The Access to COVID-19 Tools Accelerator, or ACT-A, is asking a set of countries for $16 billion to deliver life-saving COVID-19 tools to low- and lower-middle-income countries, even as its proponents emphasized that the COVID-19 pandemic is not yet over.
“There are many parts of the high-income countries of the world that [want] to declare this thing over, they want to declare victory over COVID. There is no such thing as victory over COVID. That ship sailed rather a long time ago,” said Dr. Ayoade Alakija, World Health Organization special envoy for ACT-A, during a press briefing on Tuesday.
While many high-income countries have vaccinated more than 70% — and in some cases over 90% — of their eligible populations for COVID-19, vaccination rates continue to lag in low-income countries. Only 10.6% of the population in low-income countries have received at least one dose, according to Our World in Data.
COVID-19 testing in low-income countries also continues to be limited. According to FIND, co-lead of ACT-A’s diagnostics pillar, an average of 6.03 tests per 1,000 people were conducted in high-income countries in the last 12 months to date compared to 0.07 tests per 1,000 people in low-income countries.
This makes it challenging to implement a test and treat strategy that uses the new COVID-19 antiviral treatments in low-income settings, which will need to be given within five days of symptom onset.
ACT-A needs a total of $23.4 billion as part of its current strategic plan and budget, covering the period October 2021 to September 2022. This includes an immediate ask of $16.8 billion from governments — it has received pledges amounting to $814 million to date — and $6.5 billion to be self-financed by middle-income countries, with support from multilateral development banks.
An additional $6.8 billion is needed for “in-country delivery needs of vaccines and diagnostics” but this is separate and is expected to come from a combination of countries’ domestic resources, development banks, and other international grant financing.
The $16.8 billion is meant to fund the multilateral initiative’s “most urgent” work, including the delivery of COVID-19 vaccines under COVAX; the procurement of treatments benefitting 120 million patients as well as 433 million cubic meters of oxygen; the purchase of 700 million tests; and the provision of personal protective equipment to protect 1.7 million health workers.
There is no such thing as victory over COVID. That ship sailed rather a long time ago.”
— Dr. Ayoade Alakija, World Health Organization special envoy for ACT-ADr. Bruce Aylward, who coordinates the work of ACT-A, said the lack of funding could hamper vaccine deliveries. It has already impeded agencies’ abilities to respond to country requests for tests, treatments, and PPEs.
“With the COVAX Facility, we're able to put a lot of contracts in place using funding from last year, but we're now shipping those vaccines. So on the vaccine side that has been okay, but the problem we've had … is a huge number of donations for which we don't have financing to cover the ancillary costs, the shipping costs of syringes, etc. And we're running out of that,” he said.
In addition, he said countries have made specific requests for tests, treatments, and PPEs to the Global Fund to Fight AIDS, Tuberculosis and Malaria costing over $1 billion that “couldn’t be fulfilled” because of lack of funding. They also needed money to continue to test new tools, such as new COVID-19 vaccines.
ACT-A is banking on a “fair share” model to cover its financial needs, which is calculated based on the size of countries’ economies and how much they would benefit from a faster recovery of the global economy from COVID-19. A 20% risk buffer is included in the current fair share model to account for instances when countries don’t pay up, or pay less than their calculated share of the financing.
Aylward said they received nearly $19 billion in financing in 2021, much of it from additional financing. While that’s below their funding ask, he said “it got us part of the way there and hence the firepower behind going out with the fair share call again this year.”
In 2020-2021, only six countries — Germany, Canada, Sweden, Norway, Saudi Arabia, and Kuwait — met and exceeded their share of ACT-A’s funding needs. Twenty countries have not given any of their share of the funding, while 14 countries have only given 5% of their share, or less than that.
An overview of country shares for the current budget cycle, 2021-2022, shows that the United States is expected to provide nearly $6 billion of ACT-A’s total ask, the largest amount coming from a single country. European Union member states meanwhile are expected to cover 24% of the total.
Gordon Brown, former U.K. prime minister and currently WHO ambassador for global health financing, said Norway has already made a contribution, and Germany has announced it will pay its fair share of the financing. But other countries need to step up.
“Today is the moment to call on all G-7 leaders to lead … and let us be clear about the significance of our request today. We are at an important moment because this is not the time to relax or let our guard slip. The actions of world leaders will determine the fate of millions, and they will decide whether or not we can overcome further waves of COVID,” he said.
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
