the pack in terms of doses secured per capita". Nature. doi:10.1038/d41586-020-03370-6. PMID 33257891. S2CID 227246811. Retrieved 11 December 2020.
  23. ^ "COVAX: Ensuring global equitable access to COVID-19 vaccines". Gavi.
  24. ^ a b So, Anthony D; Woo, Joshua (15 December 2020). "Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis". BMJ. 371: m4750. doi:10.1136/bmj.m4750. ISSN 1756-1833. PMC 7735431. PMID 33323376.
  25. ^ a b c d Matt Apuzzo; Selam Gebrekidan (28 December 2020). "For Covid-19 Vaccines, Some Are Too Rich — and Too Poor". The New York Times. Retrieved 29 December 2020.
  26. ^ "Why is no one safe until everyone is safe during a pandemic?". GAVI. 14 September 2020. Retrieved 16 December 2020.
  27. ^ a b c Le TT, Cramer JP, Chen R, Mayhew S (4 September 2020). "Evolution of the COVID-19 vaccine development landscape". Nature Reviews Drug Discovery. 19 (10): 667–68. doi:10.1038/d41573-020-00151-8. ISSN 1474-1776. PMID 32887942. S2CID 221503034.
  28. ^ a b Wake D (4 May 2020). "EU spearheads $8 billion virus fundraiser". Yahoo Finance. Archived from the original on 29 June 2020. Retrieved 4 May 2020.
  29. ^ Yamey G, Schäferhoff M, Hatchett R, Pate M, Zhao F, McDade KK (May 2020). "Ensuring global access to COVID‑19 vaccines". Lancet. 395 (10234): 1405–06. doi:10.1016/S0140-6736(20)30763-7. PMC 7271264. PMID 32243778. CEPI estimates that developing up to three vaccines in the next 12–18 months will require an investment of at least US$2 billion. This estimate includes Phase 1 clinical trials of eight vaccine candidates, progression of up to six candidates through Phase 2 and 3 trials, completion of regulatory and quality requirements for at least three vaccines, and enhancing global manufacturing capacity for three vaccines.
  30. ^ a b c Steenhuysen J, Eisler P, Martell A, Nebehay S (27 April 2020). "Special Report: Countries, companies risk billions in race for coronavirus vaccine". Reuters. Archived from the original on 15 May 2020. Retrieved 2 May 2020.
  31. ^ Sanger DE, Kirkpatrick DD, Zimmer C, Thomas K, Wee SL (2 May 2020). "With Pressure Growing, Global Race for a Vaccine Intensifies". The New York Times. ISSN 0362-4331. Archived from the original on 11 May 2020. Retrieved 2 May 2020.
  32. ^ Hamilton IA (1 May 2020). "Bill Gates thinks there are 8 to 10 promising coronavirus vaccine candidates and one could be ready in as little as 9 months". Business Insider. Archived from the original on 16 May 2020. Retrieved 2 May 2020.
  33. ^ Haley Yamada; Jon Schlosberg; Seni Tienabeso (10 December 2020). "Bill and Melinda Gates Foundation announces $250 million COVID vaccine commitment". ABC News - Technology. Retrieved 11 December 2020.
  34. ^ "Bill and Melinda Gates call for collaboration, continued innovation to overcome challenges of delivering COVID-19 scientific breakthroughs to the world". Bill & Melinda Gates Foundation. 9 December 2020. Retrieved 11 December 2020.
  35. ^ "Global equitable access to COVID-19 vaccines estimated to generate economic benefits of at least US$ 153 billion in 2020–21, and US$ 466 billion by 2025, in 10 major economies, according to new report by the Eurasia Group". World Health Organization (WHO). 4 December 2020. Retrieved 11 December 2020.
  36. ^ "Over US$ 2 billion raised to support equitable access to COVID vaccines with additional US$ 5 billion needed in 2021". Gavi. 13 November 2020.
  37. ^ "CEPI: Our vaccine and platform portfolio". Coalition for Epidemic Preparedness Innovation (CEPI). 30 April 2020. Archived from the original on 7 May 2020. Retrieved 3 May 2020.
  38. ^ "CEPI collaborates with the Institut Pasteur in a consortium to develop COVID-19 vaccine". Coalition for Epidemic Preparedness Innovations. 19 March 2020. Archived from the original on 22 March 2020. Retrieved 23 March 2020.
  39. ^ Aiello R (4 May 2020). "'A global challenge': PM Trudeau commits $850 million to global fight against COVID-19". CTV News. Archived from the original on 10 May 2020. Retrieved 4 May 2020.
  40. ^ Yuliya Talmazan; Keir Simmons; Laura Saravia (18 May 2020). "China's Xi announces $2B for coronavirus response as WHO faces calls for investigation". NBC News. Archived from the original on 18 May 2020. Retrieved 18 May 2020.
  41. ^ Ore D (23 July 2020). "Mexico says China plans $1 billion loan to ease Latam access to virus vaccine". Reuters. Archived from the original on 25 September 2020. Retrieved 16 August 2020.
  42. ^ So AD, Woo J (December 2020). "Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis". BMJ. 371: m4750. doi:10.1136/bmj.m4750. ISSN 1756-1833. PMC 7735431. PMID 33323376.
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