India’s potential participation in COVAX advance market commitment is under way: Trevor Mundel

With 11 COVID-19 vaccines having entered Phase-3 trials and six vaccines already approved for limited use, the next challenge is to support manufacturing and ensure that vaccines are accessible, affordable and available to all people. India is yet to agree to purchase COVID-19 vaccines through the COVAX Advance Market Commitment (AMC). Discussions about the terms of India’s potential participation in the COVAX AMC are getting under way.

With 11 COVID-19 vaccines having entered Phase-3 trials and six vaccines already approved for limited use, the next challenge is to support manufacturing and ensure that vaccines are accessible, affordable and available to all people. Gates Foundation has committed over $650 million towards tackling COVID-19. The foundation has signed an agreement with Serum Institute to facilitate vaccine production, in which the foundation will provide at-risk funding of $300 million to manufacture up to 200 million doses of COVID-19 vaccines for India and low-and-middle income countries. The funding is being provided through GAVI.

Trevor Mundel, President of the Global Health Division, Bill & Melinda Gates Foundation, has led the foundation’s efforts to support the development of diagnostics, therapeutics, and vaccines for the global response to COVID-19 explained by email to how the Gates Foundation is ensuring equitable distribution of vaccines developed and developing countries.

Has India agreed to purchase vaccine doses through the COVAX facility? How many million doses of the vaccine will India get through COVAX?

India is among the 92 countries that are eligible to access COVID-19 vaccines through GAVI’s COVAX Advance Market Commitment (AMC), a donor-supported mechanism that will help cover part of the cost of vaccines to ensure that all countries — not just wealthy countries — can access them.  Discussions about the terms of India’s potential participation in the AMC are getting under way.

What steps has the Gates Foundation taken to ensure equitable distribution of vaccines to developing countries, including those that have not expressed interest to purchase vaccines through the COVAX facility?

The foundation is working on multiple fronts to help ensure equitable access to COVID-19 vaccines, because we know that COVID-19 anywhere means that COVID-19 could continue to spread everywhere. Earlier this year, we committed $100 million to Gavi’s COVID-19 Vaccine Advance Market Commitment (COVAX AMC), to finance COVID-19 vaccines for lower income countries. Through our collaboration with GAVI and the Serum Institute of India, we are financing the manufacture of 200 million future vaccine doses for low- and middle-income countries. We are also funding research and development of vaccines that could be less expensive to produce or easier to distribute in low- and middle-income countries, such as those that only need one dose or do not require extreme refrigeration or freezing.

We also joined forces with 16 life science companies, who have agreed to cooperate on rapidly escalating supply of COVID-19 innovations, ensuring that approved vaccines are broadly distributed globally as early as possible at an affordable price.

Much of this work is in support of the Access to COVID-19 Tools Accelerator (ACT-A), the largest global collaborative effort to develop and equitably delivery new COVID-19 innovations, including vaccines. We encourage all countries to engage in this effort — since we know that we can only bring this pandemic to an end with global collaboration.

Will countries have to wait to get the vaccines through COVAX even after paying up-front?

No one knows yet which vaccines will prove safe and effective, which is why it’s important to scale up manufacturing capacity as much as possible now, so that no time is wasted once clinical trials are completed and regulatory approval has been given.

The Gates Foundation envisions an equitable distribution of COVID-19 vaccines and our efforts are focused on helping improve the chances that low- and middle-income countries have access to doses at the same time as wealthier countries. COVAX — an initiative led by GAVI, the vaccine alliance, WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) — is one of the best ways to achieve this.

Will the pre-defined number of vaccine doses that a country gets be related to the amount of funding that the country makes?

No. For the Facility, participating countries will receive allocations proportional to their population, not their financial contribution.

Even after financial commitment, will countries be assured of vaccine supplies if developed countries directly tie-up with the manufacturers to secure supplies, as seen in the case of the U.S. getting most of Remdesivir? 

The purpose of the COVAX Facility is to avoid this type of situation, and the fact that so many countries have signed on shows that these countries see the value of joining forces to protect their own populations while making doses available and affordable in lower-income countries. The only way to bring this pandemic to an end is for diagnostics, treatments and vaccines to be globally distributed based on specific public health criteria. Without global distribution, securing limited supply of vaccines for just a few countries will only undermine efforts to stop circulation of the virus, extending the health and economic toll.

How safe will COVID-19 vaccines be since their development has been accelerated? What steps has the Foundation taken to address safety concerns about COVID-19 vaccines?

While the current pandemic has created urgency to work as quickly as possible to develop safe and effective therapeutics, speed and science should never be at odds, especially where ensuring safety is concerned. The Foundation, along with the global community working to develop new tools to prevent and combat COVID-19, has stressed that it is crucial that decisions to approve COVID-19 vaccines are based on the results from rigorously conducted clinical studies. The Foundation is committed to ensuring the safety of individuals who will be receiving products that we have funded. All of the research that we fund follows regulatory protocols and ethical standards for safety. Additionally, the 16 life sciences companies that I mentioned earlier have all committed to adhere to strict scientific and ethical standards in product development and the manufacturing processes.

In the U.S., a Gallup survey has found that trust in vaccines has been reducing even among those inclined towards vaccines. What is the Foundation doing to address this?

We’re concerned about how perceptions about vaccines could hinder public health efforts. Strong scientific evidence underpins the safety of vaccines and existing vaccines have a proven track record of preventing diseases. Experts believe that vaccines will be critical to ending this pandemic and it will be important for governments and communities to work together to increase trust. We know that people everywhere are trying to figure out what’s best during this period of uncertainty and it’s becoming increasingly confusing to make decisions about health. The best thing we can do to combat misinformation about vaccines is to spread the facts, and work with local leaders and trusted community members to help increase trust in vaccines and improve vaccine uptake.

Published in The Hindu on October 31, 2020