One of the few silver linings of the COVID-19 pandemic is the unprecedented collaboration of every sector of society to overcome it – best demonstrated by the Access to COVID-19 Tools Accelerator (ACT-Accelerator), which celebrated its first anniversary on Friday.

The ACT-Accelerator’s most famous pillar is the vaccine facility, COVAX, which has distributed almost 40 million vaccine doses to 119 countries so far.

“Vaccinating at this scale and in this time frame constitutes the largest and most complex vaccine rollout in history,” according to the WHO, but added that there are also “severe supply constraints characterising the market at present”. 

Other key achievements in the past year include:

• procuring 65 million COVID-19 tests for LMICs and supporting the development and Emergency Use Listing (EUL) of reliable rapid antigen diagnostic tests by its diagnostics pillar 
• supporting the identification of dexamethasone as the first life-saving therapy against COVID-19 and, within 20 days of its identification, making 2.9m doses available to LMICs vis its therapeutics pillar
•  Assisting to providing oxygen to half-a-million COVID-19 patients every day in LMICs.
• Procuring $50 million of PPE for LMICs via the Health Systems Connector pillar. 

While the ACT Accelerator has attracted $14.1 billion in funding, it needs another $19-billion this year to meet its aim of vaccinating 20% of the world’s population by the end of the year. 

Equitable Access Still a Long Way Off

“The ACT Accelerator was conceived with two aims: the rapid development of vaccines diagnostics and therapeutics, and equitable access to those tools,” Dr Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director-General, told the virtual anniversary featuring all partners.

While the first objective “has been achieved”, said Tedros, “we have a long way to go on the second objective”. 

Of the more than 950 million vaccinations that have been given,  0.3% have been administered in low-income countries and testing rates in high-income countries are about 70 times higher than those in low-income countries, according to the WHO.  

“Around the world, people are dying because they are not vaccinated. They are not tested and they are not treated. We’re deeply concerned about the increasing number of cases in India right now,” said Tedros.

India recorded 332,730 new cases and 2,263 deaths on Friday amid reports that many hospitals had run out of oxygen.

South African President Cyril Ramaphosa told the event that “a COVID-19 vaccine is a public good and must be recognised as such”.

South Africa and Norway co-chair the accelerator’s facilitation council, which provides political leadership for the body.

TRIPS Waiver and Technology Transfer

“South Africa and India are calling for a temporary TRIPS waiver to respond to COVID-19,” Ramaphosa added. “This, in our view, will facilitate the transfer of technology and intellectual property to more countries for the production of COVID-19 vaccines, as well as diagnostics and treatments.” 

He also welcomed the WHO initiative to establish a COVID-19 mRNA vaccine technology transfer hub and called on the pharmaceutical industry to “directly transfer this technology free of intellectual property barriers to low and middle-income countries”.

Norway’s Minister of International Development, Dag Ulstein, said that his country and South Africa had sent out letters to 89 countries appealing to them to contribute to the ACT-Accelerator.

“At this one-year anniversary, our choice is simple: invest in saving lives by treating the course of the pandemic everywhere now, or continue to spend trillions on the consequences of the pandemic with no end in sight,” said Ulstein, whose country has donated a number of its vaccine doses to COVAX.

Describing the accelerators’ achievements as “a miracle”, Ursula von der Leyen, President of the European Commission, said that the EU had recently doubled its contribution. 

Meanwhile, French President Emmanuel Macron said that “now was the time to share”, and announced that his country would donate 500,000 vaccine doses to COVAX by mid-June. He appealed to other countries to donate vaccines to COVAX, saying that he hoped that the goal of EU members donating 5% of their vaccine stocks he set in February would be “exceeded” by the end of the year.

However, Macron said the lack of technology transfer, not intellectual property rights, was hampering vaccine rollout. France is one of a handful of wealthy countries opposing the TRIPS waiver.

Thomas Cueni, Director General of International Federation of Pharmaceutical Manufacturers (IFPMA), said that a year into the AC-Accelerator “we can say science wins”. 

“Not one but several highly effective vaccines are being developed at record speed, and now being produced in historic quantities,” said Cueni, committing his industry to accelerating  “global access to safe, effective and affordable COVID-19 treatments and vaccines”.

Jeremy Farrar, Director of Wellcome, said in a press release about the anniversary that “huge strides have been made in the last year” but “science only works if it reaches society”.

“The world remains in the grip of a devastating pandemic – and it is not slowing, only escalating. There must be no further delays to getting COVID-19 vaccines, tests and treatments to the most vulnerable groups everywhere,” added Farrar, whose organisation is a partner and significant contributor to the accelerator.

“We are in desperate need of strong global leadership. Wealthy countries with access to surplus vaccine doses must start sharing these with the rest of the world now through COVAX, alongside national rollouts. And they should urgently set out a timetable for how these donations will be increased as they vaccinate more of their populations.”

Surge of COVID-19 in India is ‘Really, Really Difficult’

Mike Ryan, WHO’s Executive Director of Health Emergencies Programme, said the global body was assisting India to secure oxygen, as well as with technical assistance and clinical management and triaging of patients. 

“There’s a lot of fear in India right now. We support the Government of India, like we support all governments, in facing this really, really difficult situation. This is not time for recommendations. It  is the time for solidarity, the time to move quickly together to reduce deaths and reduce transmission by decreasing mobility and mixing, supporting communities with mask-wearing, maintaining social distance and reducing social gatherings,” said Ryan.

Seth Berkley, CEO of the vaccine alliance, Gavi, added that because of India’s domestic need, “the first 10 million vaccine doses from COVAX went to India”.

However, Berkeley acknowledged that COVAX was trying to ”balance the acute needs for India, where there’s a very large population, with the needs of many other countries that rely on India as one of the main vaccine manufacturers for the world”. 

Image Credits: WHO.