By Sharon Atieno

With the COVID-19 pandemic being marred with vaccine inequality whereby high income countries amass vaccines at the expense of low-middle income countries (LMICs), a new policy report gives recommendations on how to correct this inequality and prevent future access crisis for other pandemics and epidemics.

Some of the recommendations of the Drugs for Neglected Diseases initiative (DNDi) report include, increasing attention on the need for therapeutics; transforming the governance structure of the Access to COVID-19 Tools Accelerator (ACT-A) to provide equal representation from low- and middle-income countries; and finally securing policies such as a temporary waiver on intellectual property to ensure transfer of technology to ensure access to all.

Shortcomings in the COVID-19 Global Response

The report notes that despite the creation of COVAX, the vaccine pillar of ACT-A, dedicated specifically to ensuring equitable access to COVID-19 vaccines in every country, only a fraction of the more than 3.6 billion vaccine doses given globally have been in low-income countries. This is majorly attributed to vaccine nationalism.

Besides, massive amounts of public funding went into the discovery and development of vaccines but funders have failed to use their leverage to ensure contractual conditions that would facilitate the sharing of technology, data, and know-how – for example, through the WHO COVID-19 Technology Access Pool (C-TAP) and the Medicines Patent Pool (MPP) – in order to enable greater global production capacity.

“Pharmaceutical companies, meanwhile, have largely refused to non-exclusively license and share IP and know-how. Too little has been done to promote the expansion and decentralization of vaccine manufacturing capacity in Africa, Asia, and Latin America to help meet regional and global needs,” the report adds.

To address COVID-19, future pandemics and other emerging threats, the report says that decisions about whether and how to discover, develop, produce, allocate, and price essential health technologies cannot be left to narrow national interests or market forces.

“Great strides have been made in the development of new tools for COVID-19, especially vaccines, but the past year has made it painfully clear that access is the unfinished business of global health,” said Dr Bernard Pécoul, Executive Director of DNDi in a statement. “We now have the opportunity to course correct with treatments and make the response to COVID-19 a model for equity, collaboration and knowledge- sharing.”

The group of authors from Kenya, India, USA, and Switzerland argue that “the need for treatments at all stages of COVID-19 is more pronounced than ever given inequitable access to vaccines and surging COVID-19 crises across the world, including in Africa, Asia, and Latin America.”

The report notes that there has been insufficient political and financial attention paid to therapeutics research and regulation as a whole, and the majority of research conducted has been highly fragmented and focused in high income countries.

It warns that with these countries achieving high rates of vaccine coverage, their attention may shift almost entirely to investing in surveillance, testing, and follow up vaccination, even as LMICs with profoundly limited access to vaccines may increasingly need to prioritize treatment access as a means of coping with COVID-19.

One of the solutions, the report gives to address the issue is the need for ACT-A and other global health institutions including the World Health Organization to articulate the resource needs, and research and development (R&D) priorities for COVID-19 therapeutics in order to give funders a clearer picture of the needs and ensure ambitions and actual financing are commensurate with needs.

One area that has been particularly neglected are early therapeutic interventions that could prevent disease progression and the need for hospitalization, intensive care, or worse. The report calls for more support for open drug discovery and development of novel antivirals, host-targeted interventions, and repurposed compounds and robust testing of these options in comparable adaptive platform trials.

In addition to calling for more equal representation on the ACT-A, the authors argue that ACT-A should make addressing intellectual property barriers a key transversal work stream across all pillars and explicitly support the TRIPS waiver and licensing initiatives that would facilitate the sharing of technology, data, and know-how. The report also urges ACT-A to take explicit steps to improve transparency with respect to development, production, and supply of COVID-19 medicines, diagnostics, and vaccines.

The report also offers timely policy recommendations, which come as decision-makers around the world are assessing options for the future of global health and pandemic preparedness. It argues that more urgent steps need to be taken to reorient to a more decentralized, distributed, and democratic approach that ensures greater parity between rich and poor and delivers new health technologies as global public goods.

“With the rapid spread of variants of concern, the international community cannot afford to wait to respond to the needs of those at highest risk of infection and death. But we also need to act now if we are serious about building a safer world from future pandemics – now is the time to build an international system that will guarantee equal access to life-saving biomedical innovations.”