Eight months after the World Health Organization (WHO) declared the COVID-19 crisis a pandemic, the public health agency issued its first emergency use validation for the Pfizer/BioNTech vaccine in December 2020. For people around the world, the news brought a welcome sigh of relief, as well as hope that the pandemic would soon end.

But now a year and a half in, with more than 6 billion vaccine doses administered globally, people are still dying from COVID-19. Part of this is due to widespread vaccine inequity.

Some countries and international organizations want to achieve vaccine equity through dose sharing initiatives like COVAX, the vaccine pillar of the ACT-Accelerator. Global health experts have communicated the efficacy of the WHO-approved vaccines and encouraged wealthier nations to share enough dollars and doses to end the pandemic everywhere. Until they do, cases and deaths are going to continue.

The other side of it is that we don't have widely accessible treatments that can help those infected with the coronavirus.

Diagnostics and therapeutics are at the front lines of the pandemic. Countries that have widespread testing sites report fewer cases of COVID-19. The same is true for countries that provide at-home test kits for residents. For patients hospitalized with COVID-19, effective treatments will save lives — but only if we invest in their research and development.

We have to use every tool we have to prevent unnecessary deaths. That’s why initiatives like the COVID-19 Therapeutics Accelerator (CTA) are important, and why we have to make sure they're able to continue investing in treatments.

CTA was launched in March 2020 by the Wellcome Trust, the Bill & Melinda Gates Foundation, and Mastercard in response to the pandemic. The initiative began researching existing therapeutics that could help patients diagnosed with COVID-19, as well as developing new ones.

To focus on getting therapeutics to low-income countries that lack resources, CTA coordinates with the Therapeutics Partnership of the ACT-Accelerator. Like COVAX, the Therapeutics Partnership relies on global collaboration to ensure the world ends the pandemic as soon as possible. But whereas COVAX focuses on sharing doses with vulnerable countries, the Therapeutics Partnership accelerates the development and production of COVID-19 tests, treatments, and vaccines.

It does so through funding public health research. Since Oct. 26, 2020, it has awarded over $98 million in grants, which are being used to perform studies of the efficacy of treatments for moderate to extreme cases of COVID-19. If the coronavirus is going to continue hitting those living in low-income countries the hardest, initiatives like the CTA are giving us a chance to fight back.

To understand how CTA has taken on the coronavirus by investing in therapeutics, Global Citizen spoke to Sophie Evekink, lead of Global Government Relations at the Wellcome Trust.

Global Citizen: How is the CTA working to ensure low- and middle-income countries are granted access to therapeutics?

Evekink: We have supported clinical trials like RECOVERY International, which operates in low- and middle-income countries such as Nepal. These trials enable earlier access to promising drugs through clinical trial protocols and ensure that any promising products can be delivered within low- and middle-income countries. Further to this, having local clinical trial data can support the rapid approval of treatments in these countries.

The COVID-19 Therapeutics Accelerator is aligned with the ACT-Accelerator Therapeutics Pillar. To ensure effective treatments reach people in low- and middle-income countries, the COVID-19 Therapeutics Accelerator collaborates with other organizations in the ACT-Accelerator, such as Unitaid, to support the development of procurement and delivery frameworks that work in these contexts.

What were some barriers to drug development that the CTA has helped overcome?

COVID-19 was a completely new virus, and in the early stages of the pandemic, we were learning more about it every day. This uncertainty meant we needed to take a portfolio approach to treatment research and invest in several different treatments and projects simultaneously because we couldn’t be sure which treatments would work.

Further, there is a high level of risk in early-stage drug development, with limited funding allocated for discovery research. To alleviate this risk, the COVID-19 Therapeutics Accelerator provided significant financial support for innovators and guidance on how to navigate the development pathway. This guidance included advice on transitioning from academic-led early stage clinical drug development to later stage, Phase II clinical trials, access to in-vivo and in-vitro clinical trial platforms run by the Drugs for Neglected Diseases Initiative (DNDi), and access to expertise from partners within the ACT-Accelerator Therapeutic Partnership.

What are some examples of the progress CTA has made in the research and development of COVID-19 treatments?

The COVID-19 Therapeutics Accelerator supported pre-clinical and early clinical evaluations of repurposed drugs in treating COVID-19 patients through trial platforms like AGILE. These trials conducted rapid early assessments of potential treatments and helped identify treatments that could be taken forward for later stage clinical trials.

We have also funded in later stage clinical trials such as RECOVERY International, which operates in India, Nepal, and Southeast Asia. These trials have clinically assessed both repurposed and novel treatments of COVID-19 in different use cases.

Why should we fund COVID-19 therapeutics when we need to expand access to COVID-19 vaccines?

Delaying funding for treatments will prolong the pandemic, leading to more lives lost and more economic damage. The global roll-out of these vaccines is taking a long time; we still need to treat people who fall ill and anyone who is unable to get vaccinated.

Treatment options for coronavirus patients in all countries are currently limited to only dexamethasone, hydrocortisone, and tocilizumab, together with oxygen — proven to save lives for the most seriously-ill patients so far. We do not have effective, proven treatments for most patients, including the prevention of mild symptoms from worsening. Having these treatments will be crucial in changing the course of the pandemic.

How can world leaders better support the CTA to increase access to COVID-19 therapeutics?

To save lives, resume global trade and contain COVID-19, every country needs equal access to tests, treatments, vaccines, and stronger health systems. It’s essential that leaders take a holistic approach and invest right now in all these elements to contain COVID-19.

However, the mechanism for ensuring access to treatments in low-and middle-income countries — the ACT-Accelerator — is facing a significant funding gap across all pillars.

In just a year, the ACT-Accelerator has driven real progress. It has delivered the first vaccines to low- and middle-income countries, significantly reduced the costs of tests, procured PPE, and secured access to the first proven COVID-19 treatments. But to lead our way out of this crisis, each country needs to do their fair share and close the ACT-Accelerator funding gap for this year and the next.

Disclosure: The Bill and Melinda Gates Foundation is a funding partner of Global Citizen.

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