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Delivering a potential COVID-19 vaccine to the world: understanding the scale of the challenge

The overarching theme of this year’s virtual World Health Assembly, which brought together health leaders from 194 member states, was naturally the global response to the biggest public health crisis of a generation, COVID-19. Considering this pandemic has got the world’s nearly 8 billion inhabitants on standby, it’s no wonder this was dubbed the most important assembly in the history of World Health Organization. So, two days on from the closing speeches, where do we stand on the critical issue of access to novel vaccines and therapeutics?

Unwavering Political Commitment

A sentiment repeatedly expressed by member states throughout the assembly’s two days was the need for solidarity. We heard strong affirmations of health as a human right and that a future COVID-19 vaccine should be a global public good with equitable access.

Access to medicine advocates have also welcomed the bold wording in the COVID-19 response resolution. The text adopted by member states makes explicit reference to TRIPS flexibilities, which are tools at the disposal of governments to ensure intellectual property rights (or patents) on pharmaceutics are not detrimental to public health. Another welcome component is reference to the use of voluntary pooling and licensing of patents. This is an amicable option, which would see the industry allow manufacturers in low- and middle-income countries to produce a novel vaccine or treatment products under a licence agreement. Think of voluntary pooling and licensing as a franchise option for pharmaceutics to expand the availability of the medicines to a wider population. And as the ability to use TRIPS flexibility as an insurance policy should any innovator (university, government, pharmaceutical company or non-profit organisation) choose to exploit their monopoly power of a future patented vaccine or therapeutic.

Beyond the Rhetoric: Let’s talk details!

Now the resolution is passed, state and non-state actors including governments, multilateral agencies and the private sector must operationalise their commitments and thrash out the technicalities of how to achieve equitable access to this global public good.

The challenge ahead is no small feat. Herd immunity from COVID-19, as with any other infection, could occur either through the population developing natural immunity by getting infected and recovering (though the evidence is still uncertain on this) or through vaccination. If we assume that 70% of the world’s 7.8 billion people would need to be immunised to achieve herd immunity, that would mean producing enough vaccines for more than 5 billion people. To put this into context, the global demand for vaccines totalled 3.5 billion doses in 2018 (excluding oral poliovirus vaccine, seasonal influenza, travel and military markets) and the world’s maximum production capacity for an influenza vaccine is estimated at 6.4 billion doses.

So, it is evident that producing a COVID-19 vaccine at this scale in a very short space of time and without disrupting the existing supply of vital routine vaccines requires unleashing manufacturing capacity at a scale not before imagined – let alone operationalised!

Global supply constraints aside, what would an allocation mechanism look like for what would inevitably be a finite supply? How do we stop high-income countries galvanising whatever little supply there is at the expense of low- and middle-income countries? If the response by countries to date in banning the export of medical supplies – including personal protective equipment – is anything to go by, sentiments of solidarity are nothing more than lip service.

And if an equitable allocation mechanism is agreed on, what would a deployment model look like? Long-standing issues around the procurement model (pooled procurement vs. self-procuring), cold chain, vaccine hesitancy and reaching the last mile, which continue to challenge routine immunisation programmes, will not suddenly disappear for a COVID-19 vaccine.

Where is the Accountability for Access?

Those who don’t learn from history are doomed to repeat it. This certainly rings true for our quest to develop and deploy COVID-19 therapeutics equitably. To ensure we do not repeat past failures and exacerbate rampant inequities in access, access arrangements must be formulated in a transparent, inclusive and consultative manner. The meaningful participation and inclusion of civil society and communities in this process is critical.  This includes decisions made within the recently launched Access to COVID-19 Tools Accelerator, which drew in close to $8 billion, mainly in the form of public funding.

Governments must ensure adequate provisions to guarantee equitable access for any new COVID-19 vaccine, diagnostics or treatment, as they arise. This will require incorporating pro-public safeguards on public contributions to research, development and deployment of COVID therapeutics – such as clauses on transparency, accessibility and affordability as well as non-exclusive licensing – to ensure they are available and affordable for all. We must also ensure that strong accountability and governance mechanisms are in place so that conditionalities attached to public funding for COVID-19 commodities are adhered to and operationalised by partners.

Governments, industry, civil society and communities must now work together to deliver on these commitments to equitable access. Only then will we achieve the call for a ‘people’s vaccine’.

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