US global COVID-19 response shifting from vaccine supply to uptake

If it can secure funding from the U.S. Congress, President Joe Biden’s administration is planning a major scale-up of an initiative that aims to pivot from increasing global COVID-19 vaccine supply to actually getting shots into arms.

“We are trying to significantly accelerate and expand vaccine uptake, particularly in sub-Saharan Africa,” a senior U.S. Agency for International Development official told Devex.

The amount of funding under discussion would put the Initiative for Global Vaccine Access, or Global VAX, on par with the largest U.S. global health programs. Its goal would be to draw upon the capabilities of those other U.S. programs — such as the President’s Malaria Initiative and the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR — while minimizing “the degree to which we need to cannibalize them” by diverting people and resources from other health priorities, the official said.

USAID Administrator Samantha Power launched Global VAX at a ministerial meeting on COVID-19 in December, with initial funding of roughly $500 million drawn from USAID’s portion of the American Rescue Plan — a nearly $2 trillion U.S. stimulus bill passed in March.

“We will be spending down in effect the remainder of that funding to get Global VAX underway, and then we will need to see what the … [fiscal year 2022] budget cycle holds,” the senior USAID official said.

The official — who spoke on the condition of anonymity, citing agency policies — said that the White House’s estimate from September of a $10 billion funding gap to achieve 70% vaccination rates in low- and middle-income countries by mid-2022 still holds up. The cost requirements are likely a bit higher now that the scientific case for adding boosters to the COVID-19 immunization schedule is stronger, the official noted.

“What we're trying to do now is figure out both what is an appropriate U.S. government share of that, but also to work with other donors and the World Bank in order to mobilize what it will take to get that done,” the senior official said.

“The World Bank is going to have to play a really, really critical role here as well,” the official said, adding that the administration is also working to bring private sector and philanthropic partners into the mix.

“Global companies have a strong interest in seeing the world get vaccinated and try to return to some sort of new economic normal,” the official added.

A group of U.S. lawmakers have called on their colleagues to include $17 billion in supplemental funding in the fiscal year 2022 budget bill for accelerating delivery of COVID-19 vaccines to lower-income countries, as well as for testing, therapeutics, personal protective equipment, ventilators, low-temperature supply chains, and health care workers. That budget bill is expected to be negotiated by Feb. 18, and the Biden administration is under pressure to include the same amount in its next budget request.

The Global VAX initiative is led by USAID. “That’s been tasked to Administrator Power, and she has been driving really hard on that,” the senior official said.

This would continue to be the case if Global VAX receives a major injection of funds. A previous pandemic response proposal that was developed during the final year of former President Donald Trump’s administration — which was never approved — would have put a State Department coordinator in charge of leading these efforts.

“Obviously, it's not something that only USAID is going to do,” the senior official said, citing roles for the Centers for Disease Control and Prevention, the Peace Corps, and particularly PEPFAR, which already coordinates staffers from multiple U.S. agencies to deliver HIV-specific health services.

The senior official told Devex that USAID’s goal in coordinating Global VAX will be “to build off of those platforms” that the U.S. government has already built.

“What we're in the process of doing now is kicking off some country planning that will marshal all those different capabilities, country by country, to engage with country governments on what they need and how best we can support their plan,” the senior official said.

“That's where the additional resources become really important … The partners that we work with always have capacity to expand it [their COVID-19 response planning] if more resources can be added to the next,” the official said, citing the response to West Africa’s 2014 Ebola outbreak, which built on existing water and sanitation programs.

“We're pretty optimistic that by bringing these new resources into the mix, we can capitalize on the capabilities that those platforms have in place without diverting their ability to continue to serve their core missions,” the senior official said.

Last week, the heads of PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria wrote jointly in The Hill that their combined efforts to prevent and treat HIV have built the “foundations” for many countries to respond to COVID-19.

“We are poised to continue supporting them to meet these evolving challenges well into the future,” wrote acting U.S. Global AIDS Coordinator Angeli Achrekar and Global Fund Executive Director Peter Sands.

Asked about PEPFAR’s role in Global VAX, a spokesperson for the global AIDS coordinator’s office, which oversees PEPFAR, referred Devex back to USAID.

Global VAX’s focus on increasing vaccination rates reflects the Biden administration’s assessment that the biggest binding constraint in low- and middle-income countries has shifted from vaccine supply to vaccine uptake capacity, the senior USAID official said.

The official added that while some media reports have raised doubts about the level of demand for COVID-19 vaccines in low-income countries or suggested high amounts of vaccine hesitancy, the U.S. government has found that increasing vaccination rates quickly and significantly is possible with the sufficient resources.

“I think what we have seen very consistently in our engagement and our planning that has underpinned Global VAX is that there is really high potential. The challenge is not so much one of hesitancy. It's one of accessibility,” the senior official said.

“When [low- and middle-income countries] have access to the resources and the technical support and planning support that they need, they can show … rapid, significant improvement in vaccine uptake,” the official said.