Pandemic Action Network Statement on the Second Global COVID-19 Summit

The Second Global COVID-19 Summit showed a renewed commitment to end the COVID-19 crisis and prevent the next pandemic threat. Against complacency and pandemic fatigue, leaders from over 35 countries, the private sector, philanthropy, and civil society brought forward new actions and commitments — both financial and non-financial — to meet urgent needs across the summit’s priorities of vaccinating the world, protecting the most vulnerable, and preventing future pandemics. Financial commitments totaled almost US$3.2 billion, with approximately US$2.5 billion in funding from governments, and approximately US$700 million from the private sector, foundations, and other non-government actors.

Statement from Carolyn Reynolds, Co-Founder, Pandemic Action Network

Today’s Global COVID-19 Summit was a win against complacency and has provided a much-needed shot in the arm for both the global COVID response and to begin to prepare the world for the next pandemic threat. We are pleased that the Summit has yielded important new commitments to vaccinate the world, save lives, and nearly US$1 billion to establish a new Fund for global health security and pandemic preparedness. This is a significant down payment and enables the World Bank to move forward on establishing the Fund this summer. But we must maintain the momentum beyond today and political leaders must stay in the fight. This pandemic is not over, and the world must move faster to deliver lifesaving tools and prepare for whatever variant or pandemic threat is coming next. The U.S. Congress must urgently approve additional funding for the global COVID response, and other governments and private and philanthropic partners must step up support for the response and for the Fund as soon as possible.

Statement from Eloise Todd, Co-Founder, Pandemic Action Network

World leaders‘ commitments at the Global COVID-19 Summit today have helped give a much-needed reset to the global COVID response. But without sustained and decisive action, the world could slip into permanent inequity between those that are able to be treated and vaccinated for COVID-19 and those that are not. All eyes are on global and regional bodies to see how they can build on today’s starting shot and deliver real progress by the G7 Summit at the end of June.

As long championed by Pandemic Action Network, equity featured prominently in both reflections on the COVID-19 pandemic and in new commitments. We welcome commitments and new investments to close the funding gap for the Access to COVID-19 Tools Accelerator (ACT-A), solve for last-mile vaccination delivery challenges, accelerate access to generic therapeutics, and diversify manufacturing and procurement of medical countermeasures to build strong and sustainable systems in every region of the world.

Pandemic Action Network was also pleased to see political and financial support for a new Fund for Global Health Security and Pandemic Preparedness from across sectors. As we double down to end the COVID-19 pandemic, we also must look ahead and prepare both for future COVID-19 variants and emerging disease threats. Government leaders from around the world stepped up today to support a new pandemic preparedness fund and advocated for the need to include diverse voices in the design and governance of a new fund. Financial commitments from the U.S., European Commission, Germany, and the Wellcome Trust total nearly US$1 billion, and represent a significant down payment toward the US$10 billion needed annually for this Fund.

But while today’s Summit serves as a needed jolt to the global COVID-19 effort, there is still much work to do. Today’s financial commitments for response sum just over US$2 billion, and while this funding is urgently needed, it’s long overdue and far short of the current ACT-A funding gap (nearly $US15 billion). It is critical that all governments and sectors step up and prioritize significant new resources to end the global COVID crisis — including the U.S. Congress and Administration working together to transcend politics and quickly pass at least US$5 billion for the global COVID-19 response. In addition, it is critical to heed the call from many African leaders for Gavi, the Global Fund, and other vaccine purchasers to prioritize purchases from African vaccine manufacturers to ensure new facilities are sustainable. It will also be important for a diversity of donors and stakeholders to commit to the new Fund for Global Health Security and Pandemic Preparedness to ensure it is inclusive, representative, and effective. 

As we look ahead to the World Health Assembly, G7 and G20 Summits, and UN General Assembly, Pandemic Action Network will stay vigilant to make sure Summit commitments are realized and accountable, and that world leaders are collectively challenging themselves to do whatever it takes to end this crisis for everyone, everywhere.

Call to Action! Accelerating an Effective and Equitable COVID-19 Response and Pandemic-proofing the Future

We are at a pivotal moment in the COVID-19 pandemic. With only 14% of people in low-income countries vaccinated with at least one dose, progress against the disease is at risk. Equitable access to vaccines, tests, and treatments remains elusive, compromising the health of millions of people, increasing the chances of more deadly variants, and endangering recovery. Now Russia’s invasion of Ukraine has brought a new security challenge, further threatening global health and safety. The humanitarian crisis in Ukraine and looming food and energy emergencies will continue to strain economies, people, and systems — not only in Europe, but also in other regions where progress against COVID-19 is still fragile.  

The convergence of different security crises with a still-present COVID-19 emergency will only deepen global suffering unless world leaders act urgently. It is essential that G7, G20, and all leaders not retreat from COVID-19 and acknowledge that ending this pandemic remains critical to the world’s security and stability. It is the time to double down and finish this solvable crisis — before the world is faced with a more transmissible or deadly variant, or even a novel pathogen. 

Together with nearly 30 partners, Pandemic Action Network calls on leaders to revamp their response to the pandemic in upcoming Summits and global coordination meetings taking place in 2022 and stay the course and secure the future, by prioritizing the following actions:

  1. Accelerate equitable access to and acceptance of vaccines, diagnostics, and therapeutics
  2. Provide new, diversified funding to fill country-identified gaps in response and preparedness
  3. Build now to pandemic proof the future

Read the full call to action here

This call to action is open for sign-ons. Please email Hanna if you’d like to add your organization. 

Steps Taken, a Leap Required — CEPI’s Replenishment Statement

Today, as the world reaches a grim milestone of six million official deaths from the COVID-19 pandemic and as Russia wages war in Ukraine, world leaders gathered at the Global Pandemic Preparedness Summit to address what we must do better to prevent and prepare for pandemic threats. The Summit, organized by the Coalition for Epidemic Preparedness Innovations (CEPI) and the U.K. Government, represented a critical opportunity for global leaders to prioritize pandemic preparedness and support CEPI’s groundbreaking 5-year plan to develop life-saving vaccines to help prevent a crisis of similar scale to the COVID-19 pandemic, including its 100 Days Mission to develop safe and effective vaccines in 100 days following an outbreak. 

Pledges of financial and political support were made in nearly equal measure with a total of 13 countries and 2 philanthropic donors pledging US$1.54 billion to CEPI’s US$3.5 billion five-year plan. Japan’s announcement of US$300 million made it the largest contributor, followed by the U.K. in addition to commitments from Australia, Austria, Finland, Germany, Indonesia, Italy, Japan, Mexico, New Zealand, Norway, Singapore, and the U.S. 

At least nine other countries (Brazil, Canada, Greece, Kuwait, Lithuania, Nigeria, South Korea, Spain, and Switzerland) and the European Commission expressed their support, though no specific financial contribution was mentioned. 

While this is a welcome and important first step toward a world that is better prepared for pandemic threats, it is disappointing that many governments failed to match political support with bold and meaningful financial commitments. The COVID-19 pandemic showed us that the world is ill-prepared to prevent and respond to a pandemic caused by a novel respiratory pathogen. The pandemic research and development (R&D) system as it exists does not work to address the challenges of emerging infectious diseases. As we look toward year three of COVID, we are already witnessing the familiar and costly cycle of panic and neglect around pandemics spinning into motion. CEPI’s plan to reduce vaccine development time to 100 days is one in a set of critical measures to get ahead of the cycle of panic and neglect and avoid another trillion-dollar pandemic that needlessly costs millions of lives and livelihoods. 

Eloise Todd, Pandemic Action Network’s co-founder, said:

“While today’s commitments of over US$1.5 billion to CEPI are a welcome and strong start, they are not enough. The COVID crisis showed us that the vaccine R&D system as it exists cannot meet the challenges of emerging infectious diseases before they cause severe damage, nor can it ensure all people everywhere have equitable access to the tools and technologies they need to curb a global health emergency. Leaders can avoid repeating past mistakes and build a system that is forward looking and equitable. Fully funding CEPI is an impactful way to do just that. An investment in CEPI is a fraction of the trillions lost to pandemic response and an investment that pays a multitude of dividends. We expect key global leaders to step up in the coming weeks to align their financial commitments with their political commitments, and make a fully-funded CEPI a reality.”

Pandemic Action Network and its network of over 250 partners will follow up closely on the actions of governments, philanthropies, and decision makers who have expressed their commitment to this goal, especially those key global leaders who can convene other governments, rally support, and mobilize resources. Building on the strong momentum from the Global Pandemic Preparedness Summit, concerted action from world leaders in the coming months will be crucial to fully fund CEPI and ensuring the COVID crisis leaves a legacy of pandemic preparedness.

Civil Society Support Calls for Increased Quality in Dose Donations to Africa

The Africa Working Group on Pandemic Preparedness and Response supports the Joint Statement on Dose Donations of COVID-19 Vaccines to African Countries by the Africa Centres for Disease Control and Prevention (Africa CDC), the African Vaccine Acquisition Trust (AVAT), and COVAX published on November 29, 2021.

The statement draws the attention of the international community to the quality of donations of COVID-19 vaccines to Africa, and other COVAX participating economies, particularly those supported by the Gavi COVAX Advance Market Commitment (AMC).

Read the full letter here.

Civil Society Organizations Call on G20 Leaders and Ministers to Deliver Concrete Action on Global COVID-19 Targets

Ahead of the G20 Finance and Health Ministers Meeting on Oct. 29 and the G20 Leaders’ Summit on Oct. 30-31, Pandemic Action Network and more than 20 civil society partners call upon the G20 countries to deliver specific, concrete action on key targets set out at the Global COVID-19 Summit on Sept. 22. The Global COVID-19 Summit rallied world leaders and secured commitments to ensure at least 70% of the population in all income categories in all countries are fully vaccinated by mid 2022 — and at least 40% by the end of this year.

But meeting this target will require specific, concrete action. Civil society organizations urge the G20 leaders and Ministers to agree on a plan of action in the forthcoming meetings to deliver on these targets, including commitments to:

  1. Ensure at least 70% of people in every income category in every country are fully vaccinated by sharing doses at scale, releasing production slots, and supporting non-exclusive knowledge and technology sharing measures;
  2. Increase multi-year financing for the pandemic response and preparedness in low- and middle-income countries (LMICs) to match the scale of need;
  3. Reallocate Special Drawing Rights to support the fight against the pandemic in LMICs;
  4. Strengthen global leadership and accountability.

Humanity deserves a world where every country is equipped to end the COVID-19 crisis and every country is prepared to stop infectious disease outbreaks from becoming deadly and costly pandemics. Read the full letter.

If your organization would like to endorse the letter, please contact Aminata Wurie by Tuesday, Oct. 26. 

Do Whatever It Takes! Making the COVID-19 Summit a Step Change in Global Response

Pandemic Action Network is relentlessly focused on ending the COVID-19 crisis everywhere and preventing the next pandemic. We work with our global network of more than 140 partners to push governments to bridge the divide between rhetoric or piecemeal efforts and meaningful actions. When we first learned about the prospect of a global COVID-19 Response Summit — something we have been calling for over the past 18 months — we set out to define the step change in ambition that leaders would need to take after the devastatingly inadequate action taken to tackle this pandemic crisis to date.

That’s why in advance of this Summit, we worked with our partners at the COVID Collaborative and across multiple centers at Duke University to bring more than 60 organizations together around a common position on what’s needed to end this crisis. We’re pleased to see much of what we have been calling for reflected in the Summit targets, which we support. But this Summit has to set itself apart by being the starting point in a much longer journey.

It’s beyond time for an action plan, leadership, and accountability. The world is divided between the haves and the have nots like never before. Those with access to COVID-19 vaccines, and those with no access in sight. We have to change this, and at the 22 September COVID-19 Summit, leaders must pledge to do whatever it takes to fully vaccinate 70% of the population in every country in less than 12 months. We will be tracking their progress towards that commitment and the interim target of at least 40% by the end of 2021.

To get there, we must dramatically ramp up support NOW for:

  • Vaccine donations, queue swaps, manufacturing, and delivery
  • Development and deployment of testing and treatments — including oxygen — and PPE
  • A strong frontline health workforce to reach the most vulnerable communities

We make our own commitment to deliver. We will continue to help mobilize the political support and resources necessary to deliver the targets, and track progress of countries towards their goals. We will also push the private sector and philanthropic donors to play their part in delivering the funding — and the policies — to achieve global vaccination and delivery of COVID-19 tools. We will convene and tap the deep expertise and capabilities in our Network across sectors to inform their design and ensure they are inclusive, accountable, sustainably funded, and commensurate with the threat.

It’s time to shine a light on the problems in the system, and fix them, before they take more lives. We are in a race against time. The world has the resources and the ingenuity to solve these challenges.

It’s a matter of leadership and political will. We will be working to ensure that this Summit leaves a legacy to end this crisis and pandemic-proof the world once and for all.

Read and share the full Framework for a Global Action Plan for COVID-19 Response endorsed by more than 60 partners here.

Framework for a Global Action Plan for COVID-19 Response

We are at an exceedingly perilous and urgent moment in the COVID-19 pandemic. As the Delta variant has demonstrated, we are fighting a virus that doesn’t respect borders and rapidly advances across continents. If the virus continues to circulate unchecked in large parts of the world, we will see not only many more millions of infections and deaths, but also new variants that could totally pierce vaccine immunity, returning the world to square one. The global COVID-19 crisis demands leadership and a global plan of attack. A coordinated, global response, the only possible successful response to the pandemic, must be grounded in equity at all levels – global, regional, national, subnational and community. An “all hands on deck” crisis response must deploy all available resources and capabilities – multilateral and bilateral, public and private sector. A robust and effective response to the current crisis is also the best foundation for health systems strengthening and future pandemic preparedness. World leaders should therefore urgently convene a “Global Pandemic Response and Vaccination Summit” and commit to urgent actions detailed in our Framework For a Global Action Plan for COVID-19 Response. Read more here.

An “all hands on deck” crisis response must deploy all available resources and capabilities – multilateral and bilateral, public and private sector. A robust and effective response to the current crisis is also the best foundation for health systems.

 

Why Smooth Vaccine Rollout and Social Proof Are Key to COVID-19 Acceptance and Trust

Note: Policy recommendations to decision makers available here

Since the world began to entertain viable vaccines as a real prospect in the fight against COVID-19, we have been confronting the challenge of vaccine hesitancy and navigating what is required to address this challenge. While recent surveys show that vaccination intent has been on the rise globally, increasing hopes that the world will be able to turn the tide on the pandemic relatively soon, the dynamic nature of this pandemic shows that vaccination intent and trust correlates to vaccine access, management of vaccine rollout, and social proof.

The challenge of vaccine hesitancy to end the pandemic
Vaccine hesitancy remains a looming threat to the successful rollout of vaccines and the prospect of ending the COVID-19 pandemic globally. The “anti-vax industry” is well-financed and organized, and determined to spread doubt as to the safety and efficacy of COVID-19 vaccines. A study by Imperial College found that hesitancy around COVID-19 vaccines could lead to thousands of extra deaths. The study, from March 2021, compares current levels of hesitancy compared to the ideal level of uptake. The potential risk is particularly acute in countries like France, where vaccination intent is among the lowest. France could see 8.7 times more deaths in 2021/22 than it would under the ideal level of uptake. This compares to just 1.3 times more in the U.K., which has among the highest vaccination intent.

In many countries, one of the main reasons for vaccine hesitancy is that corners have been cut due to the speed of the clinical trials, and that unknowable long-term side effects potentially exist.

In addition, conflicting public health messages have led to increased mistrust from the public. For example, inconsistent guidance on face-coverings earlier in the pandemic has primed people to distrust proclamations about vaccine safety and efficacy. This has led to many people wanting to “wait and see” real-world proof of safety and efficacy before getting a shot. As a result, a critical element of increasing COVID-19 vaccine uptake is building vaccine confidence among this “wait and see” group, the moveable middle.

“Wait and see” approach to COVID-19 vaccines

Because of concerns on the speed of development and potential unknown side effects, a share of the population wants to “wait and see” how the COVID-19 vaccines work for other people before they get vaccinated themselves.

The share of people in this “wait and see” category has declined since vaccines have started rolling out globally.

Smooth rollout and social proof as tools to increase vaccine trust among the “wait and see”
The emerging evidence, including from the U.K. vaccine rollout, shows that social proofing through communication about widespread acceptance and a fast and uninterrupted vaccine rollout seems to increase trust in COVID-19 vaccines. The more people get vaccinated and the more people hear about others getting vaccinated, the more normal it becomes. A study by Rockefeller Foundation from March 2021 found that social proof of others getting immunized and seeing the tangible benefits that come with it might be the most determining factor in motivating people to get vaccinated.1 In their study they found that among U.S. adults who weren’t sure they’ll get the vaccine, 43% said they were waiting for more people to get vaccinated before they do so themselves. Other research found that people are more willing to get the COVID-19 vaccine when hearing about its popularity, suggesting that public health officials should communicate about the growing and widespread intention to get vaccinated among the population rather than overstating vaccine hesitancy. Finally, in a study conducted amongst 18-30 year olds in the U.K., study participants reported slightly stronger intentions to take the vaccine when they learn that 85% of others plan to take the vaccine, versus 45% of others.

The U.K. is a good example of how social proofing and a smooth rollout may help address vaccine hesitancy, particularly among the “wait and see” group. The U.K.’s rollout strategy has been to vaccinate as many people as possible from the start. Within the U.K., the Welsh rollout program has been the speediest in the world, faster than Israel. A key element of that was the decision to delay the administration of second doses in order to get a first dose in as many arms as possible, as quickly as possible. Experts believe that the speed of the U.K. rollout and the decision to delay second doses had an important impact on attitudes towards COVID-19 vaccines. Another important component of the U.K. strategy has been to proactively emphasize the widespread uptake of COVID-19 vaccines, for example social media posts such as “Join the millions already vaccinated.” With more and more people knowing or hearing about someone who had had their first vaccination, it helped build momentum as well as create social proof to build trust and convince those in the “wait and see” category to eventually get vaccinated.  

In January, 90% of people in the U.K. said that they would either probably or definitely take a COVID-19 vaccine, up 7% since December, when the rollout started. Just two months later (March 2021), the proportion of adults who said they would not be likely to get vaccinated had more than halved since December — from 14% to just 6%. Between January and March, 53% of adults shifted to a more positive attitude — either already receiving a jab or reporting that they are now more likely to do so. According to Imperial College’s Year Review of ‘COVID-19 Global Behaviours and Attitudes’, of the 29 countries surveyed for study,  the U.K. had the highest intention of vaccination among those not yet vaccinated in April 2021 (67% of those not yet vaccinated), and had the lowest share of respondents who stated they were worried about side-effects (27%).

The U.K. also had a different response to the AstraZeneca and Johnson & Johnson (J&J) blood clotting issues compared to the U.S. and many European countries.  The U.K. did not pause the use of the AstraZeneca shot, instead it simply updated its guidelines advising people with a predisposition to blood clots and those under 30 (in April) and subsequently under 40 (in May), to get an alternative shot. Research and pollings indicate that the U.K.’s ‘restrained reaction’ helped keep hesitancy low. A study found there was no change in the intentions and attitudes of the U.K. public in the aftermath of the blood clot story. A YouGov poll in April suggested this led to only a minor decrease in trust. The number who considered the drug to be unsafe ticked up only slightly, from 9% in March to 13% in April, with still 75% of Britons considering the vaccine to be very or somewhat safe. 

The impact of pauses on vaccine trust globally
After extremely rare cases of blood clots, unlike the U.K., a number of governments in the U.S. and Europe temporarily paused the roll-out of the AstraZeneca or J&J vaccines. These pauses have had a significant impact on public trust, not only in the countries where the rollout was paused, but globally. 

Despite the European Medicines Agency (EMA) safety committee’s recommendation from 11 March “that the vaccine’s benefits continue to outweigh its risks and the vaccine can continue to be administered while investigation of cases of thromboembolic events is ongoing”, at least 13 European countries paused the use of the AstraZeneca shot. Skepticism in France and Germany increased rapidly after the use of the AstraZeneca vaccine was paused over blood clot concerns in March. In a YouGov poll conducted in March, 32% of Germans said the AstraZeneca vaccine was safe, down from 42% a month before. Confusion also plagued the rollout of the AstraZeneca vaccine in European countries, further tarnishing the shot’s reputation. For example, in February when it finally started using the AstraZeneca vaccine, German health officials decided to restrict its use to people under 65. It took until March 4 for Germany to update its guidelines and recommend AstraZeneca’s use for people over 65. Just 11 days later, on March 15, Germany paused its use entirely for several days over blood clot concerns. Finally, on March 30, Germany officials tweaked their recommendations yet again, limiting its use to people over 60. In the case of France, it all started with a comment by French President Emmanuel Macron in January incorrectly describing the shot as “quasi-ineffective” for people over the age of 65. Like Germany, French officials then also did a U-turn on their age restriction guidelines in addition to pausing the vaccine use for a few days in mid-March.   

In the US, public trust in the safety of the J&J shot was down to 37% after the government paused the rollout in April, compared to 52% before the announcement. A Washington Post-ABC News poll from mid-April found significant mistrust in the J&J vaccine after health officials paused its use with fewer than 1 in 4 Americans not yet immunized willing to get the shot. The Kaiser Family Foundation COVID-19 Vaccine Monitor found that in early May less than half of Americans believed the J&J vaccine was safe, and concerns about potential side effects had increased among those not yet vaccinated, especially women. About one in five unvaccinated adults say the news caused them to change their mind about getting a COVID-19 vaccine. The Monitor also found indications that concerns about side effects from the vaccines in general had increased following the pause, particularly among women. The reputation of the AstraZeneca vaccine that has not been approved for use in the U.S. yet has also been damaged by blood clotting concerns and temporary suspension in Europe. Only 38% of Americans surveyed in April 2021 considered the AstraZeneca vaccine safe.  In contrast, trust in the Pfizer-BioNTech (Pfizer) and Moderna vaccines appeared unaffected. The Ad Council found that conservatives, in particular, increased in skepticism after the J&J pause.2

Even beyond Europe and the U.S., these short pauses and confusion around age restrictions have damaged the reputation of the AstraZeneca and J&J shots around the world, including in low-income settings where they are particularly crucial. Both the J&J and AstraZeneca vaccines that use adenovirus-vector technology have raised hopes of better global access and, in the case of the J&J shot, faster rollout. These vaccines are less expensive, more stable, and easier to distribute than their mRNA-based counterparts from Moderna and Pfizer. Because they are less expensive and easier to store than Moderna’s or Pfizer’s, and the J&J vaccine requires only one dose, these shots have been considered particularly crucial for less developed and hard-to-reach parts of the world. Yet, experts raised concerns that short suspensions in Europe and the U.S. may further hit an already fragile vaccine confidence in low-income countries and threaten to undermine vaccination campaigns in these settings. Cameroon, the Democratic Republic of Congo, Indonesia, and Thailand all suspended the AstraZeneca vaccine rollout following pauses in European countries. Concerns about rare blood clots on top of the rubbishing of COVID-19 vaccines by some African leaders and confusion over expiry dates have slowed vaccine uptake across the African continent. Health workers in countries such as Nigeria, Ivory Coast, and Malawi noticed growing fears and conspiracy theories, as well as slower demand for vaccines. Africans have expressed their reluctance to use the AstraZeneca shot when Europeans have stopped using it.  At the G7 Vaccine Confidence Summit hosted by the U.K. in June 2021, Dr John Nkengasong, Director of Africa CDC, highlighted that confidence in Africa was significantly hit by the suspension of the AstraZeneca vaccine in a number of European countries with some African ministries being reluctant to continue the rollout of the vaccine. 

Lessons learned and recommendations
The world has only started its vaccination effort against COVID-19 with millions of people around the globe, particularly in developing countries, still needing to get inoculated against the disease. Yet, lessons can start to be drawn from vaccination programs that started in early 2021.

  • All indications point to the fact that consistent messaging about the safety and efficacy of vaccines and about widespread acceptance, as well as smooth and effective rollouts that build social proof of the safety, efficacy, and benefits of COVID-19 vaccines have been key ingredients to build trust and increase vaccination intent and intake.
  • On the contrary, conflicting public messages and guidance as well as temporary suspensions of the use of certain jabs have created a breeding ground for doubt, fears, and conspiracy theories, not only in the country where they occurred but globally. As Heidi Larson, the founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, said: “Don’t let the ambiguity drag on. Because every day just opens the space for misinformation, disinformation, anxiety, and confusion.”

As they progress in their vaccination campaign and in advance of vaccination delivery, decision-makers should take stock of these lessons learned and quickly adjust their strategy accordingly.

Decision-makers should:

  • Increase vaccine trust through a social proofing strategy. Decision-makers should put social proofing at the heart of their vaccination rollout strategy, learning from best practices in countries that have successfully deployed this approach. Such best practices may include proactively emphasizing the growing and widespread intention/acceptance to get vaccinated of others rather than overemphasizing hesitancy levels. Another way may be, where the supply and timing of the second second for two-dose vaccines is guaranteed, delaying the administration of second doses in order to get a first dose in as many arms as possible, as quickly as possible. Experts believe this can have an important impact on attitudes towards COVID-19 vaccines as more people know someone who has been vaccinated.
  • Refrain from temporarily suspending the use of shots over unconfirmed safety concerns (unless recommended by the regulator), and instead take swift decisions to prioritize certain demographics while concerns are being investigated. Total suspension, even when temporary, increases mistrust not only in the countries where the rollout was paused, but globally. For example, the temporary suspension of the use of the AstraZeneca vaccines in a number of European countries despite the EMA’s recommendation to continue to administer the vaccine led to many African countries suspending the use of the shot and increased hesitancy globally, including on the African continent where the AstraZeneca jab is particularly crucial because it is less expensive, more stable, and easier to distribute than the mRNA-based counterparts from Moderna and Pfizer.
  • Always act on scientific advice and follow the regulator recommendation before making any statement on the safety or efficacy of COVID-19 vaccines as well as before introducing any demographic restrictions. Unfounded statements and age restrictions in some European countries early in their roll-out, i.e., limiting the use of the AstraZeneca vaccine only to young people, created confusion and a fertile ground for fear and conspiracy theories. Scientific evidence should be very carefully and regularly assessed by decision-makers and their teams before making any decision or statement on the use of COVID-19 vaccines.

 

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1 The research included focus groups among people expressing concerns about getting the vaccine in March 2021 and a message testing study in February 2021
Source: Ad Council | IPSOS National survey conducted April 12-19, 2021

Call-to-Action: Global Roadmap to Vaccinate the World

There is currently no plan to get to global herd immunity, needlessly leaving the world vulnerable to case resurgence and the proliferation of variants. We are calling on leaders to agree to a Global Vaccine Roadmap to achieve global herd immunity as soon as possible (at least 70%, more if the evolving science points to the need for further coverage). This Roadmap should:

  1. Set out a comprehensive, coordinated strategy to get to global herd immunity as soon as possible.
  2. Increase and improve the global supply of all COVID tools through investment, policies, and the redistribution of excess doses.
  3. Fully cost the response, agree to a burden-sharing model, and begin to plug the gap by fully funding the Access to COVID-19 Tools Accelerator (ACT-A).

Most existing funds are mainly focused on procurement, yet multiple analyses show that it will take hundreds of billions of dollars on top of procurement financing to fully deliver a global response. If successful, ACT-A, for example, will provide vaccines for 27% of low- and middle-income (LMIC) populations in 2021 on current financing levels — but ACT-A finance does not cover rollout costs from “tarmac to arm” of its own vaccines. The situation in India also underscores the importance of oxygen and other tools that are needed before herd immunity is reached. We need a fully-funded, holistic response. We are therefore calling on leaders to:

Set out a comprehensive, coordinated strategy, as has been called for by the IMF, World Bank, WHO, and WTO, to get to global herd immunity as soon as possible, which:

  • Gives countries the support they need so that all efforts to deliver the global response are mapped, efforts are mutually-reinforced, duplication can be avoided and critical gaps can be identified and filled.
  • Delivers a comprehensive costing and analysis covering all elements of a global response to establish what is already covered and identify gaps in supply, procurement, and resources needed in-country for the delivery of vaccines, tests, and treatments.

Increase and improve the global supply of all COVID-19 tools through investment, policies and the redistribution of excess doses.

  • Scale up the production of tests, treatments, and health commodities, including oxygen, and accelerate LMIC-led research and development (R&D) through fully-funded diagnostics and therapeutics pillars.
  • Increase vaccine manufacturing through investments in regional capacity and back policies to increase knowledge sharing, remove trade-related barriers, and create tech transfer hubs.
  • Ensure vaccines are offered at an affordable price and on a not-for-profit basis.
  • Prioritize dose-sharing. G7 leaders should pledge 2 billion doses at the Leaders’ Summit, delivering 1 billion by the end of August and the second billion by the end of 2021 and as part of this delivery, ensure that 250 million additional people in low-income countries (LICs) and LMICs have actually received their doses by the end of August in parallel with national vaccine rollout plans.

Fully cost the response, agree to a burden sharing model, and begin to plug the gap by fully funding the ACT-A.

  • Agree to a burden-sharing model to set out fair share contributions and fully funding ACT-A.
  • Leverage funding opportunities by identifying new funding streams to protect official development assistance (ODA).
  • Fully fund global vaccination to reach 70% coverage, requiring at least US$50B according to IMF estimates, with more in grants needed to enable LMICs to cover the full costs of delivery.
  • Work with countries to urgently cost all delivery needs outside of ACT-A’s mandate so vaccines and other tools can be distributed and administered, including the costs of frontline and community health workers.

Three key deliverables for the G7: leadership, supply, and finance 

G7 leaders must:

1. Develop a Global Roadmap to Vaccinate the World: 

  • Develop a comprehensive, coordinated strategy that plugs gaps and shines a light on the blind spots of current efforts, including delivery of tools to low-resource settings.
  • This Global Roadmap should be kicked off at the G7 Summit and delivered with full costings and logistical, human, and financial resource needs by the end of June at the latest, when other costings will also be available to inform the roadmap.
  • There are growing calls for leaders to step up and set out the plan that is designed to bring the acute phase of the pandemic to an end and vaccinate the world. As well as the proposal from the IMF, World Bank, WHO, and WTO, the Spanish Government has set out a ‘Vaccines for All’ plan, more voices in the U.S. are calling on the Biden Administration to show leadership, and in the vacuum left by the lack of a truly global response, other organizations are stepping up to offer policy prescriptions for a global plan. The report of the Independent Panel on Pandemic Preparedness and Response also recognized the lack of global coordination and political leadership during this pandemic and called for a Global Health Threats Council to be formed.
  • The G7 must not delay in corralling leaders to deliver a Global Roadmap. The UK Presidency is well placed to work hand in glove with the G20 to deliver a comprehensive roadmap that plans to vaccinate at least 70% of people in the world and provides the support needed for every country to get the vaccine delivered and administered safely to 70% of each country’s population.


2. Increase the supply of vaccines available globally by: 

  • Prioritizing dose-sharing. The G7 should pledge 2 billion doses at the Leaders’ Summit, delivering 1 billion by the end of August and the second billion by the end of 2021 and as part of this delivery, ensure at least 250 million additional people in LICs and LMICs have actually received their doses by the end of August. Without dose-sharing, G7 countries would have enough supply to vaccinate to share over 3 billion excess doses even after vaccinating 70% of their own populations.
  • Scaling global capacity to produce COVID-19 vaccines by the end of 2021 through investments in regional capacity, backing policies to increase knowledge sharing, removing trade-related barriers, and creating tech transfer hubs.
  • Buying vaccine supply for COVAX and other mechanisms to help reach 70% coverage.


3. Fully finance the global response to COVID-19 by: 

  • Fully funding global vaccination to reach 70% coverage, requiring at least US$50B according to IMF estimates, with more in grants needed to enable LMICs to cover the full costs of delivery, on the basis of a clear burden-sharing agreement, which will:
    1. Fill the immediate ACT-A funding gap of US$19B.
    2. Commit in principle to fund the global roadmap to get to 70% global coverage on the basis of a clear burden-sharing agreement, finding new resources and protecting existing ODA.
    3. Leverage multilateral development banks (MDBs) to help finance the global roadmap.
  • Ensuring the costs needed to administer vaccines — including to health systems and health workers, including frontline and community health workers — are also met, so that vaccines are not just available but also administered, as part of a fully-costed global plan to reach global herd immunity.
  • Costing and then mobilizing the additional finance needed to deliver this plan to vaccinate the world, using all possible finance tools to raise the amounts necessary, including, but not limited to, SDRs, funds from MDBs, and new sources of funding, including innovative mechanisms and providing finance beyond government funding.

 

                           PATH                 

 

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It’s Time to Pandemic-Proof the World: A 2021 Agenda for Action

The devastating health, economic, and social impacts of the COVID-19 global health crisis show that it is well past time for world leaders to prepare for pandemics as the existential, catastrophic, and growing global security threat they are. In 2010, well before COVID-19, there were six times more zoonotic spillover events than in 1980, and the number of new outbreaks continues to grow. Persistent gaps in international pandemic preparedness and response capacities have been flagged by various expert panels in the wake of previous health emergencies, but time and again, once the crisis disappears, political attention and funding shifts to other priorities. This dereliction of duty must stop once and for all.

Despite impacting people around the globe, COVID-19 has not affected everyone equally. The pandemic has exposed and exacerbated long-standing health and socio-economic inequalities within and across countries and in marginalized and vulnerable populations, including inequalities due to gender, race, ethnicity, class, and disability. The glaring disparities in global access to lifesaving COVID-19 vaccines, therapeutics, diagnostics, and vital tools such as oxygen and personal protective equipment (PPE) underscore the inequitable global health and preparedness system. And the lack of proactive attention by leaders to address and account for these inequities has significantly undermined the global COVID-19 response.

As the Global Preparedness Monitoring Board (GPMB) made clear in its September 2020 report A World in Disorder, the world cannot afford to continue to ignore or delay preparations to bolster our collective defenses against emerging pandemic threats. As they battle the current crisis, countries and international institutions must act now to ensure the world is better prepared for the next pandemic threat, which may be lurking just around the corner. These commitments should include building and reliably funding a well-trained and well-equipped health and research workforce, more resilient frontline health systems, timely and transparent disease surveillance, and effective supply chains for vaccines, diagnostics, PPE, and other tools to enable every country to detect, prevent, and rapidly respond to outbreaks before they become deadly and costly pandemics. It is time to invest in a smarter, more responsive, and more resilient global health security architecture.

Pandemic Action Network’s 100+ partners urge world leaders to take urgent action in the following areas to bolster the global COVID-19 response, hasten an end to this global crisis, and lay the groundwork for a more pandemic-proof world.

Support an equitable global response to COVID-19

The only way to end this pandemic is to end it for everyone through a coordinated global response. Yet as world leaders navigate the second year of responding to COVID-19 and securing vaccine doses for their constituents, nationalist inequitable approaches are still pervasive. Recent data shows that the world has now procured enough COVID-19 vaccine doses to reach herd immunity globally, but while some high-income countries have secured multiple times the number of doses as there are eligible adults in their countries, only 0.2% of doses administered have been in low- and middle-incomes countries (LMICs). Although it may seem intuitive for governments to first take action at home, this approach belies the fact that the virus — and its swiftly spreading variants — do not respect borders. Many countries that managed to control or even stop the spread of the virus earlier in the pandemic are once again seeing a surge in cases. There simply is no effective domestic response without also embracing a global approach. Everyone deserves to hope for a swift end to the pandemic, regardless of where they live. But it will only be possible if political leaders act globally as well as locally, knowing no country will be safe until every country is safe.

1. Accelerate global access and delivery of COVID-19 vaccines needed to achieve at least 70% coverage in all countries and enable an equitable global response and recovery.

World leaders should:

  • Fully fund the Access to COVID-19 Tools Accelerator (ACT-A) in 2021, filling the $22.1 billion funding gap as soon as possible with countries paying their fair share for this global public good. Countries should also commit to continue to invest in research and development (R&D) as well as scale-up of proven tools to prevent, test, and treat COVID-19 and ensure that medical countermeasures are effective against all strain mutations and all variants of concern. Given the scale of resources required, countries will need to tap into fiscal stimulus funding and other financial sources beyond official development assistance (ODA).
  • Agree to a roadmap to achieve at least 70% coverage of vaccines for LMICs, with at least 30% being secured, delivered, and administered in 2021. Leaders need to agree to a fully costed plan to achieve equitable global coverage as soon as possible. The full costs of delivering and administering doses in-country should be included in this roadmap, as well as the investments in vaccine education required to increase vaccine confidence.
  • Commit to donate, free of charge, all excess COVID-19 vaccine doses to the COVAX facility in parallel to their domestic vaccination efforts and start those donations as soon as possible. Countries should immediately announce commitments to share their full surplus supply on the most ambitious timeline possible, putting plans in place to deliver on this commitment as soon as is feasible in 2021 in line with COVAX’s dose sharing principles. These donations should not count as ODA, and should be in addition to funding the ACT-A.
  • Commit to “slot swaps” as another way to give COVAX additional supply. “Slot swaps” should be undertaken whereby high-income countries reallocate some of their existing orders immediately, potentially ordering replacement vaccines to arrive farther in the future, effectively giving their earlier “slots” to COVAX to help provide vaccines for LMICs to close the current acute gap in supply.
  • Ramp up global access and delivery of rapid testing, medical oxygen, and personal protective equipment to the frontlines. Continuing shortages of PPE and medical oxygen for frontline health workers and extremely limited deployment of testing — including genetic sequencing capacity to detect variants of interest — especially in LMICs, is hampering the global COVID-19 response and is a rate limiting factor for global rollout of COVID-19 vaccines and restoration of essential health services.

Prioritize and invest in pandemic preparedness and prevention

According to the IMF, the pandemic will cost the global economy and the World Bank projects that more than 160 million people will fall into poverty by the end of 2021. Conversely, recent estimates are that as little as $10-20 billion annually can ensure the world is much better prepared to detect, prevent, and respond to the next infectious disease outbreak before it becomes another deadly and costly pandemic. To minimize human lives lost from infectious diseases and lessen the impact on countries due to economic fallout, leaders should take the actions below to be prepared for the next pandemic.

2. Establish a catalytic, sustainable multilateral financing mechanism that is dedicated to promoting pandemic preparedness and prevention.

World leaders should:

  • Pledge new investments toward a target $20 billion initial capitalization co-funded from public, private, and philanthropic sources. Priorities for this new multilateral financing mechanism — which will fill a strategic gap in the existing global health architecture — should be on supporting LMICs to develop and implement national action plans for health security and pandemic preparedness, to close their urgent health security gaps, and foster a global “race to the top” among all nations for preparedness. The catalytic nature of this mechanism will help ensure both countries and other global health initiatives prioritize coordinated, multisectoral, prevention and preparedness funding in their domestic budgets, including support for country-level programmatic and managerial capacity in health systems strengthening.
  • Align funding with target country priorities to strengthen pandemic preparedness and containment as well as promote efforts toward pandemic prevention. Programs that should be financed at scale include detecting and stopping the spread of outbreaks and ensuring compliance with the International Health Regulations (IHRs), strengthening laboratory and manufacturing capacity, bolstering and protecting a trained, compensated health workforce, building and strengthening health information systems, ensuring resilient national and regional supply chains, One Health initiatives, and stopping zoonotic spillover from causing new outbreaks through measures such as reductions in deforestation and wildlife trade.

3. Bolster financing and at-the-ready global R&D capacity and coordination to combat emerging infectious diseases and pandemic threats without undermining important funding for existing epidemics research and innovation, including poverty-related and neglected diseases.

Applying the lessons learned from COVID-19, leaders should support the development and financing of mechanisms and initiatives that coordinate and catalyze research and development for new tools, including the Coalition for Epidemic Preparedness Innovations (CEPI), Global Antibiotic Research and Development Partnership, and other not-for-profit product development partnerships (PDPs) addressing the broad range of health threats.

World leaders should:

  • Fully fund CEPI’s $3.5 billion replenishment. This funding would support the organization’s moonshot initiative of compressing vaccine development for new pandemics to 100 days, and continuing efforts to develop vaccines for known threats. It would also support CEPI’s other objectives, including preparing clinical trial networks to quickly respond to new threats, coordinating with global regulators to streamline vaccine oversight, and linking manufacturing facilities to speed up global production.
  • Support integration of R&D into the Global Health Security Agenda (GHSA) framework to include R&D capacity-building for medical countermeasures. Inclusion of metrics through a GHSA R&D taskforce will help countries assess, prioritize, and better plan for strengthening their R&D capabilities.
  • Build on the ACT-A’s response to COVID-19 to ensure a robust, end-to-end, and sustainable investment in global health R&D for pandemic preparedness, including long-term investments to strengthen global research, laboratory, and manufacturing capacities. This future readiness state should also foster more investments and partnerships with diverse research and academic institutions to both build regional R&D prior to crises and scale up support during emergencies. Investments should be made with policies that promote equitable global access to and affordability of tools like vaccines, diagnostics, and therapeutics.

4. Strengthen global and national surveillance capacities & outbreak analytics.

COVID-19 has demonstrated global gaps in early detection and data sharing around emerging threats, as well as gaps in ongoing surveillance capacities of countries, especially low-resource countries. Current emerging infectious disease surveillance and investigation is poorly allocated, with the majority of the globe’s resources not focused on areas with the most zoonotic hotspots where the next emerging deadly pathogen is likely to originate.

World leaders should:

  • Strengthen integrated national disease surveillance capacities in LMICs. Such surveillance capacities should take a One Health approach and be responsive to local needs (i.e., give results in real-time for use by clinicians and public health officials). Such capacities should not be developed in a silo for pandemic risk monitoring; rather they should provide utility for day-to-day public health programs, leverage the latest developments in digital tools to streamline operations for health workers, and accelerate data flow and analysis.
  • Strengthen mechanisms and platforms that allow for independent sharing and verification of data related to emerging health threats, complementary to and in partnership with the WHO’s role in collecting data from official sources under the IHRs. Such capacities should enable and promote more transparency and accountability in data access for all relevant stakeholders.
  • Commit to the rapid publishing and sharing of line list and pathogen genome data into shared repositories (e.g., the Global Influenza Surveillance and Response System and the International Nucleotide Sequence Database Collaboration) to ensure that data necessary to monitor variants of concern can be acted upon before they become dominant.
  • Support innovations in outbreak detection and analytics capacity nationally through emergency operations centers, regionally through academic centers of excellence, and globally through laboratory and disease surveillance networks. The ACT-A has taught the community about the importance of collaboration and rapid response, and these lessons should be applied to future tools.

5. Bolster global capacities, institutions, and systems for pandemics, health security and resilient health systems, including through reforming WHO and strengthening international frameworks for pandemic preparedness and response.

World leaders should:

  • Build consensus for, and rapidly move to implement, proposals that will strengthen the WHO as the global coordinating authority on health. Leaders should support proposals for sustainable financing of the WHO, including incremental increases in assessed contributions and more (and more flexible) voluntary financing. Such resourcing should go hand-in-hand with strengthening the WHO’s normative and technical capacities, including the Chief Scientist’s Office, the Health Emergencies Programme, and the WHO Academy, and with encouraging greater staff mobility and budget flexibility to bolster the WHO’s capacities at the country-level. In line with the Framework for Engagement with Non-State Actors (FENSA), leaders must enable more robust and transparent engagement with key stakeholders such as civil society and the private sector.
  • Strengthen the IHRs to foster more timely and accountable response to pandemic threats, including to authorize international investigations. Leaders should afford the WHO the ability to independently investigate potential and emerging threats, specify better information sharing, and better calibrate the definitions of a Public Health Emergency of International Concern (PHEIC). Metrics on equity, R&D, infection prevention control, capacity strengthening, and water, sanitation and hygiene should also be included in the IHR Monitoring and Evaluation Framework, to incentivize countries to assess, plan, prioritize, and better support sustainable and resilient health systems, and promote healthcare worker safety.
  • Support other voluntary and compulsory instruments to strengthen accountability of nation states and foster multilateral cooperation for pandemic preparedness and response. Many gains can be made by strengthening existing mechanisms and instruments, which should be prioritized alongside the proposal for a new pandemic treaty. Such instruments should promote accountability in functions including ensuring novel countermeasures are treated as global public goods; motivating faster flow of financing to address direct and collateral impacts of pandemics, including protecting frontline health workers and social protection for vulnerable populations such as refugees and those living in conflict-affected areas; reaffirming the centrality of human rights considerations in the context of a pandemic; boosting domestic R&D and manufacturing capacity; and establishing up data surveillance systems, and norms and standards around data sharing and data privacy.
  • Scale up national and global vaccine education efforts to increase vaccine confidence, distribution, and uptake. Countries should have budgets dedicated for vaccine education within health ministries, initiate public education campaigns to manage the spread of misinformation online, and build capacity for vaccine hesitancy research. Training should be prioritized for frontline healthcare workers, community leaders, and others in how to engage in difficult conversations on vaccine hesitancy.

6. Promote equity-focused initiatives and human rights protections in all aspects of pandemic preparedness, response, and recovery, including specific attention to address the intersectional and gendered effects of outbreaks.

World leaders should:

  • Commit to equitable financing to support populations most at risk for morbidity and mortality, including addressing inequities due to disparities in gender, race/ethnicity, sexual orientation, socioeconomic status, and disability.
  • Ensure commitments to human rights and equity are met, in alignment with IHR Article 3 on human rights, the United Nations Security Council Resolution 1325 for Women, Peace and Security, the UN Political Declaration for Universal Health Coverage, and the UN Sustainable Development Goals.
  • Commit to equal and diverse representation on emergency committees, including the IHR Emergency Committee and UN technical working groups, with active and meaningful participation of gender advisors and civil society groups as non-participant observers of EC meetings.
  • Ensure that all data pertinent to pandemic preparedness and response collected by the WHO and other health-focused UN bodies (as well as national governments) is published and disaggregated by sex and key socioeconomic groups.

 


 

An array of upcoming international summits — including the G20, G7, World Health Assembly, World Bank/IMF Meetings, and UN General Assembly — offer opportunities for leaders to act on this agenda. Critically, while health ministers have a key role to play, a concerted effort to end pandemics is a whole of government effort — and must be addressed at the level of heads of state. That is why the Pandemic Action Network supports the GPMB’s call for the UN Secretary-General to convene a focused UN High-Level Summit on Pandemic Preparedness and Response to mobilize increased domestic and international financing and advance efforts toward a new international framework for pandemic preparedness. Such a summit at head of state level should take up the forthcoming findings of the Independent Panel for Pandemic Preparedness and Response (the Independent Panel), the G20 High-Level Independent Panel for Financing the Global Commons (HLIP), the International Health Regulations (IHR) Review Committee, and the proposal for a new international treaty on pandemic preparedness and response.

World leaders must seize this opportunity to commit to action and leave a legacy of a healthier and safer world. We can pandemic-proof the future if world leaders act now. The world can’t afford to wait.

Calling on Wealthy Countries to Reallocate Excess Vaccine Doses

As more and more people in high-income countries become vaccinated against COVID-19, the inequitable allocation of approved vaccines across the globe is coming into stark relief. Wealthy nations have secured multiple times the amount of vaccine needed to protect their population, while low- and middle-income countries still need to get to the 20% of the population coverage offered by the COVAX Facility.

Pandemic Action Network’s Funding and Access to COVID-19 Tools Working Group produced a policy brief urging high-income countries to coordinate with COVAX to donate excess COVID-19 vaccine doses to low- and middle-income countries – and to engage in ‘slot swaps’ to make sure vaccines can be delivered without delay to LICs and LMICs. As vaccines arrived in wealthy nations in December and January,  it became clear that countries without bilateral deals with pharmaceutical companies could be left behind. In light of this reality, the working group pushed COVAX to offer countries the option to reallocate excess supplies.

Read the paper here. If your organization wishes to add their logo to the briefing, please email [email protected].

Guaranteeing Equitable Access: Considerations During Vaccine Development Impacting Global Access

As world leaders come together to strategize how best to inoculate against, test for, and treat COVID-19 across the world, they must prioritize equity in their agendas to end this pandemic as swiftly as possible. The Pandemic Action Network’s Ending Barriers to Equitable Access Working Group has crafted a briefing with key considerations for decision-makers to ensure vaccines, therapeutics, and diagnostics reach those who need it most, when they need it most. We are all at risk until this disease is defeated internationally. We must ensure that low- and middle-income countries and vulnerable groups have equitable access to the tools needed to fight COVID-19 on every front. Read the full paper here.

Contributors to the paper include Deutsche Stiftung Weltbevölkerung (DSW), Global Citizen, Global Health Technologies Coalition (GHTC), PATH, and VillageReach. Special thank you to DSW for design support.