Access to COVID-19 Tools Accelerator

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The Access to COVID-19 Tools Accelerator (ACT Accelerator or ACT-A), or the Global Collaboration to Accelerate the Development, Production and Equitable Access to New COVID-19 diagnostics, therapeutics and vaccines, is a G20 initiative announced by pro-tem Chair Mohammed al-Jadaan on 24 April 2020.^[1] A call to action was published simultaneously by the World Health Organization (WHO) on 24 April.^[2]

The ACT Accelerator is a framework for collaboration, not a new organization or a decision-making body, that was set up in response to a call from G20 leaders in March 2020 and launched by WHO, European Commission, France and the Bill & Melinda Gates Foundation in April 2020.^[3]

On 10 September, the UN and the European Union cohosted the inaugural meeting of the Facilitation Council of the ACT-Accelerator, which had received $2.7 billion of the $35 billion necessary to secure the 2 billion COVID-19 vaccine doses, 245 million treatments, and 500 million tests that the initiative deemed necessary to end the pandemic and speed economic global recovery.^[4] Sir Andrew Witty and Dr Ngozi Okonjo-Iweala have accepted to act as Special Envoys to the ACT Accelerator from the WHO.^[5] Although the Trump administration of the United States had withdrawn its financial support of the WHO and ACT Accelerator in 2020,^[6] the United States reasserted its support of the WHO and COVAX on 21 January 2021 following the inauguration of President Joe Biden.^[7]

The ACT Accelerator is a cross-discipline support structure to enable partners to share resources and knowledge. It comprises four pillars, each managed by two to three collaborating partners:^[8]

• Vaccines (also called "COVAX")
• Diagnostics
• Therapeutics
• Health Systems Connector

By December 2020, more than 10 billion vaccine doses had been preordered by developed countries. The manufacturers of three vaccines closest to global distribution – Pfizer, Moderna, and AstraZeneca – predicted a manufacturing capacity of 5.3 billion doses in 2021, which could be used to vaccinate about 3 billion people (as the vaccines require two doses for a protective effect against COVID-19).^[9] Due to the high demand in preorders from rich countries for 2021,^[10][11] people in low-income developing countries may not receive vaccinations from these manufacturers until 2023 or 2024, increasing the use of the COVAX initiative to supply vaccines equitably.^[9][12] Emphasizing the need for broad distribution of safe, effective vaccines against COVID-19, especially across developing countries, GAVI uses the slogan, "No one is safe until everyone is safe."^[13]

A multinational collaboration, including the World Health Organization (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI), FIND, GAVI the Vaccine Alliance, the Global Fund, UNICEF, Unitaid, Wellcome, the World Bank and governments, formed the Access to COVID-19 Tools (ACT) Accelerator to raise financial support of accelerated research and development, production, and globally-equitable access to COVID-19 tests, therapies, and vaccines. Vaccines are in a specific development program called the COVAX pillar.^[14][15] The COVAX pillar has the goal of facilitating licensure of several COVID-19 vaccines, influencing equitable pricing, and providing equal access for up to 2 billion doses by the end of 2021 to protect frontline healthcare workers and people with high-risk of COVID-19 infection, particularly in low-to-middle income countries.^[16][17]

During 2020, major changes in the overall effort of developing COVID‑19 vaccines since early in the year have been the increasing number of collaborations of the multinational pharmaceutical industry with national governments, and the diversity and growing number of biotechnology companies in many countries focusing on a COVID-19 vaccine.^[18] According to CEPI, the general geographic distribution of COVID‑19 vaccine development involves organizations in North America having about 40% of the world's COVID-19 vaccine research, compared with 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.^[18]

Coalition for Epidemic Preparedness Innovations[]

A multinational organization formed in 2017, CEPI is working with international health authorities and vaccine developers to create vaccines for preventing epidemics.^[17] CEPI has organized a US$2 billion fund in a global partnership between public, private, philanthropic, and civil society organizations for accelerated research and clinical testing of nine COVID-19 vaccine candidates, with the 2020–21 goal of supporting several candidate vaccines for full development to licensing.^[18][19][20] The United Kingdom, Canada, Belgium, Norway, Switzerland, Germany and the Netherlands had already donated US$915 million to CEPI by early May.^[21][22] The Gates Foundation, a private charitable organization dedicated to vaccine research and distribution, is donating US$250 million in support of CEPI for research and public educational support on COVID‑19 vaccines.^[23][24]

Over 2020 throughout the pandemic, CEPI was funding the development of nine vaccine candidates in a portfolio deliberately made diverse across different vaccine technologies to minimize the typically high risk of failure inherent in vaccine development.^[19][25] As of December, the vaccine research organizations and programs being supported by CEPI were AstraZeneca/University of Oxford (AZD1222), Clover Biopharmaceuticals (SCB-2019), CureVac (Zorecimeran/CVnCoV), Inovio (INO-4800), Institut Pasteur (MV-SARS-CoV-2), Moderna (mRNA-1273), Novavax (NVX-CoV2373), SK bioscience (GBP510), and Hong Kong University.^[19][26][27]

Financial contributions[]

As of December 2020, US$2.4 billion had been raised for the overall ACT Accelerator, with nine vaccine candidates being funded by COVAX and CEPI – the world's largest COVID-19 vaccine portfolio – with 189 countries committed to the eventual deployment plan.^[19][28] See table above.^[29]

Earlier in 2020, the WHO had a telethon which raised US$8.8 billion in pledges from forty countries to support rapid development of vaccines.^[21] In December, the Gates Foundation donated another US$250 million to the WHO ACT Accelerator to "support the delivery of new COVID-19 tests, treatments, and vaccines, particularly in low- and middle-income countries" during 2021, making the Foundation's total donation of US$1.75 billion toward the COVID-19 response.^[30][31]

The Global Research Collaboration for Infectious Disease Preparedness (GLoPID-R) is working closely with the WHO and member states to identify priorities for funding specific research needed for a COVID‑19 vaccine, coordinating among the international funding and research organizations to maintain updated information on vaccine progress and avoid duplicate funding.^[32]

Potential inequities[]

COVAX is designed to assist vaccine purchases and distribution for poor and middle-income countries unable to compete in the open market and avoid inequities for vaccine access.^[14][15] However, by December, more than 10 billion vaccine doses had been preordered mostly by high-income countries comprising only 14% of the world's population.^[33]

While rich countries like the United Kingdom, Canada, and the United States secured delivery of several COVID-19 vaccines in December 2020,^[11][9] poorer countries, such as South Africa, have difficulty obtaining vaccine deliveries, despite having a factory for making COVID-19 vaccines within the country.^[12] Half of South African citizens live in poverty, and may receive a vaccine only by participating as volunteers in clinical trials.^[12]

The COVAX administration, governments, and vaccine manufacturers have been criticized for lack of transparency and accountability over fair pricing and equitable allocation of COVID-19 vaccines to developing countries where financial and vaccination resources are limited, and government corruption may exist.^[11][12]

Diagnostics[]

Until vaccines are proven safe and effective, and distributed widely across the world, diagnostics are the most important medical technology available to monitor and control the spread of COVID-19.^[8][34] A thorough testing program within countries and regions, combined with tracing and quarantining of confirmed cases, is needed to avoid repeated lockdowns, which threaten economies and ways of life.^[34] Testing supports healthcare services to be managed and COVID-19 transmission to be suppressed.^[8][34] Rich countries, such as Germany and South Korea, have used extensive testing with simple, high-performance kits, to reduce the rate of epidemic spread, preferably administered at the point of care or at home.^[34] In September 2020, ACT Accelerator partners committed to provide 120 million COVID-19 rapid tests for low- and middle-income countries.^[8]

Therapeutics[]

The therapeutics pillar is a multinational research effort to discover and develop promising treatments for COVID-19 infection and illness.^[8] It involves monitoring over 1,700 clinical trials, and was part of the effort to provide dexamethasone for up to 2.9 million patients in low-income countries. It also facilitates future access to monoclonal antibody therapies in low- and middle-income countries.^[8]

Health systems[]

The pillar for health systems analyzes needs and resources in some 100 countries to identify problems, capacity, and requirements for access to and implementation of COVID-19 tools across world regions.^[8]

National governments[]

Among European Union countries, France announced a US$4.9 million investment in a COVID‑19 vaccine research consortium via CEPI involving the Institut Pasteur, Themis Bioscience (Vienna, Austria), and the University of Pittsburgh, bringing CEPI's total investment in COVID‑19 vaccine development to US$480 million by May.^[35][36] Belgium, Norway, Switzerland, Germany, and the Netherlands have been major contributors to the CEPI effort for COVID‑19 vaccine research in Europe.^[22]

On 4 May, the Canadian government committed CA$850 million to the WHO's live streaming effort to raise US$8 billion for COVID‑19 vaccines and preparedness.^[37] On 18 May, China had pledged US$2 billion to support overall efforts by the WHO for programs against COVID‑19.^[38] On 22 July, China additionally announced that it plans to provide a US$1 billion loan to make its vaccine accessible for countries in Latin America and the Caribbean.^[39] On 24 August, Chinese Premier Li Keqiang announced it would provide five Southeast Asian countries of Cambodia, Laos, Myanmar, Thailand and Vietnam priority access to the vaccine once it was fully developed.^[22]

References[]