Opinion: COVAX and the case for multilateralism

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Health professionals participate in a vaccination campaign in Lima, Peru. Photo by: Minsa / Handout / Latin America News Agency

Humanity is facing an unprecedented challenge: Develop a vaccine for a novel virus and distribute at least 2 billion doses in just two years. By the end of 2021, demand for a COVID-19 vaccine will outstrip current global capacity for vaccine development, manufacturing, and distribution. Nevertheless, it can be done.

We can overcome the obstacles before us, but only if we commit to multilateral solutions. Unfortunately, during this time of crisis, many global players are instead prioritizing narrow self-interest, abandoning multilateralism at the expense of humanity. The United States’ withdrawal from the World Health Organization is one of the clearest indicators of this growing nationalism — and its potential impact on global public health and the COVID-19 pandemic.

Nationalist policies undermine the global strategy and cooperation required to end the current pandemic.

This is not to say that countries are not accountable to their citizens, but global crises require global solutions. Now is not the time to walk away from multilateralism. This pandemic will cost the global economy $11 trillion in lost output before the end of 2021, growing to $28 trillion by 2025. The global economy cannot recover anywhere until they recover everywhere. All countries have an obligation to contribute their fair share for the health of humanity.

Now more than ever we rely on conveners like the United Nations, WHO, the African Union, and many other multilateral organizations to coordinate our response. And more specifically, as we try to develop, manufacture, and disseminate a COVID-19 vaccine at global scale, COVAX — a collaboration coordinated by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and WHO — is the essential global organizing structure.

The success of COVAX is not certain. The same political factors that contribute to nationalism could threaten its effectiveness.

COVAX represents the largest global effort to streamline research, development, and manufacturing to allow for rapid availability of a successful vaccine candidate — while also ensuring safety, quality, and equity. With the world’s largest and broadest portfolio of technological approaches, COVAX is the world’s best chance of achieving these goals.

In exchange for the shared risk of vaccine development, COVAX is helping shape the market for COVID-19 vaccines, through its COVAX Facility and Advance Market Commitment. It provides countries an opportunity to aggregate demand and purchasing power. It provides suppliers insight into how many doses are needed and works with them to ensure COVID-19 vaccines are affordable and available in low- and middle-income countries — countries that would otherwise be left out of deals between manufacturers and wealthy countries with ample resources.

But success of COVAX is not certain. The same political factors that contribute to nationalism could threaten its effectiveness in three ways.  

First and foremost, the success of COVAX will hinge on global collaboration — not just among companies and countries with world class research facilities and significant manufacturing facilities — but also among policymakers, public health officials, and communities around the world that will ultimately adopt the vaccines.

Too often, these critical stakeholders are left out of early scientific conversations, resulting in products not suited for use in all places. If this occurs, we can only hope to reach millions, not billions, with COVID-19 vaccines. Millions won’t cut it.

Second, while a number of high-income countries have committed to procure an eventual vaccine through the COVAX Facility, there are several notably absent, including the world’s leading funder of global health research and third most populous country — the U.S.

Participation in the COVAX Facility signals an intention to collaborate in an equitable distribution of vaccines, prioritizing highest risk populations first, regardless of where they reside. No country will reap the full benefits of a COVID-19 vaccine by only considering the needs of its own population.  

Third, ensuring global recovery from COVID-19 will require significant support for vaccine delivery in LMICs. The economies of many of these countries have been decimated by the pandemic.

As the Bill & Melinda Gates Foundation’s recent Goalkeepers report points out, 25 years of progress has been lost in just 25 weeks. The COVAX Advance Market Commitment enables the scale up of vaccines in countries without the ability to procure them. While recent pledges of just under $1 billion on the margins of the virtual U.N. General Assembly have helped increase resources for the Advance Market Commitment within COVAX, significantly more is needed.

Commitments to COVAX are a demonstration that health is a human right that cannot be denied based on nationality, geography, or any other characteristic. And in a pandemic, health equity is our only option.

So, with multilateral efforts such as COVAX, and similar efforts through the Access to COVID-19 Tools Accelerator, we improve our ability to respond to COVID-19 faster and better. It is only through global cooperation that we will bring the pandemic to an end, restore economic productivity around the world, and build — and rebuild — strong health systems for the future.

COVAX represents just one of three pillars within the ACT Accelerator, launched by WHO, the European Commission, and France in April. The total cost to cover all three pillars of the ACT Accelerator, plus associated support for health systems is expected to be $38 billion, of which less than 15% has been raised.

Many countries and global partners have offered loans and other forms of support, including previously announced funds that can be utilized in support of the Accelerator’s aims. While these contributions are a good start, a concerted global effort will be needed to ensure that the global resource gap is filled so that tools are developed and reach people around the world without delay.

We must all come together to address a global problem as a global community.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Nikolaj Gilbert

    Nikolaj Gilbert is president and chief executive officer of PATH and managing director of PATH’s Swiss subsidiary, Foundation for Appropriate Technology in Health. He brings to his roles more than 20 years of international experience as a leader, strategist, and director of complex partnerships. With a proven track record in both the private and public sectors, his expertise spans health, peace building, humanitarian aid, and development solutions.