ACT-A set to transition to a new phase

The Access to COVID-19 Tools Accelerator, or ACT-A, has unveiled its plan to transition into a new phase. The plan, which will be in operation until March 2023, was set up to “optimize efficiencies and adapt to the ever-evolving pandemic context.” But experts say it fails to address the concern about involvement of voices from low- and middle-income countries.

Speaking to reporters, the World Health Organization’s Dr. Bruce Aylward, who coordinates ACT-A, called the transition one of the “pivot points” of the COVID-19 response. The current plan for ACT-A, which was set up at the beginning of the pandemic to coordinate access and ensure equity of COVID-19 treatments and vaccines, ran until September.

“Countries are moving … behaviors are changing,” Aylward said. “The world is changing and carrying forward that strategy and plan was not going to meet the needs of those populations in those countries.”

The new plan outlines three key priority areas  —  research and development, securing long term institutional arrangements, and concentrating on delivery.

It also highlights which scopes of work will be “maintained, transitioned, sunset, or kept on standby,” while maintaining provisions of resuscitating some of the functions “in the event there is a major global surge in cases or mortality due to a significant new SARS-CoV-2 variant”  or mortality spikes due to eroding levels of immunity in the face of a new variant.

“A key part of this transition will see the mainstreaming of current COVID-19 emergency work into routine public health and disease control programmes, some of which may need to be adapted to take on these additional functions,” the plan states.

Involving LMICs: A blindspot

Experts believe that the plan does not address the lack of involvement of LMICs — a concern highlighted in the external evaluation report. “Without LMIC expertise, it compromises coordination, it compromises deployment,” Fifa Rahman, the CSO representative to the diagnostics pillar, told Devex.

Rahman cited the example of when the Democratic Republic of Congo returned COVID-19 vaccines to COVAX, stating that they could not administer the doses before they expired. It was only when she spoke to health workers in DRC that it became apparent that COVAX did not engage with provincial health leadership, and they didn’t mobilize community health workers from the Ebola response.

“I wouldn’t have known this without chatting with DRC colleagues who are experts in their own context,” she said, adding that the transition does not outline steps to involve Black and Brown experts to discussions on rollout and mobilization.

“Race and representation is always a blindspot in global health architecture because people think it’s a diversity-related thing, when it’s by and large an expertise thing and an effectiveness of your response thing,” she said.

Role of institutional partners

A key area of change is the role of institutional partners including Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. While the two organizations came on board to help facilitate delivery of vaccines, tests, treatments, and personal protective equipment, their original mandate is entirely different — for Gavi it’s childhood immunization, and the Global Fund focuses on AIDS, TB and malaria.

“[Gavi] doesn't really have that big focus on adult vaccination, … so that would be a shift if GAVI is to continue in the longer term to provide access for for COVID-19 vaccines and this is a crucial issue that its board will be looking at over the coming months,” Aylward said.

Similarly, Global Fund, which co-convenes the diagnostics and therapeutics pillars, will have to reconsider the arrangement.  

“So the issue there is, will they sustain the arrangement that they've had through … their C-19 mechanism? Or will we be relying on UNICEF and other players. But again, the institutional arrangements to sort out here are crucial, especially if we're going to be able to maintain … surge capacity as we go forward,” he said.

Addressing the funding gap

The transition plan does not include a new budget for the interim period, but it acknowledges a funding gap of $386 million. While the past version of ACT-A considered supply-side costs, the transition plan will take domestic demands into consideration and look into what countries are actually asking for, how much money is in the pipeline, and which partners can meet those needs,” Aylward said.

The plan also outlines the role of the new ACT-A Tracking and Monitoring Task Force, which will “provide an important forum for maintaining a coordinated approach to tracking financing requirements and pledges and facilitating resource mobilization for ACT-A if needed in this next phase.”

This means the ACT-A facilitation council will be placed on standby — and the work from the council and financial resource mobilization working group and the tracking accelerating progress working group will be consolidated into the new task force composed of senior officials, Aylward explained. India and the United States will chair the task force.