More than nine months after she took over the role of WHO Special Envoy for the Access to COVID-19 Tools Accelerator, Dr. Ayoade Alakija believes the goal of the coordinating body has not been achieved yet.
“Our goal was to reach equitable access, we haven't reached it yet,” she told Devex in an interview last week. Clearing the air about ACT-A’s future, she said it is not winding down. “Nothing is ending because the pandemic has evolved and the virus is evolving.”
Alakija was also candid about the limitations of the body. She believes it was the best possible mechanism that was created at a time of crisis — but one that is not without its flaws in communication and execution.
Alakija, a Nigeria-born medical doctor with a master's degree in Public Health and Epidemiology from The London School of Hygiene and Tropical Medicine, is also one of the fiercest critics of racism in global health. In July, as several AIDS activists from the global south were denied visas to enter Montreal for AIDS2022, Alakija tweeted in protest, stating that she will not be attending the conference in person.
“What would have happened if we didn't have the accelerator? It was flawed in its execution. But we got the products. But we failed on equitable access.”
— Dr. Ayoade Alakija, WHO Special Envoy for the Access to COVID-19 Tools AcceleratorAsked what role she sees for herself in dismantling power structures, she said, “I think my role is just to show up every day … to hold up a mirror to those who are perpetuating racism and help them to see what they're doing and help them to see the hurt.”
This conversation has been edited for length and clarity.
What is the current status of ACT-A, is it going to continue in its current form or will it be winding down?
ACT-A is not winding down. I think that there's been a lot of confusion and one of the weaknesses of ACT-A has been the messaging and the communication … which is understandable because it was all set up so quickly in the middle of a crisis. But it is not winding down. The facilitation council [representatives of civil society and communities] is ending the regular scheduled meetings [but] they will still convene as needed.
You know, I chair a meeting every Thursday of the [ACT] accelerator with the top guys in global health, with the head of Global Fund Peter Sands, with [World Health Organization chief] Tedros, Seth Berkley of CEPI, and that is not changing.
Nothing is ending because the pandemic has evolved and the virus is evolving. Our goal was to reach equitable access, we haven't reached it yet … not just the vaccines, but all countermeasures. We haven’t reached it. I mean, there's vaccines available, but are they fully accessible?
Some countries have a next generation vaccine, the bi-valent vaccine. The U.S. has their BA.5 vaccine [to protect against omicron], but other countries in the world are still trying to get the first and second doses out to high risk people. That is not equity.
And COVAX has assured funding until 2023, is that right?
Everyone who talks to me about ACT-A talks about COVAX. I mean, COVAX is the vaccine pillar of ACT-Accelerator, there is also a diagnostics pillar and the therapeutics pillar and a health systems connector. All of those have been supported through until 2023. But I mean, if there is need for greater funding in the future, I imagine the world is not going to stop and say, “well, we're not going to fund what is needed going forward.”
It's been an emergency response to a global threat, which came unexpectedly and so we have to … remain flexible and agile and nimble in how we address it. And so that I think too, too much of the world is thinking of both ACT-A and the various pillars as development structures. One of my theses from the word go is that we haven't had enough of a humanitarian mindset towards this crisis. You know, those who are humanitarians will not imagine that anyone says the ACT-A is coming to an end because — end of what?
As flawed as it was, it is the only mechanism that exists that was end-to-end. … What you need to do is look at the counterfactual, what would have happened if we didn't have the accelerator? It was flawed in its execution. But we got the products. But we failed on equitable access.
Are you satisfied with the amount of funding ACT-A has received so far?
I think that there has been funding provided, but … we need to see more of a spend. There's still money left over that hasn't been rolled out. Some of the World Bank money at the very beginning was very slow to roll out. We're now beginning to see that come out.
Part of this comes [down] to the top-down nature, there has been very little commitment to funding communities, to funding grassroots work for delivery. … A lot of it was very top-heavy. We invested a lot of money in the purchase and the product delivery side … so there was a lot of money invested back into high-income countries, back into the pharma industry, back into those places of the product development and purchase side. But when it comes to equitable access, when [it comes to] the delivery side, funding needs to go into strengthening of health systems, [it] needs to go into community mobilization, community … support, and funding health care workers, health workforce, all of that. We have seen too little of that. And we still continue, to my mind, to see too little of that and it comes from a place where there's a lack of trust. There's a lack of trust in funding local regional initiatives.
You’ve been outspoken about racism in global health and the harm that is caused by the colonial attitude of global north institutions. What do you see as your role in dismantling these ingrained power structures and your impact in these rooms?
I think my role is just to show up every day, to push back — either the cost or the perceived cost — to hold up a mirror to those who are perpetuating racism and help them to see what they're doing and help them to see the hurt. Not just that we’re angry? No, it's hurt. It's a deep, deep sense of hurt that it causes and how that affects the world.
I have found allies within ACT-A, and, you know, a lot of the people that I have met, just in that space, they understand us more because more of us are in the room. There’s the scope for change, we need more of us at the table.