The Global Accountability Platform (COVID GAP) blog series.
October 27, 2022
By Nellie Bristol

While global health experts have long urged heightened attention and funding toward pandemic preparedness, COVID-19 showed the world remained woefully ill equipped. Lacking an established system to ensure medical countermeasures reached everyone everywhere, urgent ad hoc efforts were undertaken, leading to the establishment of the Access to COVID-19 Tools Accelerator (ACT-A). Led by the World Health Organization, Gavi, Wellcome Trust, the Gates Foundation, and other UN and global health organizations, ACT-A has raised $23.7 billion and aided distribution of more than 1.7 billion vaccine doses. Nonetheless, it has struggled to meet expectations centered around the ambitious goals of globally equitable distribution of vaccines, therapeutics and diagnostics, as well as enhancing health systems in low resources settings. According to an independent assessment, ensuring products reached their intended recipients was a particular failing, with many efforts coming too late and too slowly. While low- and lower-middle income countries confirmed the need for aid in procuring medical countermeasures, the assessment cites inadequate input from the countries ACT-A was most intended to help, informal coordination, lack of strong leadership, and slow access to funding as particular weaknesses.

In delineating lessons learned from ACT-A’s performance, the assessment cites the need for clear lead agencies for R&D on each of the vertical pillars—vaccines, diagnostics, therapeutics—with a joint platform to coordinate work across each. It also calls for a pandemic Advance Commitment Facility with a line of credit to provide “zero day” funding. Reviewers also cite the importance of better pandemic response enabling environments including supportive political leadership, technology transfer, rapid prequalification, and the critical addition of regional manufacturing capabilities.

Similar weaknesses and recommendations are laid out in an assessment of the vaccine pillar of ACT-A, known as COVAX, in a forthcoming review conducted by senior development expert Jirair Ratevosian. In an October 23 interview with COVID GAP, Ratevosian cited the importance of having immediate financing available and a governance structure inclusive of civil society and the private sector to help understand and address country-level implementation barriers. Development of regional manufacturing is critical to ensure geographic dispersion of medical countermeasures, Ratevosian said, and should be based on sustained production of other locally necessary drugs and supplies. Establishing the regulatory and manufacturing environment needed before a pandemic hits will ensure smoother production and distribution of emergency countermeasures.

Importantly, both the ACT-A and COVAX assessments cite the need for adequate primary care systems that can provide early detection capabilities, patient care, and platforms for countermeasure distribution.

Learning the lessons from the COVID-19 pandemic and building better prevention, detection, and response capacities from the local to global level is critical to saving lives in the next pandemic. While multiple efforts are under way to address global pandemic governance, those processes will take several years to come to resolution. But given the increasing risk of further large scale outbreaks, more practical and immediate actions are needed as well. In an Oct. 24 New York Times essay, Craig Spencer of Brown University argued the next pandemic may come sooner rather than later and called for urgent improvements to disease surveillance, workforce, and systems of equitable countermeasure delivery.

With a global economic slowdown on the horizon and many countries, including traditional donors, dealing with their own financial woes, funding is likely to be scarce. Yet given a pandemic’s threat to lives and economies, immediate concrete preparedness advances are imperative. While global governance conversations continue, health and development organizations should work with low- and middle-income country and regional leaders to identify urgent local priorities for emergency preparedness and develop specific action plans. Successful country based approaches to improving speed of response, coordination, community engagement, and front line health work training are highlighted by Resolve to Save Lives.

COVID-19 taught us important lessons as well as the enormous cost of preparedness failures. Our job now is to turn those lessons into the health security actions that will protect us all immediately and into the future.

The Duke Global Health Innovation Center is a proud partner of the COVID Global Accountability Platform (COVID GAP). The COVID GAP blog aims to provide thoughtful, timely analysis and insights on important news and developments, guided by our ongoing research, analysis, and stakeholder engagement.

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ACT-A Assessments Point the Way to More Effective Pandemic Response