To facilitate equitable access to Covid-19 tests, treatments, and vaccines, WHO launched the Covid-19 Access Accelerator (ACT) in April. COVAX is the vaccine arm of this initiative. It is led by WHO, the Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) and the Geneva-based public-private partnership Gavi, the Vaccine Alliance (GAVI). Heidi.news sits down with Gavi's CEO, Seth Berkley, to discuss the challenges of what could be the most massive immunization campaign ever conducted.
Why it's important. A vaccine is probably the only way to halt a pandemic that, according to WHO’s latest data, has led to more than 20 million reported cases and 750,000 deaths. More than 200 vaccine candidates are in development, of which three have entered the final phase of clinical trials. But the potential demand for some 7.8 billion people is running headlong into what could be a precariously limited vaccine supply. Will rich countries preempt available vaccines, as suggested by the behavior of the United States and some European countries, including Switzerland, all of whom have pre-ordered millions of doses? And what if one of these countries is betting everything on the wrong candidate? These are some of the big questions now on the table.
Heidi.news - As an epidemiologist and director of one of the world's leading vaccination organizations, how are you coping with the pandemic period?
It's a very difficult time. I wouldn't say I'm working 24/7, but 20 hours a day, seven days a week is probably close to reality. Our work at Gavi is critical, so we're motivated. We had our funding summit recently. Normally, I would have had to travel all over the world for that. This time we did it online via video conferences with 42 heads of state. They committed $11 billion to our next program.
A recent article published in Science stated that "vaccine nationalism" threatens the global plan to distribute future Covid-19 vaccines equitably. Do you share the same concern?
Seth Berkley — Yes, we do. That's why we're building the Covax mechanism. We have the experience of the "swine" flu in 2009. Then, a small group of rich countries bought the entire vaccines stock with just a few donations here in there. It could happen again. We may end up in a situation where about 30 countries have all the vaccines and 170 countries do not have access, at least initially. We know that vaccines will be a limited commodity for the next 12 to 18 months. The challenge is to stop the pandemic. It must be seen as a global public health issue. People should realize that in a pandemic situation we are only safe if others are safe. With an infection spreading at the speed of light, this solidarity is the condition for the economy, the commerce, the trade, among others, to resume.
Seth Berkley and GAVI
Founder of the Global AIDS Vaccine Initiative (IAVI), Seth Berkley co-leads the Covax initiative to provide equitable and effective access to future Covid-19 vaccines.Trained in medicine at Harvard and in epidemiology at the Center for Disease Control (CDC), Berkekey has been Executive Director of Gavi, the Vaccine Alliance (GAVI), since 2011. Over the past two decades, GAVI, a private-public partnership, has facilitated vaccination of more than 760 million children in developing countries, preventing more than 13 million unnecessary deaths. During the Covid-19 pandemic, Gavi has provided medical equipment to health workers and supported screening initiatives.
The United States and Europe are ordering hundreds of millions of doses of potentially effective vaccines in advance. Does that mean that we will not have the equitable access that you are advocating?
Advance orders are a necessary mechanism for vaccine manufacturers to make the investment possible. Normally we have a global production capacity of about 1.5 billion vaccines that we need to continue to produce. That means huge investments for the new Covid-19 vaccines, which may potentially require two doses. Meanwhile, we don't know which of these vaccines will be effective. In any case, we do know that there will not be enough vaccines, to begin with. So we need an equitable, but also effective, way to distribute it globally. This means first vaccinating the groups of people most at risk, namely health workers, who make up 3% of the world's population, and the elderly (17%). And we need to do this at the global level, which is what Covax is all about.
How does it work?
The Covid-19 vaccine global access facility (Covax Facility) consists of two parts. The Covax Advance Market Commitment (AMC) is modeled on what Gavi usually does for other vaccines in developing countries. It is intended to support the procurement and delivery of vaccines for developing countries, financed by funds from donors in rich countries. The AMC will provide guarantees to manufacturers to create sufficient global production capacity before vaccines are licensed. It will then purchase vaccines and help deliver them to 92 countries, representing half of the world's population.
The second mechanism is the financing of vaccines for upper-middle and high-income countries. It is a pooled fund set up by contributing countries to guarantee them doses of various vaccines. There will probably be between 12 and 15 vaccines selected. This fund functions as insurance by providing access to a wide range of vaccines, including those for which there have been no specific pre-orders. Therefore, if the candidate in which a country has invested fails, it will still have access to other vaccines for about 20% of its population.
The advantage of such a global program is that it allows production capacities to be optimized.
Two billion dollars for two billion doses
How much funding are you looking for?
The goal is to raise $2 billion to have 2 billion doses available by the end of 2021. That's 950 million doses for Covax AMC, 950 million doses for high- and upper-middle-income countries, and 100 million doses are reserved for humanitarian and emergency situations to prevent some outbreaks from getting out of control. The vaccine portfolio will be actively managed and adjusted.
How many countries have signed up to date?
As far as Covax is concerned, 78 countries have declared their interest in this mechanism. Some of them publicly, such as Switzerland, the European Union, South Korea, Argentina, Brazil, and Canada. Together, they represent 1.6 billion people. These countries now have until the end of August to conclude legally binding agreements. As far as the AMC is concerned, we have raised almost $600 million. This allowed our board to formally approve the mechanism on July 30.
Are you sure that one of these vaccines will be effective?
Between Gavi, CEPI, and the Gates Foundation, we have already identified 16 or 17 eligible vaccines. But the truth is that we do not yet know if they will be effective and safe. Preliminary data is promising. Antibodies against the spike protein, which allows the virus to enter cells, are being produced. But we don't know how effective these antibodies will be in neutralizing the coronavirus. And there are still many questions about the right dosage, the manufacturing, among others.
"Health care workers should be the first to be vaccinated."
How did you choose which people to vaccinate first?
Health care workers should be the first to be vaccinated. Not only are they the most at risk, but they are essential to the proper functioning of the health care system. Older people are a challenge because we know they develop a weaker immune response than younger people. In addition, there are fewer elderly people in developing countries and there is little experience in vaccinating this segment of the population. Vaccine adjuvants can be used to better treat the elderly, but their effectiveness also remains to be demonstrated. Finally, we need to ensure vaccines for minority groups who are most at risk and dense urban areas in developing countries.
Are you concerned that the anti-vaccine movement will derail the public health objective of vaccination?
This is a concern that exists only in the developed world. And it doesn't help to have political leaders who don't follow science-based recommendations. But at the end of the day, there are only a small number of people who are anti-vaccine. Probably the same number of people who would get vaccinated at all costs. The challenge is to convince everyone in between.
Do you think the cost of vaccines could be a barrier?
We don't know the final price, mainly because of the unknown manufacturing and dosage. But Covid-19 vaccines are likely to be cheap. With a single-digit price, maybe double-digit for some, but under $50 a dose. Most people will be able to afford these prices. But here’s the thing: the pandemic is costing the world $375 billion a month in lost GDP. If you look at the overall costs, the vaccine bill could be as high as $75 billion. That means that an effective vaccine that would help the economy recover would pay for itself in five or six days.