Infectious diseases care not for passports, visas or borders. As the COVID-19 pandemic has illustrated, viruses can spread quickly around the world. And, even where outbreaks can be controlled temporarily, numbers rise quickly as restrictions ease.
It has been clear since early spring 2020 that vaccines offer the most promising exit route from this crisis. More than 100 vaccines are currently at various stages of development, with several now in phase III clinical trials (the final phase before applying for approval from independent regulators).
The question now coming into sharper focus is how the first doses will be distributed. When the first vaccines are approved, it will take time to produce enough doses to meet the unprecedented demand.
Several countries have signed agreements with vaccine developers to secure access to vaccines once they have been shown to be safe and effective. But some worry that poor countries will be at the back of a long queue.
As well as being unfair on some at-risk populations, critics argue that allowing the virus to circulate in low-resource countries leaves the world vulnerable to ongoing outbreaks.
‘At an early stage during this pandemic, it quickly became apparent that to end this global crisis we don’t just need COVID-19 vaccines, we also need to ensure that everyone in the world has access to them,’ says Seth Berkeley, CEO of GAVI, the vaccine alliance.
‘This triggered global leaders to call for a solution that would accelerate the development and manufacture of COVID-19 vaccines, as well as diagnostics and treatments, and guarantee rapid, fair and equitable access to them for people in all countries.’
The result is COVAX, a new initiative coordinated by Gavi, the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI). It is working with vaccine manufacturers to provide countries with worldwide equitable access to safe and effective vaccines, once they are licensed and approved.
The aim of COVAX is to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world. It will achieve this by sharing the risks associated with vaccine development, and where necessary investing in manufacturing upfront so vaccines can be deployed at scale.
It is already working with 172 countries and has engaged with the developers of nine leading COVID-19 vaccine candidates. It has the support of 80 self-financing countries as well as the European Commission. They join 92 low- and middle-income countries eligible to be supported by the COVAX Advance Market Commitment. Together, this large group of nations will pool its purchasing power ‘to achieve sufficient volumes to end the acute phase of the pandemic by 2021’, according to GAVI.
COVAX is part of the vaccines pillar of the ACT Accelerator, a global partnership designed to boost access to COVID-19 tests, treatments and vaccines.
‘COVID-19 is an unprecedented global health challenge that can only be met with unprecedented cooperation between governments, researchers, manufacturers and multilateral partners,’ said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.
‘By pooling resources and acting in solidarity through the ACT Accelerator and the COVAX Facility, we can ensure that once a vaccine is available for COVID-19, it’s available equitably to all countries.’
Ultimately, the COVAX Facility hopes to have 2 billion doses of vaccine from several manufacturers. As doses become available, they will be allocated to participating countries at the same rate until all countries have received enough vaccines to ensure coverage of 20% of their populations. This is estimated to be sufficient to vaccinate healthcare workers and other high-risk groups – allowing societies to begin returning to normal.
‘COVAX can deliver the vaccines that could end the pandemic, but it needs countries to step forward both to join the COVAX Facility, and also to address the serious funding shortfalls, including for R&D,’ said Richard Hatchett, CEO of CEPI.
‘In the scramble for a vaccine, countries can act alone – creating a few winners, and many losers – or they can come together to participate in COVAX, an initiative which is built on enlightened self-interest but also equity, leaving no country behind.’