On Sept. 22, the US will host a long-rumored summit on the global COVID-19 response during the UN General Assembly, with great potential to further expand American leadership on ending the pandemic.
But despite multiple summits on this issue over the past year, including the G7, none have generated the comprehensive action the world needs to address the massive global imbalance in access to vaccines and other medical tools. Will this one be different?
The news follows efforts by Global Citizen and nearly 60 other organizations to develop and promote a comprehensive framework for global action against COVID-19, with the goal of setting the standard for success of any summit that’s convened. We have also shared key asks, together with US-based organizations, with the White House.
Yesterday, the Washington Post published a set of new US-led targets and calls to action that the White House shared with countries invited to the summit, covering global access to vaccines, tests, and treatments, as well as pandemic preparedness and financing. Let’s look at how some of the key pieces measure up:
Vaccinating the World
The headline is the call to fully vaccinate at least 70% of people in all countries by this time next year. That’s three months faster than the target set by UK Prime Minister Boris Johnson at the G7 Summit this past June, but three months slower than a widely supported $50 billion plan released by the International Monetary Fund (IMF) back in May (albeit for reaching a target of at least 60%).
When it comes to vaccines, it’s as much about timing as it is about supply and execution. A dose given now means much more in terms of saving lives and slowing the spread of the virus than one given three months from now.
According to Airfinity, a science analytics company, the world is projected to produce over 12 billion vaccine doses in 2021 alone. By the end of March 2022 (Q1), that total will rise to 18.4 billion. That’s not only more than enough to fully vaccinate 70% of people in every country; it’s enough to give each of them three doses.
So a delivery timeframe by September 2022 can and must be accelerated. Barring unforeseen changes in the production landscape or insufficient delivery support, we need a more ambitious target of vaccinating at least 70% of people in all countries by between April and June (Q2) next year. That being said, the summit’s success will likely hinge on whether world leaders commit to backing the target.
Closing the Vaccine Access Gap
The US is calling on high-income countries to support lower-income countries this fall by purchasing or donating 1 billion additional vaccine doses and expediting delivery of around 2 billion previously committed doses — likely a combination of the 1.425 billion dosesCOVAX is now forecast to provide plus around 575 million in-kind doses that the G7 and EU have pledged to share before the end of this year. Ways to do this include converting existing dose-sharing pledges into near-term deliveries, swapping delivery dates, and eliminating cross-border bottlenecks in supply.
If met, this could result in nearly 1.6 billion doses shared with lower-income countries in 2021 — an ambitious amount, and the G7 and EU countries could do it. Per Airfinity, if those countries reserved two doses for 80% of their populations age 12 and up, as well as boosters for high-risk individuals like those with immunodeficiencies, they would still be left with over 1.7 billion excess and unused doses in 2021.
But the challenge with dose sharing is getting governments to commit what they can and to follow through. As of Sept. 8, the G7 and EU had reportedly only delivered just over 170 million doses to low- and middle-income countries out of a total pledged amount of 575 million doses for 2021, with nearly 125 million of that by the US alone.
The G7 and EU should answer the call of the US and increase their dose-sharing ambition by increasing existing 2021 pledges up to 1 billion doses by the end of September and delivering this year. But additionally by the end of the year, they should increase pledges even further to 2 billion doses and deliver by the end of Q1 2022. Doses should be shared through or in coordination with COVAX and a transparent delivery schedule should also be made public.
Getting Shots Into Arms
On top of accessing enough doses, another issue is developing countries having the logistics and capacity to get vaccines from tarmac to arm, including having enough trained health workers to administer doses (without compromising other health needs). Hesitancy is also a factor so community outreach efforts are critical. To support vaccine delivery readiness, the US is calling for at least $3 billion to be pledged for 2021 and another $7 billion for 2022.
The IMF plan called for at least $6 billion in financial support for vaccine readiness and outreach to be provided urgently this year. If lower income countries have to wait for the bulk of this support throughout 2022, it will only delay efforts to scale up logistics and health systems capacity and get doses into arms as quickly as possible. This will take time so there can be no delay on this crucial funding.
On financing more broadly, after more than a year of unsuccessful efforts to fully fund the Access to COVID-19 Tools (ACT) Accelerator and the additional elements in the IMF plan, there still remains a $25 billion funding gap, including for tests, treatments, PPE, and health systems support in lower-income countries to fight COVID-19. It’s unclear if the US targets add up to filling this gap, so the White House should spotlight it and press countries to finally step up.
From Vaccine Charity to Vaccine Justice
As mentioned above, the world is projected to produce 12 billion doses in 2021 alone — but only a handful of countries and companies control access to that supply. This limited group effectively decides who gets doses, how many, and when, while human lives, global economic recovery, and a return to normal for everyone hang in the balance.
Making matters worse, countries like the US are already planning to offer third dose boosters to their general populations, which, together with booster supply contracts already signed for next year and beyond, raises the potential for ongoing cycles of vaccine inequity.
So on top of financing, dose-sharing, and delivery support, the vaccine nationalism we’ve seen through this pandemic has emphasized how badly we need to empower countries and all regions of the world with the opportunity, technology, and know-how to produce vaccines and other life-saving medical tools they need for themselves.
On these issues, the US targets lack clarity and teeth. They recognize a need for the manufacturing of doses over the medium and long term to which all countries need access, except only offer vague calls for “supporting sufficient global and regional production” and expanding manufacturing and technology transfer, including for mRNA vaccines.
The problem is pharma companies have had over a year to voluntarily engage in open sharing of their technology — they simply don’t want to, even with ready-made opportunities to do so through WHO’s COVID-19 Technology Access Pool and now the new Africa mRNA tech transfer hub (for which they could still be financially compensated). They need to be compelled, and that means the US, UK, and Germany putting legal and political pressure on companies in their jurisdiction to cooperate.
The US targets also avoid mention of a proposal by South Africa and India to waive IP around the production of COVID-19 vaccines and other medical tools — backed by over 100 countries. This would allow new producers to help expand global vaccine supply and access, especially for lower-income countries. The Biden administration stated support for a waiver on vaccine IP back in May, but has done little since to change the minds of other powerful countries.
Calls for a waiver are underscored by the billions in public funding these companies received by governments to fast-track R&D and de-risk the manufacturing process. A waiver would open up opportunities for new producers to help expand supply of these life-saving tools for countries in need globally.
Today, the Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS) at the World Trade Organization (WTO) resumed debate on the waiver after pausing for the month of August. Three-hundred thousand people died from COVID-19 globally in that time. After 11 months of debate, the US should re-invigorate its support for the proposal and use the opportunity of the summit next week to build consensus ahead of the key WTO ministerial meeting starting Nov. 30.
Transparency and Accountability
The US targets call for establishing “a robust vaccine, consumables, and ancillary supplies global dashboard in 2021” — something Global Citizen and others have been demanding for months. It also calls on pharma companies to provide data on production and projections to include in the dashboard.
If we’re to get through this historic global crisis, the global public needs basic information updated in real time. How many doses have been produced? What is the priority queue for deliveries, and when are they occurring? What prices have they been sold for? What are the realistic projections for the amount of doses produced this year and beyond? We also need transparency around dose-sharing so the dashboard should include real time updates on delivery against pledges made.
Will Leaders Answer the Call?
It’s one thing to put targets out, quite another to meet them. For the US summit to be a success, the Biden administration will need to take ownership and mobilize commitments with energy, reflecting the urgency of the crisis the world still faces.
There have been many injustices in this pandemic, with the poorest and most vulnerable disproportionately affected, but among the most glaring surrounds vaccine access. Humanity has succeeded in quickly discovering and mass producing multiple safe and effective vaccines, with even more in the pipeline. Yet we have woefully failed in ensuring equitable distribution, leaving us all at risk of a vaccine-evasive variant emerging and setting us back to square one. After all we’ve been through, we can’t let that happen.
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