The WHO-led pandemic response coalition plans to focus on the countries worst hit by inequities in COVID-19 resources. Ann Danaiya Usher reports.
On the eve of the G20 summit in Rome, WHO appealed to the governments of high-income countries to provide at least US$23 billion for the Access to COVID-19 Tools Accelerator (ACT-A) to help low-income countries control the pandemic. “We would be happy to see G20 countries begin to announce the first new pledges this weekend”, an ACT-A spokesperson said on Oct 29. But the G20 made no financial commitments. Instead, a communiqué from the summit referred to WHO's goals of vaccinating 40% of people in all countries by the end of 2021, and 70% by September, 2022, and promised to set up a task force on pandemic preparedness, which will convene before the end of the year. Oxfam accused the G20 of an “abysmal and total failure of leadership”.
ACT-A—a loose coalition of organisations, including WHO, Gavi, the Global Fund, UNICEF, and the Bill & Melinda Gates Foundation—has struggled to meet funding targets over the past year. The first ACT-A budget was for $33 billion, but donors contributed only about half the amount, leaving huge funding gaps especially for tests, medical oxygen, and personal protective equipment.
A new strategy, launched on Oct 30, covers the period up to September, 2022, and will cost $23·4 billion. Its investment case calls for a shift in focus to the countries worst hit by inequities in access to COVID-19 tools. ACT-A now aims to “[close] gaps in access…especially in countries that are not on track to meet the global coverage targets to achieve an end to the acute phase of the pandemic” the strategy states.
Andrea Taylor of Duke University welcomes this shift. “It is encouraging to see the ACT-A strategy pivot, in response to evidence on how the model is and is not working”, she said. “We now have deep and growing gaps in access to vaccines, oxygen, and diagnostics, which put all of us at higher risk. The new strategy starts from a realistic assessment of where we are and targets vulnerable populations specifically.”
Most of the funding provided by donors this past year has been directed towards vaccines. The strategy draws attention to an even wider gap in access to tests and emphasises the need to support “the full suite of COVID-19 countermeasures.” $14 billion are to be spent on procurement of 600 million additional doses of vaccine and 1 billion COVID-19 tests with the aim of advancing testing rates to a minimum of 100 tests per 100 000 individuals per day. $5·9 billion requested for the health systems arm of ACT-A will mainly be used to purchase protective gear for health workers. For therapeutics, $3·5 billion are assigned for medical oxygen and corticosteroids for 6–8 million critical patients and access to new COVID-19 therapies for up to 113 million treatment courses for mild and moderate cases, subject to WHO recommendation.
The ACT-A strategy acknowledges the emergence of other initiatives over the past year—such as the Africa Vaccine Acquisition Task Team (AVATT) and the Quad, initiated by the USA with Australia, India, and Japan—and promises to cooperate with them. However, it notes that to date, COVAX (the vaccine arm of ACT-A) has provided 80% of the vaccines that have gone to low-income countries, while AVAT has provided just 2%. According to Gavi, 27 countries, including Afghanistan, Syria, and Yemen, are wholly reliant on COVAX for COVID-19 vaccines.
ACT-A makes clear that fully financing the $23·4 billion is far from sufficient. An additional $19·7 billion for procurement of tools, delivery of vaccines, voluntary licensing, and technology transfers to create regional manufacturing capacity will be “essential to end the acute phase of the pandemic in all countries”. These will have to be covered by other mechanisms.
The total bill of $43 billion is equivalent to a quarter of global official development assistance. Many have pointed out that ending the pandemic is a global public good that should not be financed from aid budgets.
The ACT-A strategy warns that in light of escalating inequities, more “delta-like surges” are likely, even in countries with high vaccination coverage. Citing the International Monetary Fund, the strategy states that the emergence of new and highly infectious virus variants could result in global GDP losses of up to $5·3 trillion by 2026. Assuming that two-thirds of this economic toll is borne by high-income countries, the losses would be more than 240 times greater than ACT-A's current budget requirement. According to ACT-A, the failure to finance the response could also lead to more than 5 million avertable deaths over the next 12 months. Sweden, not a member of the G20, pledged a month ago to give COVAX $243 million for 2022.
In a comment to The Lancet, Gordon Brown, WHO Ambassador for Global Health Financing, called for “concrete actions” from the G20, “most notably fully funding the new ACT-Accelerator budget of $23·4 billion”.