Access to COVID-19 Tools Accelerator
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The Access to COVID-19 Tools Accelerator (ACT Accelerator or ACT-A), or the ''Global Collaboration to Accelerate the Development, Production and Equitable Access to New COVID-19 diagnostics, therapeutics and vaccines'', is a
G20 The G20 or Group of Twenty is an intergovernmental forum comprising 19 countries and the European Union (EU). It works to address major issues related to the global economy, such as international financial stability, climate change mitigation, ...
initiative announced by pro-tem Chair
Mohammed al-Jadaan Mohammed Al-Jadaan ( ar, محمد بن عبد الله الجدعان; born 1963) is a commercial lawyer and co-founder of Al-Jadaan and Partners Law Firm who has served as Saudi Arabia's minister of finance since November 2016 and concurrently as ...
on 24 April 2020. A call to action was published simultaneously by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) on 24 April. As of January 2022, it was the largest international effort to achieve equitable access to COVID-19 health technologies.


Definition

The ACT Accelerator is a multinational collaboration, and
multistakeholder initiative Multistakeholder governance is a practice of governance that employs bringing multiple stakeholders together to participate in dialogue, decision making, and implementation of responses to jointly perceived problems. The principle behind such a s ...
including the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
, the Coalition for Epidemic Preparedness Innovations (CEPI), FIND,
GAVI GAVI, officially Gavi, the Vaccine Alliance (previously the GAVI Alliance, and before that the Global Alliance for Vaccines and Immunization) is a public–private global health partnership with the goal of increasing access to immunization ...
the Vaccine Alliance,
the Global Fund The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) is an international financing and partnership organization that aims to "attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, t ...
,
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
,
Unitaid Unitaid is a global health initiative that works with partners to bring about innovations to prevent, diagnose and treat major diseases in low- and middle-income countries, with an emphasis on tuberculosis, malaria, and HIV/AIDS and its deadly co ...
, Wellcome, the
World Bank The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Interna ...
and governments, to raise financial support of accelerated
research and development Research and development (R&D or R+D), known in Europe as research and technological development (RTD), is the set of innovative activities undertaken by corporations or governments in developing new services or products, and improving existi ...
, production, and globally-equitable access to COVID-19 tests, therapies, and vaccines. It is a framework for collaboration, not a new organization or a decision-making body. In March 2020, G20 leaders had called for a cross-discipline support structure to enable partners to share resources and knowledge and in April 2020 it was launched by WHO, European Commission, France and the Bill & Melinda Gates Foundation. On 24 April 2020 pro-tem Chair
Mohammed al-Jadaan Mohammed Al-Jadaan ( ar, محمد بن عبد الله الجدعان; born 1963) is a commercial lawyer and co-founder of Al-Jadaan and Partners Law Firm who has served as Saudi Arabia's minister of finance since November 2016 and concurrently as ...
announced it, simultaneously to the WHO. Sir
Andrew Witty Sir Andrew Philip Witty (born 22 August 1964) is a British business executive, who is the current chief executive officer (CEO) of UnitedHealth Group. He was also the CEO of GlaxoSmithKline between 2008 and 2017. He formerly held the role of chan ...
and Dr Ngozi Okonjo-Iweala accepted to act as Special Envoys to the ACT Accelerator from the WHO. The ACT Accelerator comprises four pillars, each managed by two to three collaborating partners:1) Vaccines (also called "COVAX" pillar), 2) Diagnostics, 3) Therapeutics and 4) Health Systems Connector. Diagnostics are the most important medical technology available to monitor and control the spread of COVID-19, to avoid repeated lockdowns, which threaten economies and ways of life. Testing supports healthcare services to be managed and COVID-19 transmission to be suppressed. The therapeutics pillar is a research effort to discover and develop promising
COVID-19 drug development COVID-19 drug development is the research process to develop preventative therapeutic prescription drugs that would alleviate the severity of coronavirus disease 2019 (COVID-19). From early 2020 through 2021, several hundred drug companies, bi ...
for COVID-19 infection and illness. It involves monitoring over 1,700 clinical trials, and was part of the effort to provide
dexamethasone Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cav ...
for up to 2.9 million patients in low-income countries and facilitates future access to monoclonal antibody therapies in low- and middle-income countries. The pillar for
health system Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
s analyzes needs and resources in some 100 countries to identify problems, capacity, and requirements for access to and implementation of COVID-19 tools across world regions. The COVAX pillar has the goal of facilitating licensure of several COVID-19 vaccines, influencing equitable pricing, and providing equal access for up to 2 billion doses by the end of 2021 to protect frontline healthcare workers and people with high-risk of COVID-19 infection, particularly in low-to-middle income countries.


Coalition for Epidemic Preparedness Innovations

In 2017, a multinational organization named Coalition for Epidemic Preparedness Innovations, CEPI was formed. It is working with international health authorities and vaccine developers to create vaccines for preventing epidemics. Over 2020 throughout the pandemic, CEPI funded the development of nine COVID-19 vaccine candidates in a portfolio deliberately made diverse across different vaccine technologies to minimize the typically high risk of failure inherent in vaccine development. As of December 2020, CEPI supported the vaccine research organizations and programs of AstraZeneca/
University of Oxford , mottoeng = The Lord is my light , established = , endowment = £6.1 billion (including colleges) (2019) , budget = £2.145 billion (2019–20) , chancellor ...
( AZD1222), Clover Biopharmaceuticals (SCB-2019),
CureVac CureVac N.V. is a German biopharmaceutical company that develops therapies based on messenger RNA (mRNA). Legally domiciled in the Netherlands and headquartered in Tübingen, Germany, the company was founded in 2000 by Ingmar Hoerr (CEO), S ...
(Zorecimeran/CVnCoV),
Inovio Inovio Pharmaceuticals is an American biotechnology company focused on the discovery, development, and commercialization of Synthetic genomics, synthetic DNA products for treating cancers and infectious diseases. In April 2020, Inovio was among so ...
(INO-4800),
Institut Pasteur The Pasteur Institute (french: Institut Pasteur) is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who invented pasteurization and vaccines fo ...
(MV-SARS-CoV-2),
Moderna Moderna, Inc. ( ) is an American pharmaceutical and biotechnology company based in Cambridge, Massachusetts that focuses on RNA therapeutics, primarily mRNA vaccines. These vaccines use a copy of a molecule called messenger RNA (mRNA) to produ ...
( mRNA-1273),
Novavax Novavax, Inc. is an American biotechnology company based in Gaithersburg, Maryland that develops vaccines to counter serious infectious diseases. Prior to 2020, company scientists developed experimental vaccines for influenza and respiratory sy ...
(NVX-CoV2373), SK bioscience (GBP510), and Hong Kong University. CEPI is an observer of the
Global Research Collaboration for Infectious Disease Preparedness The Global Research Collaboration for Infectious Disease Preparedness (GloPID-R) is an international initiative to anticipate and prepare for future threats from infectious diseases. GloPID-R is intended to be a means for facilitating communication ...
(GLoPID-R) which was working closely with the WHO and member states to identify priorities for funding specific research needed for a COVID‑19 vaccine, coordinating among the international funding and research organizations to maintain updated information on vaccine progress and avoid duplicate funding.


Timeline

On 10 September, 2020 the UN and the European Union co-hosted the inaugural meeting of the Facilitation Council of the ACT-Accelerator, which had received $2.7 billion of the $35 billion necessary to secure the 2 billion
COVID-19 vaccine A COVID19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID19). Prior to the COVID19 pandemic, an e ...
doses, 245 million treatments, and 500 million tests that the initiative deemed necessary to end the pandemic and speed economic global recovery. In September 2020, ACT Accelerator partners committed to provide 120 million COVID-19 rapid tests for low- and middle-income countries. Although the Trump administration of the United States had withdrawn its financial support of the WHO and ACT Accelerator in 2020, the United States reasserted its support of the WHO and COVAX on 21 January 2021 following the
inauguration In government and politics, inauguration is the process of swearing a person into office and thus making that person the incumbent. Such an inauguration commonly occurs through a formal ceremony or special event, which may also include an inaugu ...
of President Joe Biden. By December 2020, more than 10 billion vaccine doses had been pre-ordered by
developed countries A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
. The manufacturers of three vaccines closest to global distribution Pfizer, Moderna, and AstraZeneca predicted a manufacturing capacity of 5.3 billion doses in 2021, which could be used to vaccinate about 3 billion people (as the vaccines require two doses for a protective effect against COVID-19). Due to the high demand in preorders from rich countries for 2021, people in low-income
developing countries A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
may not receive vaccinations from these manufacturers until 2023 or 2024, increasing the use of the COVAX initiative to supply vaccines equitably. Emphasizing the need for broad distribution of safe, effective vaccines against COVID-19, especially across developing countries,
GAVI GAVI, officially Gavi, the Vaccine Alliance (previously the GAVI Alliance, and before that the Global Alliance for Vaccines and Immunization) is a public–private global health partnership with the goal of increasing access to immunization ...
uses the slogan, "No one is safe until everyone is safe." During 2020, major changes in the overall effort of developing COVID‑19 vaccines were the increasing number of collaborations of the multinational pharmaceutical industry with national governments, and the diversity and growing number of
biotechnology companies Biotechnology is the integration of natural sciences and engineering sciences in order to achieve the application of organisms, cells, parts thereof and molecular analogues for products and services. The term ''biotechnology'' was first used b ...
in many countries focusing on a COVID-19 vaccine. According to CEPI, the general geographic distribution of COVID‑19 vaccine development involves organizations in North America having about 40% of the world's COVID-19 vaccine research, compared with 30% in Asia and Australia, 26% in Europe, and a few projects in South America and Africa.


Financing

In May 2020, the WHO had a telethon which raised billion in pledges from forty countries to support rapid development of vaccines. As of May 2020 CEPI organized a billion fund in a global partnership between public, private, philanthropic, and civil society organizations for accelerated research and clinical testing of nine COVID-19 vaccine candidates, with the 2020–21 goal of supporting several candidate vaccines for full development to licensing. By early May 2020, the United Kingdom, Canada, Belgium, Norway, Switzerland, Germany and the Netherlands had already donated million to CEPI. The Gates Foundation, a private
charitable organization A charitable organization or charity is an organization whose primary objectives are philanthropy and social well-being (e.g. educational, Religion, religious or other activities serving the public interest or common good). The legal definitio ...
dedicated to vaccine research and distribution, was donating million in support of CEPI for research and public educational support on COVID‑19 vaccines. In December 2020, the Gates Foundation donated another million to the ACT Accelerator to "support the delivery of new COVID-19 tests, treatments, and vaccines, particularly in low- and middle-income countries" during 2021, making the Foundation's total donation of billion toward the COVID-19 response. As of December 2020, billion had been raised for the overall ACT Accelerator, with nine vaccine candidates being funded by COVAX and CEPI the world's largest COVID-19 vaccine portfolio with 189 countries committed to the eventual deployment plan. See table above.


National governments contributions

In May 2020, France announced a million investment in a COVID‑19 vaccine research consortium via CEPI involving the
Institut Pasteur The Pasteur Institute (french: Institut Pasteur) is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who invented pasteurization and vaccines fo ...
, Themis Bioscience (
Vienna en, Viennese , iso_code = AT-9 , registration_plate = W , postal_code_type = Postal code , postal_code = , timezone = CET , utc_offset = +1 , timezone_DST ...
,
Austria Austria, , bar, Östareich officially the Republic of Austria, is a country in the southern part of Central Europe, lying in the Eastern Alps. It is a federation of nine states, one of which is the capital, Vienna, the most populous ...
), and the
University of Pittsburgh The University of Pittsburgh (Pitt) is a public state-related research university in Pittsburgh, Pennsylvania. The university is composed of 17 undergraduate and graduate schools and colleges at its urban Pittsburgh campus, home to the universit ...
, bringing CEPI's total investment in COVID‑19 vaccine development to million by May. Belgium, Norway, Switzerland, Germany, and the Netherlands have been major contributors to the CEPI effort for COVID‑19 vaccine research in Europe. On 4May 2020, the Canadian government committed million to the WHO's live streaming effort to raise billion for COVID‑19 vaccines and preparedness. On 18 May 2020, China had pledged billion to support overall efforts by the WHO for programs against COVID‑19. On 22 July 2020, China announced that it planned to provide a US$1 billion loan to make its vaccine accessible for countries in Latin America and the
Caribbean The Caribbean (, ) ( es, El Caribe; french: la Caraïbe; ht, Karayib; nl, De Caraïben) is a region of the Americas that consists of the Caribbean Sea, its islands (some surrounded by the Caribbean Sea and some bordering both the Caribbean Se ...
. On 24 August 2020, Chinese Premier
Li Keqiang Li Keqiang (born 1 July 1955) is a Chinese politician who is the outgoing premier of China. An economist by profession, Li is head of China's executive branch as well as one of the leading figures behind China's Financial and Economic Affai ...
announced it would provide five Southeast Asian countries of Cambodia, Laos, Myanmar, Thailand and Vietnam priority access to the vaccine once it was fully developed.


Controversies


Inequities

COVAX is designed to assist vaccine purchases and distribution for poor and middle-income countries unable to compete in the open market and avoid inequities for vaccine access. However, by December 2020, more than 10 billion vaccine doses had been preordered mostly by
high-income countries A high-income economy is defined by the World Bank as a nation with a gross national income per capita of US$12,696 or more in 2020, calculated using the Atlas method. While the term "high-income" is often used interchangeably with "First World" a ...
comprising only 14% of the world's population like the United Kingdom, Canada, and the United States. poorer countries, such as
South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, had difficulty obtaining vaccine deliveries, despite having a factory for making COVID-19 vaccines within the country. Half of South African citizens live in poverty, and may receive a vaccine only by participating as volunteers in
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
s. The COVAX administration, governments, and vaccine manufacturers have been criticized for lack of transparency and accountability over fair pricing and equitable allocation of COVID-19 vaccines to developing countries where financial and vaccination resources are limited, and government corruption may exist.


Limited transparency of roles and accountability

In examining the founding principles of participation, transparency, and accountability, one study found lacking clarity on the roles and responsibilities of the stakeholders, questions about potential conflicts of interest, unclear accountability with no ACT-A wide accountability framework and receding role of governments.


References

{{Authority control International responses to the COVID-19 pandemic World Health Organization G20