The COVID-19 pandemic has proven the need for cooperation between nations for global health issues, but current plans, such as COVAX do not go far enough.
COVAX (COVID-19 Vaccines Global Access) is an important pillar to the Access to COVID-19 Tools (ACT) Accelerator, which is a collaborative effort towards the development, production, and access of COVID-19 tests, treatments, and vaccines worldwide (WHO, 2021b). The ACT Accelerator consists of the pillars of diagnostics, therapeutics, vaccines, the health systems connector (tying the other three pillars together), and additionally, the WHO run workstream of access and allocation (WHO, 2021b). COVAX is the pillar focused on vaccine development and access (WHO, 2021a). As such, COVAX has received much attention, as vaccinating against COVID-19 is incredibly important to ending the pandemic. COVAX has the goal of administering COVID-19 vaccine doses for at least 20% of a country’s population long term (WHO, 2021a).
Yet COVAX has not done enough. Upper income countries have administered 84% of COVID-19 vaccines while low income countries have only administered 0.3% (Holder, 2021). Outside of the COVAX agreement, upper income countries are able to out buy other countries by large margins, making it nearly impossible for middle and low income countries to receive additional vaccines outside of their allotted amounts given through COVAX (Rouw et al, 2021). Limited materials or controls on exports cause vaccine prices to spike, making vaccines an unaffordable luxury when they are a necessity (UN News, 2021).
This can be solved through the potential improvement of the ACT-A, COVAX, in the form of the proposed APT-A (Access to Pandemic Tools Accelerator) with an improved version of COVAX called POVAX (Pandemic Open Vaccine Access Accelerator) (Basu et al., 2021).
The original ACT Accelerator consists of the following pillars and workstreams:
Health Systems Connector connecting the pillars
Access and allocation
Two more pillars should be added for economic assistance and preparedness. These pillars are necessary as many countries require additional support in times of crisis, both economically and in terms of the preparedness of their health infrastructure. Currently, the IMF estimates $200 billion is needed in order for low-income countries to increase their COVID-19 spending for obtaining vaccines and rebuilding or maintaining reserves (Chabert et al., 2021). An economic support pillar would be created in collaboration with international financial institutions providing debt-relief and interest-free loans from richer nations to poorer nations (Basu et al., 2021). A preparation pillar would address inequalities that marginalized communities face, which are especially exaggerated in times of crisis such as a pandemic, by implementing laws and policies addressing health inequalities with the input of members of marginalized communities (Basu et al., 2021).
POVAX would include the necessary steps of “1) implementing alternative reward mechanisms for new vaccines, 2) companies to pool intellectual property and other data to speed up research and development and 3) allow low-cost generic production, as well as measures to 4) ensure equitable distribution of resulting products” (Basu et al., 2021). Currently, COVAX does not adequately motivate countries to donate vaccines and it fails to encourage technological innovation rather than competition. POVAX would allow better distribution of vaccines as it would require countries to purchase vaccines ONLY through POVAX, so as to not drive up the prices. (Basu et al., 2021). POVAX would better reward companies for innovation, in order to encourage research and development rather than encouraging market competition, and would require countries to share research and development data (Basu et al., 2021).
It is already in the interest of high income countries to allot vaccines to other nations as to offset the potential for virus mutation, which becomes likely with large unvaccinated populations in lower income countries (Basu et al., 2021). Even if richer nations vaccinate their populations, it is harder to control mutations that arise, take for example the current increase in COVID-19 cases across the United States due to the Delta variant, even among the vaccinated. If only a few countries donate their resources while others hoard for themselves, they will not be able to share enough to have a strong enough influence to stop mutations (Basu et al., 2021). However, if we generate funds for research and development the incentive for R&D would be delinked from sales (Basu et al., 2021). Instead the incentive would be tied to health impact, lowering the price of vaccines and allowing every country to purchase together (Basu et al., 2021). Everyone will benefit by protecting their populations and the global community at large.
POVAX would be a permanent solution unlike COVAX, allowing for quicker vaccine development and easier cooperation the next time there is a pandemic (Basu et al., 2021). After experiencing the devastating effects of COVID-19, it is important to be prepared for the next time a global health emergency might strike.
Comments on the POVAX paper draft are welcome! https://www.brookings.edu/wp-content/uploads/2021/04/Pandemic-preparedness-and-response_final.pdf