With scarce funding for ACT-A, 'everything moves slower': WHO's Bruce Aylward

The World Health Organization-led Access to COVID-19 Tools (ACT) Accelerator is considering the potential of a burden-sharing model to unlock much needed financing. The global initiative remains severely underfunded almost 10 months since its launch in April 2020, although it received a financing boost from G-7 leaders last week.

Under the concept of burden sharing, countries will be asked to contribute based on their gross domestic product per capita and economic openness, as defined by the International Monetary Fund.

Projected asks include more than $5 billion for the United States alone, although this is not yet final and still being discussed with country officials.

“Norway is already one of the highest per capita donors to this, but ... always the world looks to the U.S. and the role they can play,” Bruce Aylward, senior adviser to the WHO director-general and coordinator of the ACT-Accelerator work, told Devex in an interview.

Pledges to the ACT-Accelerator — envisioned as the global platform through which the international community can collaborate to find the tools to detect, treat, and prevent COVID-19 and deliver them in countries — is currently at only $10.3 billion.

Adjustments have since been made to the total financial requirement, originally $38 billion, as the focus shifts from discovering and developing COVID-19 diagnostics, treatment, and vaccines to procuring, scaling, and optimizing their uptake in countries, and addressing emerging SARS-CoV-2 virus variants. But even with the additional funding boost at the G-7 last Friday, it is still short of $22.9 billion.

The struggle to raise funding has created constraints in the delivery of the initiative’s goals, from securing and procuring COVID-19 vaccine doses to ensuring there’s sufficient testing kits, treatment, and personal protective equipment in countries, particularly in lower-income countries. The ACT-Accelerator’s vaccines pillar COVAX, which has received the most attention among the initiative’s dedicated pillars, has yet to make its first vaccine delivery.

The finance working group — created under the ACT-A Facilitation Council, which was set up to provide higher level political engagement to the work of the ACT-Accelerator — is looking at a range of funding streams, including bonds, to fill the gap. However, the bulk of the financing is still expected to come in the form of aid.

“You can’t strip the health ODA budget to do this, but your ODA budget is going to fail if you can't deal with the [COVID-19] crisis,” Aylward said, referring to official development assistance.

“We're going to have to find the money in the international system,” he added.

The game plan

Consultations to create buy-in will be crucial in the burden-sharing model, as well as providing countries the evidence for why they need to support it.

Multiple studies have already been published in the past year making the case for investing in COVID-19 technologies, and ensuring their equitable distribution. A study commissioned by the International Chamber of Commerce, published last month, pointed to a slow economic recovery, including in high-income countries, if vaccines were not distributed across all countries.

Half of an estimated $9 trillion economic losses due to unequal distribution of the vaccines will be paid for by high-income countries themselves.

“You have to have that kind of a business case going into this discussion about burden sharing because otherwise they're going to say, ‘Look, our economies are shattered. We're not in a position to finance low-income countries,’” Aylward said.

The issue isn’t the availability of evidence, but where the money will come from. Aylward hopes governments will apportion a part of their domestic stimulus packages to the ACT-Accelerator.

In December, the U.S. Congress passed a $900 billion stimulus bill that included $4 billion for GAVI, the Vaccine Alliance. On Friday, U.S. President Joe Biden announced at the G-7 the allocation of $2 billion of this funding to COVAX’s Advance Market Commitment mechanism, which supports the rollout of COVID-19 vaccines to 92 low- and middle-income countries.

The remaining $2 billion will be allocated in 2021 and 2022, with the release of the first $500 million of that funding dependent on the fulfillment of donor pledges to COVAX and the facility’s delivery of initial doses to countries.

The U.S. Congress is currently discussing a larger stimulus package that could include at least $11 billion for the global COVID-19 response. Aylward said they plan to speak with the U.S. government to ask if a proportion of this stimulus package can also support their work, including COVAX.

‘Everything moves slower’

 Aylward explained that more money needs to come in by the second quarter of the year to buy the available COVID-19 products and distribute them.

This includes COVID-19 vaccines, a number of which have already been shown to work in preventing severe disease and hospitalizations. But supply of the vaccines is still very limited, and much of it is being bought up by higher income countries. This creates problems for COVAX, and delays vaccine administration in low-income countries.

Without sufficient funding, “we cannot close the deals on the vaccines that we have, or if we do close the deals and we lock in the deal, we have to buy it ...  and that requires a big cash flow,” Aylward said.

“And if we ... haven't got the money to … buy it right off the shelves, then someone else buys that stock [and] we have to wait till they produce it again right till the next production cycle,” he added.

He describes this situation as “bad for the countries, bad for COVAX, bad for equity, bad for the global economy, bad for everything.”

“It's good for people selling vaccines but it ain't good for anybody else,” he said.

Compared to the U.S. government’s Operation Warp Speed and the European Union, the COVAX Facility’s “war chest is not big enough,” the WHO official said. Aylward has also commented on emerging narratives against COVAX.

“I see people announcing that, ‘Oh we want to do this with COVAX, but COVAX isn't ready’ … but COVAX was ready in December. That is a self-fulfilling prophecy,” he said.

“If you don't want to donate vaccines through COVAX, or you don't want to finance … COVAX, you don’t want to buy your vaccines through it, you know, admit it that you want to jump the queue, or admit that you know you want to do a bilateral deal with a friendly country or something else, but don't blame COVAX,” he added.

Insufficient funding also prevents WHO and its multilateral partners from buying test kits for which it has volume and price guarantees. Lack of testing can lead to the virus spreading in populations undetected.

“Look at the map of where COVID diseases [are] today and where variants are today. There [are] holes all over it. There's insufficient testing out there. We don’t know the enemy well enough,” Aylward said.

The funding crunch can impact COVID-19 treatment too. While there’s now an effective treatment against severe COVID-19, Aylward said dexamethasone works if a patient is also given oxygen. But a number of countries are experiencing oxygen supply shortages, including those in sub-Saharan Africa. Oxygen can be challenging to deliver to countries, too.

With insufficient funding, “everything moves slower … that's the bottom line,” Aylward said.