Covid-19 vaccine development is advancing at an unprecedented pace, with more than 80 candidates in early stage development, and a number already in human clinical trials. Through vaccination, we can reduce mortality and avoid the need for repeated rounds of distancing measures, and their associated societal and economic impacts. But, while the world urgently needs safe, effective and affordable covid-19 vaccines, this alone won’t be enough to end the pandemic.
To protect the most vulnerable, stop transmission, and prevent a resurgence, beyond developing vaccines quickly, an unprecedented effort is also critical to ensure sufficient and suitable supply of the most effective vaccines and equitable access based on public need, rather than the resources and strategic bilateral connections of individual countries or companies. To achieve this ambition and address the needs of developing countries, one solution is a covid-19 Advance Market Commitment (AMC), to make sure that when vaccines are licensed the capacity is in place to rapidly manufacture and distribute the billions of doses needed.
Gavi has delivered similar innovative financing mechanisms successfully in the past to accelerate the roll-out and availability of both pneumococcal conjugate vaccines (PCV) and Ebola vaccines by committing funds to guarantee the price or purchase of vaccines once they were licensed. Providing assurances of future demand and financing serves as a “pull” mechanism, to incentivise manufacturers to invest in development and manufacturing. In the current emergency context, the covid-19 AMC would go beyond this by additionally using “push” funding whereby public sector funds directly finance, for example, expanding manufacturing, securing critical raw materials and equipment, and transferring technology from developers to manufacturers. This draws upon the experience of the Meningitis Vaccine Project, which took a vaccine from a lab in the Netherlands to a large producer in India. Furthermore, in the case of lower-income countries it would also involve supporting procurement and delivery of vaccine doses.
The ultimate aim of a covid-19 vaccine AMC would be to increase the chances of success, accelerating the availability of the most suitable candidate vaccines by sharing the risks associated with investing in some vaccines that may end up not making it. The best way is if there is a global political commitment to set aside national vaccine strategies and treat covid-19 vaccines as a global public good.
Whether or not there is a such a global agreement, we need to take a global perspective to identify and focus on those vaccine candidates most suited to rapid scaling and use in LICs and MICs, based on scientific merit, regardless of where they come from. Depending on the specific needs of different vaccine developers, push funding would provide much needed immediate cash flows to enable the expansion of manufacturing capacity, technology transfer or reservation of spare capacity. This expansion would come not just from the vaccine developer, itself, but also other manufacturers that have spare capacity or from contract manufacturers.
Once developed and manufactured, LICs and lower-MICs (LMIC) would get access to covid-19 vaccines through a centralised procurement mechanism. Initially, when supply may be limited, this would also help manage equitable allocation based on public need, prioritising highest risk groups, such as healthcare workers, and factor in the need to respond to and contain hotspots. To ensure equity and global effectiveness of deploying the vaccine, the poorest countries could receive support for the costs of securing access to the vaccine, procurement, delivery and technical assistance, while those with more resources could self-finance procurement and delivery.
Such equitable access will be contingent on manufacturers committing to transparency regarding their costs, and pricing could be based on cost of production, with a pre-established, minimal margin consistent with the non-profit principle but assuring reimbursement for the cost of capital for manufacturers to invest. Several large companies have already committed to treat vaccines against covid-19 as non-profit.
The AMC will build upon existing funding efforts aimed at securing equitable access to covid-19 vaccines, such as those initiated by the Bill & Melinda Gates Foundation and the Coalition for Epidemic Preparedness and Innovation, by serving as a common platform. In doing so, it would form a central part, and meet the critical needs, of the Access to covid-19 Tools (ACT) accelerator, launched last week by heads of state and leaders of international institutions, who committed to accelerating the development, manufacturing and equitable distribution of vaccines against covid-19.
With the European Commission hosting its international pledging event on 4 May to help address the funding gaps that must be addressed to make this goal possible, global leaders need to bear in mind not just the need for research and development, but also investment in manufacturing, procurement and delivery of covid-19 vaccines, once they are developed, and a mechanism that can serve as a bridge between development, production and delivery.
This will cost billions. That may sound like a lot. But given that this pandemic is costing the global economy at least US$ 2 trillion a year, any mechanism that helps advance the mass distribution of an effective vaccine by as little as two weeks would pay for itself. Governments can’t afford to keep closing their economies and isolating their populations as waves of this infection circulate. Make no mistake. An AMC is the cheapest option for the health and economic security we all need.
Seth Berkley, CEO of Gavi, the Vaccine Alliance
Competing interests: None declared