Vaksinekappløpet, prioritering og fordeling - ACT-A og COVAX

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Vaksinekappløpet, prioritering og fordeling -

ACT-A og COVAX

John-Arne Røttingen, Ambassadør for global helse

Kurs I: Global Helse

15.4.21

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COVID-19 has claimed >2 million lives, with >100 million confirmed cases

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The COVID-19 epidemic curve

Courtesy of Gunnstein Norheim, based on Anderson et al 2020 Lancet, Kissler Lipsitch 2020

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David J. Payne et al. Phil. Trans. R. Soc. B 2015;370:20140086

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The traditional

pharmaceutical

commercial

model

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Imbalances in global R&D investments and public health needs

Only $3 billion (1-2% of total) invested globally on R&D for neglected diseases

Neglected diseases: Tuberculosis, malaria and tropical diseases, around 12% of GBD

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Need for public private partnerships (PPPs)

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Guinea Ebola ring vaccination trial 2014-16

Henao-Restrepo et al. Lancet July 31st 2015

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8

Research as part of epidemic preparedness

A systematic approach to accelerate product R&D to contribute to uncover research gaps

DISEASE _methodol. ^Generic/ ^CCHF Ebola &

Marburg

Lassa fever

MERS-Cov &

SARS

Nipah &

henipavirviru ses

Rift valley

fever Zika virus Pathogen X Plague Chikungunya

R&D roadmap ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ^✓

TPP Vx ✓ ✓ ✓ ✓ ✓ ✓ ✓ ^✓

TPP Tx ✓

TPP Dx ✓ ✓ ✓ ✓ ^✓ ^✓

Regulatory standards ✓ ✓ ✓ ✓ ✓

Vx trials design ✓ ✓ ✓ ✓ ✓ ✓ ✓ ^✓ ^generic ✓ ✓

Tx trials design ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Decision tree design ✓ ✓ ✓

Trial simulator ✓ ✓ ✓

Innovative analysis ✓ Accumulating evidence from randomized clinical trials across outbreaks ✓

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Start stability study

1 Jan

Testing of Ebola vaccines during the West African epidemic

9 months

90 rings

Guinea working group formed WHO High level meeting

23 Oct

Extension to Sierra Leone

1 Sept

WHO Ethics Report

11 Aug

Ring design decided

5 Nov

Vaccine choice

5 Feb

Vaccination initiated

23 Mar

Last randomized ring vaccinated

7 Aug

WHO Consultation on Ebola Vaccines

29-30 Sept

Protocols / Financing

Dec-Jan

Preliminary results

31 Jul

Interim analysis

20 Jul

6-9 months

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• accelerate development of tests, treatments & vaccines

• ensure equitable access to COVID-19 tools globally

Working with Governments, Civil Society and Industry for impact

COVAX

Global collaboration –

The Access to COVID-19 Tools (ACT) Accelerator

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ACT-Accelerator made a real difference in 2020, laying the groundwork for 3 robust lines of defense against COVID-19 globally in 2021

Vaccines: COVID-19 infection can be prevented everywhere

COVAX Facility & products have transformed the outlook for vaccination, with the capacity to distribute >2Bn vaccine doses in 190 countries & economies

Tests: COVID-19 disease can now be detected anywhere

New, affordable & high-quality Rapid Diagnostics (RDTs) transform our capacity to detect infection anywhere, with access to >375 m low-cost tests for LMICs

Treatment: life-threatening illness can be treated anywhere

Dexamethasone, the first and only proven therapy for severe COVID-19 has transformed our ability to save lives, with global guidance and an urgent stockpile of 2.9 m courses

Global Access & Allocation Framework & COVAX Mechanisms

Catalytic health systems support to deliver new products & PPE Equitable Access: crucial

investments to ensure

access & stimulate

update, everywhere

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CEPI’s priority pathogens

5 vaccine candidates

6 vaccine candidates

4 vaccine candidates

2 vaccine candidates

3 platform technologies

+ COVID-19 2 vaccine

candidates

Rift Valley fever Disease X Chikungunya

Nipah Lassa

MERS

• Enabling sciences incl. epidemiology studies

• Ebola

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COVID-19 vaksiner utprøving

Svært strenge krav til vaksiner mht.

sikkerhet og innhold

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Mer enn 250 vaksiner under utvikling

16

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85 COVID-19 vaksiner under klinisk utprøving

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COVID-19 vaccine doses administered/100 people

3 big shifts inform the 2021 ACT-A Strategy

A strong global, integrated and agile response is crucial:

scaling up tools while adapting to an evolving context We have entered the era of COVID-19 vaccines

Viral variants are emerging with increasingly concerning characteristics

Variants of concern in > 100 countries

International collaboration is increasingly

fragmented & underinvesting in global solutions

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1. Ensure equitable access and fair allocation 2. Ensure delivery at scale of 2bn doses & provide

country support

3. Accelerate further development of safe, efficacious and programmatically-optimized vaccines to address new risks

Vaccines Diagnostics

1. Secure equitable access to tests: procurement of 900 mn tests

2. Stimulate rapid & effective uptake in countries 3. Drive development and at-scale availability of affordable, transformative, digitally-integrated tests

Therapeutics Health Systems Connector

1. Intensify research efforts: develop clinical pipeline & broaden portfolio, incl. combinations 2. Ensure market readiness and access & support

countries in optimizing clinical care 3. Drive successful uptake and scaled

procurement of available therapeutics, incl. O

₂

1. Contribute to the identification of key health systems bottlenecks in countries

2. Support countries to address the health system bottlenecks or weaknesses identified

3. Accelerate the availability of PPE as high priority commodity

Pillar-specific priorities for 2021

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20 Note: all financial commitments can be accessed at https://www.who.int/publications/m/item/access-to-covid-19-tools-tracker. 1. FX will be adjusted when the pledge will be disbursed.

1. US$ 10.9 billion include $470m contributed by the Diagnostics Consortium to procure automated and manual molecular tests for LMICs, not displayed on the chart 2. Contributions <US$ 12m, and including $470m contributed by the Diagnostics Consortium to procure automated and manual molecular tests for LMICs

4. Includes: CAD 330m from Canada, and EUR 460m from Germany pending allocations to pillars by ACT-A agencies (EUR 270m for WHO, EUR 140m for the Global Fund, and EUR 50m for FIND – projected to be distributed as such: EUR 190m for Vx, EUR 5m for Tx, EUR 165m for Dx, and EUR 100m for HSC).

BMGF 3.2%

European Commission 5.5%

Germany 23.9%

Saudi Arabia 2.9%

Gavi 1.4%

Canada 6.9%

United Kingdom 10.1%

Norway 4.1%

Japan 2.8%

France 1.5%

Spain 1.3%

Italy 1.1%

Michael & Susan Dell Foundation 0.2%

Netherlands 0.9%

Sweden 0.3%

Wellcome Trust 0.5%

Australia 0.7%

Reed Hastings and Patty Quillin 0.3% Mastercard 0.2%

Kuwait 0.4%

United States 22.8%

Chan Zuckerberg Initiative 0.2%

New Zealand 0.2%

Unitaid 0.3%

Others 7.4%²

Anonymous Foundation 0.2%

Switzerland 0.6% Denmark 0.1%

US$ 11.0 billion

Updated ACT-A Funding Gap Post G7

ACT-A contributions

% of total commitments

¹

, as of 25 February 2021

ACT-A 2021 Funding Gap

In USD Bn by pillar, as of 25 February 2021

Vaccines Therapeutics Diagnostics HSC Pending allocation &

operationalization⁴ Total ACT- A Gap 2021

7.4

3.5

3.2

8.9 0.8 22.2

An additional $500m from the US will be contributed to delivery

of vaccines in LMICs across 2021 and 2022

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"…if medical solutions can be made available faster and more widely relative to our baseline, it could lead to a

cumulative increase in global income of almost $9 trillion by end-2025"

IMF World Economic Outlook, October 2020

Addressing ACT-A’s urgent needs

=

only days of that income and would save countless lives

Source: full report here and IMF blog here

IMF World Economic Outlook Report (7 Oct) fully supports the ACT-Accelerator Investment Case

Aug

Jan Feb Mar Apr May Jun Jul Sep Oct Feb'21 Dec'21

4.2 Today

Weekly Number of cases by region, in million Read-outs & scale-up

Pessimistic

Optimistic

Impact

(illustrative)

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22

Investing in ACT-A delivers a higher multiplier than any

domestic fiscal measure

And here is why…

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Investing in ACT-A dwarves both the 2020 stimuli and the economic benefits that it will generate – it is a no brainer

0.8 – 1.3

Untargeted transfer Targete

d labor tax

Targete d transfer

Global trade- based

²

Untargeted

labor tax

GDP- based

¹ ICC models

0.9 – 1.3 0.1 – 0.4 0.2 – 0.4

70 - 166

~90

~40

Economic multipliers per type of fiscal support

2020 fiscal support investments Investment in ACT-A

$12t

ACT-A funding needs 2020 fiscal

support

$38b

< 1%

G20 fiscal support and ACT-A funding needs – in USD

Note: multipliers are calculated over a period of one to five years

1. ACT-A Hub analysis, example of EU 2. Eurasia report, sponsored by the Bill & Melinda Gates Foundation, RAND analysis, ACT-A Hub analysis, example of EU Source: International Chamber of Commerce, IMF WEO 2020, Eurasia report sponsored by the Bill & Melinda Gates Foundation, RAND report

Several methodologies to estimate the multiplier

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Supporting LICs is a sound economic

"security" measure, beyond a moral obligation

~50% of the global economic losses will be borne by HICs in 2021, even if they achieve total domestic vaccination

GDP losses for High Income Countries

Scenario

Cost for High-Income Countries

– in USD trillion

Cost for High-Income Countries

– in % of global losses

Scenario 1 2.1 43%

Scenario 2 4.5 49%

Scenario 3 2.4 53%

Source: International Chamber of Commerce, , January 2021

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The Facilitation Council Financial Working Group evaluated several mechanisms to unlock funding for ACT-Accelerator

1 > 10 billion USD p.a 1 1-10 billion USD p.a 1 <1 billion USD p.a Potential per annum

Classification of potential ACT-A financing mechanisms by speed of funding,

opportunity to earmark for ACT-A, and potential size

NOTE: Direct 'ACT-A funding' refers to mechanisms that earmark funds directly to ACT-A; Semi-direct funding refers to mechanisms that earmark funds to COVID- 19 related health issues; Indirect funding refers to mechanisms that do not allow earmarking or with low earmarking & tracking possibility. 'Time to unlock funding' refers to how fast funds can be disbursed for development purposes Source: Experts interviews; BCG analysis

Category of financing Mechanisms for LICs/LMICs

Mechanisms for HICs/UMICs New Public Revenue Streams for LICs, LMICs, UMICs and HICs

Di rec t

Q1-2 2021 Q3-4 2021 Q1-2 2022

Debt-swaps c

a Loan buy- downs

Liquidity &

Sustainability Facility

j

h New issuance of SDR g

Existing SDR

m Sector tax (ex: airline tickets) o

Global Transaction Tax

k Sovereign insurance pool CCRT/PRGT d

(IMF)

n Carbon tax

e Direct grants

Time to unlock funding & Complexity

World Bank f MPA

i Social bonds b Reuse IFFIm

Sem i- di rec t Indi rec t

A bi lity to di rec t funds to A C T- A

Most suitable mechanisms

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The Facilitation Council proposed a 5-step approach for countries to burden share the cost of ACT-A

5-step approach to build rational burden-sharing across HICs & UMICs, adjusted with qualitative analysis – modelled after IMF quota approach

1. For example, considering the debt or interest burden for UMICs

Public, data driven analysis Confidential Ask

Contribution should be proportional to GDP

GDP adjusted to

’openness’ per IMF quotas

Proportion rate on GDP/Capita used to reflect inequalities

Final adjusted ask for each country using qualitative assessment

¹

Risk margin built

in, in case non-

contributing

countries

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0 1 2 3 4 5 6 7 8 9

0.04%

0.10%

0.00%

0.05%

0.02%

0.01%

0.03%

0.06%

0.07%

0.08%

0.09%

0.11%

0.12%

0.13%

Weight on GDP/Capita (b) Contribution as % of GDP, including the 20% default risk

USA European Union China Japan Germany Brazil UK Canada Norway Switzerland

Model Outputs I Overview of target contribution for selected countries as share of GDP depending on the weight on GDP/Capita ("b")

Note: For EU member states we have presented numbers for both EU in total as well as for individual member states since they are contributing both from the union as well as country level Source: WHO, IMF, World Bank

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1. Model outputs including the 20% buffer to offset potential default risk of several targeted countries. Excluding EC.

Source: United Nations, WHO, IMF, World Bank

Estimated contribution range by country

¹

, top 1-30 donors in USD Bn

The co-chairs Norway & South-Africa will adjust the final ask based on target contribution from the model and other

factors – such as debt situation

Model Outputs I Target contributions generated for each country, with a progressive contribution of GDP/Capita and 20% default risk buffer (1/2)

0 1 2 3 4 5 6 7 8 9 10 11 12

Contribution range Target contribution PAN

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Model Outputs I Overview of target contribution as share of GDP in perspective with GDP per capita and target contribution by country

0.11%

0.05%

0.03%

0.06%

40 0.10%

0.08%

0.09%

0.00%

0 0.12%

20 0.14%

60 0.13%

0.15%

80 0.04%

0.07%

120 0.01%

0.02%

Korea Italy

GDP/capita in USD k

Spain

Brazil Russia Mexico China

Belgium

Saudi Arabia Japan

Denmark

Turkey Indonesia

Austria

Ireland

Poland

Argentina Australia

Sweden

Contribution as % of GDP with b=5

Czech Rep.

South Africa

USA

Luxembourg

Switzerland

Norway Singapore

UAE Israel

Finland

Germany

Qatar

New Zealand

Iran

U.K.

Chile

Netherlands

France Canada

Thailand Malaysia

G20 Countries Non G20 countries

Expected

contribution in USD Bn Legend

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Vaksinekappløpet, prioritering og fordeling - ACT-A og COVAX