LONDON – Two months after the launch, the World Health Organization (WHO) has laid out the spending plans for its push to accelerate development and production of COVID-19 vaccines, therapeutics and diagnostics.

The consolidated investment case calls for $31.3 billion over the next 12 months, of which $3.4 billion has been contributed to date.

The money will accelerate development and fund delivery of 500 million diagnostic tests and 245 million courses of therapies to poorer countries by mid-2021, with 2 billion doses of vaccine, of which 1 billion will go the poorer countries to be delivered by the end of 2021.

The investment is significant, but WHO says the total cost is less than a 10th of the $375 billion the global economy is losing every month due to the pandemic. “The numbers are not that big when you think of the alternatives,” said Ngozi Okonjo-Iweala, a special envoy for the Access to COVID-19 Tools Accelerator (ACTA).

A part of the significant funding gap will be filled on Saturday, June 27, when the European Commission is leading a global pledging event in support of ACTA.

The vaccines development arm of ACTA, called Covax, has set the goal of ending the acute phase of the pandemic by the end of 2021. To do that, it needs total funding of $18.1 billion for 2020/2021, of which $2.4 billion will be for R&D, $1.7 billion for technology transfer and scale-up, and $5.3 billion for at-risk manufacturing of multiple vaccine candidates.

Covax also needs significant amounts of capital for advance purchase agreements for countries of all income levels, including $5.5 billion to immunize health care workers and at-risk populations in low- and middle-income countries.

The final cost will depend on which vaccines are approved. As soon as it is sufficiently capitalized, Covax will offer advance purchase agreements to vaccine candidates meeting certain technical criteria, enabling them to be manufactured before efficacy trials are complete. It is expected five to 10 contracts will be agreed.

Soumya Swaminathan, WHO chief scientist, who is steering Covax, said recent epidemics have shown it is possible to shorten the timescale for vaccine development, by doing things in parallel. Rather than 10 years, it took five to develop an Ebola vaccine and two years for a Zika vaccine.

“We want to shorten that timeline to 12 to 18 months, and that can only happen through global collaboration,” she said.

Covax will be looking for a commitment from high-income countries to purchase the COVID-19 vaccines it backs. That will allow demand to be pooled, enabling Covax to procure the highest possible volume and driving down the price. Pooling risk in that way will prevent price gouging as individual buyers outbid each other for limited resources.

Many governments are pursuing bilateral deals with manufacturers to secure access to scarce COVID-19 vaccines supplies. Swaminathan said Covax’s approach will create a diversified portfolio, allowing governments and blocs like the EU, which is pursuing a joint vaccines strategy, to hedge the risk of backing unsuccessful candidates. At the same time, countries that cannot afford to buy vaccines will get access.

“Participating countries, by buying into a share of many vaccines candidates instead of just a few, will be able to insure themselves against the failure of any individual candidate,” Covax said. If fully financed, Covax will give all participating governments a guaranteed share of any successful vaccine.

Swaminathan said manufacturers are cooperating with Covax, sharing knowledge and resources. “The concept of vaccines for COVID-19 as a public good has been embraced by everyone,” she said.

Over and above having a single negotiation of advance purchase agreements, there are advantages for vaccines companies involved in Covax, including access to standard protocols for clinical trials and help in setting up studies in different countries, as the infection moves around the world.

Covax also is able to promote dialogue with regulators to avoid time lags. It will take on the delicate task of setting out a framework for allocating vaccines according to need and also will build up the infrastructure needed for mass vaccination programs.

Criteria for allocation will include population groups with higher risk of mortality, burden of disease, threat, vulnerability, product supply and logistics, country context, and global health security priorities.

As further scale-up of production occurs, and the market is considered orderly, countries will have continued allocation of doses as needed, or could revert to bilateral deals where that makes sense for them to do so.

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