Equitable access to COVID 19 vaccines must remain a priority if we are to end this crisis

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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This piece was first published in the OECD's Development Co-operation Report 2020: Learning from Crises, Building Resilience

As the first promising results for COVID-19 candidate vaccines begin to emerge, the end of this global crisis is starting to look like it’s tantalisingly within our grasp. Tantalising because even though we are now at a turning point and have a global solution that could bring the acute phase of this pandemic to an end, we are not quite there yet. Evidence that immunisation can provide protection against the virus is likely to be a game-changer, but it will also place COVID-19 vaccines in even greater demand. This is why it is so important to ensure that equitable access remains the global priority. Because unless people in all nations are protected, the virus will continue to circulate and the opportunity to resume normal life, business, trade and travel and hopes of rebooting the global economy will continue to evade us all.

COVAX is the only way to avoid this. Co-ordinated by my organisation, Gavi, the Vaccine Alliance, along with the Coalition for Epidemic Preparedness Innovations and the World Health Organization, it is the only truly global solution to make access to COVID-19 vaccines rapid, fair and equitable. In addition, by ensuring that all the necessary infrastructure is in place – the supply chains, cold storage facilities, trained healthcare workers and data systems – to carry out what will effectively be the largest and most rapid global deployment of vaccines ever, COVAX will also help the world build back better and improve our resilience to future pandemics, particularly for the poorest economies. But now that the global community has rallied, thanks to donor governments stepping up despite the current economic conditions, and we have COVAX, its success will hinge upon all stakeholders reminding themselves of why we need it and then playing their part to ensure the alternative does not prevail.

COVAX is the biggest multilateral effort since the Paris Agreement. At a time when so many governments are facing such an immediate and existential threat, to come together and work towards a common solution that benefits everyone is simply unprecedented and a remarkable show of solidarity.

With more than 189 economies involved, representing around 90% of the global population, COVAX is the biggest multilateral effort since the Paris Agreement. At a time when so many governments are facing such an immediate and existential threat, to come together and work towards a common solution that benefits everyone is simply unprecedented and a remarkable show of solidarity. But in truth, such support only exists because COVAX works to everyone’s best interest. For the 35 or so wealthy governments and economies that can afford to negotiate bilateral deals with manufacturers to secure vaccine doses for their citizens, it is an insurance policy increasing their chances of getting efficacious COVID-19 vaccines, even if those deals should fail. But for the rest of the world, it is a lifeline, providing doses to people in countries, rich or poor, who would otherwise have little or no access to these vaccines.

However, even though COVAX was designed to benefit everyone, we must remember that it was created with the world’s poorest people in mind. While the COVAX Facility provides all participating countries with access to the world’s largest and most diverse portfolio of COVID-19 vaccines and ensures that manufacturers are ready to produce doses at scale the moment vaccines are ready, the Gavi COVAX Advance Market Commitment (AMC) is there for low- and middle-income countries. Without it, the governments of these countries may go without or be forced to take desperate measures, taking out commercial loans to procure less effective or less than appropriate vaccines that are more expensive for their citizens. Such acts could allow the virus to continue to spread while pushing these already struggling countries further into debt.

More on the Forum Network: Co-operating on Vaccines: What we must do next by Anthony Gooch, Director, OECD Forum

That is why we need the AMC to succeed. Thanks to a massive show of multilateralism, we have already secured the USD 2 billion needed to jump-start the deals. But if COVAX is to achieve its initial goal of making 2 billion doses of COVID-19 vaccines available by the end of 2021—with the majority going to 92 lower income countries—then we need to secure at least a further USD 2 billion soon to finish the job*. That means ensuring that the AMC is an official development assistance (ODA) priority.

Given the devastating impact COVID-19 has already had on low- and middle-income countries, demand for ODA has arguably never been greater. But then, all the more reason to target it at areas where it will have the largest and most enduring impact, such as the Gavi COVAX AMC, because the response to this crisis is already costing low- and middle-income countries USD 52 billion every four weeks. That is not sustainable until we stop the virus in its tracks through simultaneous investments that will ensure that people in all countries have access to safe and effective vaccines. This will not only help bring the acute phase of the current pandemic to the swiftest possible end, but will also build resilience against the next one. Because there will be a next one. That is an evolutionary certainty.

*The stated funding requirement differs from that printed in the Development Co-operation Report 2020: Learning from crises, building resilience (pp. 147-148) due to advances in fundraising in December 2020 and January 2021. 

Read the OECD's Development Co-operation Report 2020: Learning from Crises, Building Resilience

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Dr Seth Berkley

Chief Executive Officer, Gavi, the Vaccine Alliance

Since 2011, I have been proudly serving Gavi as its CEO. During this time my focus has been to use my experience, as an epidemiologist and expert in vaccine development, to lead Gavi in its mission to improve access to new and underused vaccines and improve coverage and equity in poor countries. Under my leadership, in 2015 Gavi successfully raised US$ 7.5 billion in commitments during its last replenishment and has helped to reduce vaccine prices and assure a healthy vaccine market. This supported Gavi’s largest expansion, immunising an additional 300 million of the world’s poorest children and preventing 5-6 million deaths. By continuing to increase immunisation coverage, we will not only save more lives, but will also help lift millions of lives out of poverty. We will also build out the health system to deliver vaccines to the underserved, extending the base of the pyramid for primary healthcare. We continue to seek innovative ways to improve vaccination and by helping countries to improve outbreak response we are also reducing the threats to global health security. All this will prepare Gavi for what is likely to be its most challenging strategic period, post-2020, while providing solid foundations for the global health community as it takes on the most ambitious new global agenda with the Sustainable Development Goals. As a global health leader, my mandate is very clear: to ensure that no one is left behind, by creating a world where life-saving vaccines are available to everyone who needs them, regardless of their ability to pay.

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