ACT-Accelerator launches urgent US$7.7B appeal to stem surge of dangerous variants

With more COVID-19 cases reported in the first five months of 2021 than in the whole of 2020, the world is still in the acute phase of the pandemic – despite high vaccination rates in some countries protecting populations from severe disease and death. Inadequate testing and low vaccination rates are exacerbating disease transmission and overwhelming local health systems, while leaving the whole world vulnerable to new variants.

Many countries are experiencing new waves of infections – and while many high-income countries and some upper-middle-income countries have implemented widespread vaccinations, put more robust testing systems in place, and made treatments increasingly available – many low- and lower-middle-income countries are struggling to access these vital tools due to a lack of funds and supplies. Investing in the ACT-Accelerator to make tools available to everyone, everywhere, will benefit all countries through a more globally inclusive and coordinated response.

While four variants of concern currently dominate the epidemiology, there are fears that new, and possibly more dangerous, variants of concern may emerge.

With hard-won gains of the last three months at risk, the ACT-Accelerator has mounted a US$ 7.7 billion appeal, the Rapid ACT-Accelerator Delta Response (RADAR), to urgently:

• Scale up testing: US$2.4 billion to put all low- and lower-middle-income countries on track towards a ten-fold increase in COVID-19 testing and ensure all countries get up to satisfactory testing levels. This will significantly enhance local and global understanding of the changing disease epidemiology and emerging variants of concern, inform the appropriate application of public health and social measures and break chains of transmission.
• Maintain R&D efforts to stay ahead of the virus:US$ 1 billion for ongoing R&D, enable further market shaping and manufacturing, technical assistance and demand generation to ensure that tests, treatments and vaccines remain effective against the Delta variant and other emerging variants, and that they are accessible and affordable where they are needed.
• Address acute oxygen needs to save lives:  US$ 1.2 billion to rapidly address acute oxygen needs to treat the seriously ill and control the exponential death surges caused by the Delta variant.
• Rollout of tools:US$ 1.4 billion to help countries identify and address key bottlenecks for the effective deployment and use of all COVID-19 tools. As supply of COVID-19 vaccines ramps up in the coming months, flexible funding will be essential to help fill on-the-ground delivery gaps.
• Protect frontline healthcare workers:US$ 1.7 billion to provide two million essential healthcare workers with enough basic PPE to keep them safe while they care for the sick, prevent the collapse of health systems where the health workforce is already understaffed and overstretched, and prevent further spread of COVID-19.

In addition to the US$ 7.7 billion appeal, there is an opportunity to reserve the supply of vaccines through exercising options in the fourth quarter of 2021 for 760 million doses of vaccine to be available in mid-2022 beyond the fully subsidised doses that COVAX will deliver up to the end of Q1 2022.  Commitments to reserve these vaccine options in the last quarter of the year for delivery in the middle of 2022 can be made to Gavi/COVAX, as part of the ACT-A network of agencies.

• Reserve vaccines: Reserve supply of 760 million doses of vaccine by exercising options in the final quarter this year to ensure there is continued supply available to make deliveries into 2022. Reserving doses requires contingent capital; on delivery these 760m doses will cost an additional US$ 3.8 billion.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: “US$7.7 billion is needed urgently to fund the ACT-Accelerator’s work to address the Delta surge and put the world on track to ending the pandemic. This investment is a tiny portion of the amount governments are spending to deal with COVID-19 and makes ethical, economic and epidemiological sense. If these funds aren’t made available now to stop the transmission of Delta in the most vulnerable countries, we will undoubtedly all pay the consequences later in the year.”

Carl Bildt, WHO Special Envoy to the ACT-Accelerator, commented: “Ending the pandemic will generate trillions of dollars in economic return due to increased global economic output and reduced need for government stimulus plans to deal with the health and financial crisis that COVID-19 causes. The window for action is now.”

The ACT-Accelerator recently published its Q2 2021 Update Report, which provides an overview of the progress made in bringing life-saving COVID-19 tools to countries around the world, and highlights the efforts made to ensure health systems are able to receive and fully optimize the use of COVID-19 countermeasures, during the April-to-June 2021 period. It shows how investments made to the ACT-Accelerator have driven results and impact in the fight against COVID-19.

Increased global discourse and new initiatives echo the imperative to achieve equity in the fight against the pandemic. In just over 15 months, by 9 August, 2021 donors had stepped up and provided US$ 17.8 billion of the ACT-Accelerator’s US$ 38.1 billion funding needs[2]. This unprecedented generosity has driven the fastest and most coordinated effort in history to develop tools to protect global health security, and to deliver impact where it is most needed.

Achievements across ACT-Accelerator pillars include:

Diagnostics pillar, co-convened by FIND and the Global Fund, working closely with UNITAID, UNICEF, WHO and over 30 global health partners to scale up equitable access to COVID-19 diagnostic technologies:

• More than 84 million molecular and antigen rapid diagnostic tests (RDTs) have been procured via the Diagnostics Consortium
• Regionalized manufacturing has been given a boost through technology transfers
• Over 70 countries supported to expand laboratory infrastructure and ramp up testing.

Therapeutics pillar, co-convened by Wellcome, Unitaid, supported by WHO, UNICEF and the Global Fund has:

• Procured US$ 37 million worth of treatments including 3 million doses of dexamethasone, and US$ 316 million worth of oxygen supplies.[3]
• Supported identification of the first life-saving therapy for COVID-19 – dexamethasone – and provided global guidance on its use.
• A COVID-19 Oxygen Emergency Taskforce was activated to assess and address COVID-19 surges in demand to cut preventable deaths. The pillar also brokered an agreement for the world’s largest medical oxygen suppliers – Air Liquide and Linde – to collaborate with ACT-Accelerator partners on increased access to oxygen in low- and lower-middle-income countries. Global demand for medical oxygen is currently more than a dozen times greater than before the pandemic.
• From the start of the pandemic to July 1st, 2021, over US$ 97 million of oxygen provisions (2.7 million items) have been shipped to countries.
• Additionally, in the last quarter, US$ 219 million has been awarded to countries for the procurement of oxygen provisions, including oxygen concentrators and new public oxygen plants, through the Global Fund COVID-19 Response Mechanism.

COVAX, the Vaccines pillar, is co-convened by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance and the World Health Organization (WHO) – working in partnership with UNICEF as key implementing partner, and with vaccine manufacturers, civil society organizations, and the World Bank has:

• Accelerated the research and development of a portfolio of 11 vaccine candidates across four technology platforms.
• Shipped a total of 186.2 million vaccines to 138 countries and economies (as of 5 August 2021). Of these, 137.5 million doses were shipped to 84 AMC countries and economies. It is expected that a total of 1.9 billion doses will be available for shipment by the end of 2021. Of these, AMC participants are expected to receive about 1.5 billion doses, including donated doses, equivalent to approximately 23% population coverage (excluding India).
• Established a Manufacturing Task Force to identify and resolve manufacturing issues impeding equitable access to vaccines through COVAX. The Taskforce is urgently addressing short-term challenges and bottlenecks and working with a consortium in South Africa to transfer technology and establish a vaccine manufacturing hub in the region, ensuring long-term regional health security.

Health Systems Connector, co-convened by the Global Fund, WHO and the World Bank has:

• By end April, procured PPE worth more than US$ 500 million, assessed country readiness for deployment of COVID-19 vaccines in more than 140 countries (jointly by World Bank, GFF, Gavi, the Global Fund, UNICEF and WHO), and documented disruptions to 90% of health systems and services through national pulse surveys of more than 100 countries.
• Captured country-specific insights on bottlenecks and ongoing health systems-related challenges and has developed global guidelines and training across multiple critical health system areas.
• Helped reduce PPE prices, reaching 90% reduction peaks on medical masks and N95/FFP2 respirators. Both the Global Fund, through the COVID-19 Response Mechanism (C19RM), and the Global Financing Facility, through the COVID-19 Essential Health Services, awarded grants to countries to buy PPE, distribute drugs and train community health workers in vaccine rollout to reinforce the COVID-19 national response.
• PPE stock pre-positioned by UNICEF across warehouses in Copenhagen, Dubai, Panama and Shanghai is immediately available for delivery to countries in need, subject to availability of funding.