Devex CheckUp: Ditch ACT-A? But what’s plan B?

Just last month, two officials from the Access to COVID-19 Tools Accelerator, or ACT-A, told us that the global initiative set up to help tackle the pandemic will continue its lifesaving work, although it would be quite different from when it started. 

But after an independent, external evaluation of ACT-A published this week suggested that it's not the best model for future pandemic response, we’re trying to discern what that will mean for the initiative.

• Some major points in the review have been made before: It labeled COVAX as too ambitious — although it was considered the “most successful” among all of ACT-A’s activities — and said ACT-A had insufficient representation from low- and middle-income countries and regional bodies.

• But the evaluation also includes some blunt statements that few would openly comment on before such as how the health systems and response connector — meant to help strengthen health systems and build countries’ capacity to deploy new tools such as vaccines and treatments for COVID-19 — was “largely dysfunctional.” In a 2021 review of ACT-A, the role of the connector was already the subject of debate, with one civil society representative questioning why its work was limited to providing personal protective equipment.

• Amid the criticisms, more than half of online survey respondents in the independent evaluation were satisfied with ACT-A versus the 21% that expressed dissatisfaction with its work. However, almost two-thirds of the respondents don’t think ACT-A’s operating model should be replicated for future pandemics.

• Still, they want a dedicated funding facility for research, development, and procurement of lifesaving tools in the form of a pandemic Advance Commitment Facility that would act as an immediately accessible funding platform at the start of the next pandemic. It would differ from ACT-A in that it would only cover lower-income countries — COVAX’s setup included high-income countries — and funding would be made available through a credit line provided by a financing institution, instead of waiting for donor support.

• In an emailed response to Devex, a spokesperson for ACT-A said they welcome the release of the evaluation, but the aid agencies that are part of the initiative will only have an opportunity to formally comment on it next week. Their responses will be published before the 12th meeting of the Facilitation Council on Oct. 28, where the evaluation’s findings will be discussed.

Take a look back: A review says ACT-A should continue. Experts say changes are needed

More background reading:

• 'ACT-Accelerator has to change': WHO's Bruce Aylward lays out plans

• How to get vaccines to poorer countries quicker in the next pandemic (Pro)

+ If not ACT-A, what kind of pandemic response model would you rather have in the future? We’d love to hear from you; email us at checkup@devex.com.

The buzz

Several Asian countries are grappling with a huge increase in dengue cases this year. Laos, for example, saw cases soar by more than 2,000% compared to the same period last year.

Several factors are likely contributing to the surges, but they all link back to one root cause: climate change. According to the U.N. Intergovernmental Panel on Climate Change, a global temperature rise of 2.6 degrees Celsius will put an additional 2.25 billion people at risk of dengue by 2080. Dengue and other climate-sensitive diseases could also spread in areas where they were not previously a problem.

But the world is largely unprepared for these scenarios. There are currently no treatments for dengue, and only a couple of vaccines have been approved to date — and those can’t be used by everyone. Existing treatments for leishmaniasis, a parasitic disease spread by sand flies, are also limited, have serious side effects, and aren't recommended for everyone.

Read more: The insects are coming. But the world is unprepared. (Pro)

+ Not a Devex Pro member yet? Read the piece by starting your 15-day free trial of Devex Pro.

Last resort

According to the World Health Organization, 1 in 4 people in Nigeria has a mental illness. But people diagnosed with schizophrenia who can’t afford a doctor often seek the help of traditional or faith-based healers. Mental illness in the country is often blamed on illicit drug use, punishment for causing someone else harm, or the possession of evil spirits.

But human rights violations have been recorded in many of these traditional and faith-based centers, where treatment might include flogging, chaining, and animal sacrifices, according to Human Rights Watch.

“The beating is said to exorcize the demon that has possessed them,” says Dr. Jibril Abdulmalik,  founder and CEO of Asido Foundation, a nonprofit that promotes mental health advocacy. “It also includes sexual assault.”

Read: Can traditional and faith healers fill Nigeria’s mental health gap?

Did you know? The African region only has one psychiatrist for every half a million residents. That’s 100 times less than WHO recommends. Whereas in the United States, there are about 53 psychiatrists for every half a million residents.

Deadly accident

After dozens of children died in Gambia in an incident that, according to WHO, is potentially linked to their consumption of four medicinal syrups manufactured in India, there’s a new spotlight on how such drugs are regulated.

In an op-ed for Devex, Jallow and Yadav point out that while drug approval is carried out by India’s national drug regulatory authority, the licensing and inspections of manufacturing facilities falls to state-level agencies whose stringency varies. The manufacturer of the syrups at issue in Gambia, Maiden Pharmaceuticals Ltd., is licensed to export these drugs by the state regulatory agency — but not to sell them in India. Jallow and Yadav call for improving national regulatory systems, developing a global database of supplier quality noncompliance notices, and reforming India’s pharmaceutical regulatory structure.

Opinion: Death of 66 children a wake-up call for drug regulatory system

What we’re reading

Researchers are worried the wildfire smoke may carry microbes that cause fungal infections. [WIRED]

Johnson & Johnson delays could leave South Africa paying for COVID-19 vaccine doses. [Devex]

In Ethiopia’s Tigray region, patients and doctors feel helpless amid a lack of drugs and medical supplies. [BBC]