1. Global strategy, preparedness and coordination
In the absence of a global system for managing global public goods, “governments will need to take a step back, follow epidemiology and… ensure that the vaccine is plural”, said Smith. A new vaccine should be globally accessible, available equitably and equally everywhere. “What you don’t want is a national vaccine. We want the best science anywhere”, stressed Berkley. He added that dialogue and transparency, including in the pharmaceutical industry, is vital to such an unprecedented emergency. “It’s up to the global community to make sure to invest and insure adequate capacity for the winning vaccine to be available worldwide.”
Berkley added that any future vaccine should be distributed first to health workers, to other groups at-risk, and finally to the general population, adding that ground rules have to be laid now, however:. “Those discussions have to happen before the vaccine is ready. We need to prepare” said Berkley. “We need scale-up of manufacturing and finance ready when it happens”, added Cerrell.
2- Scale and organize production
89 vaccines are currently in development, some already in clinical trials, but there might eventually be twice as many coming up through the pipeline, Berkley said. “They cannot all go to the stage of [clinical] testing. So, we need to regulate to have the best potential product for the world, efficient, usable, scalable.” Cerrell called upon drug manufacturers to commit to supporting vaccine scale up, whatever candidates prove to be winners. But more coordination is needed to hone down on the most promising ones. “The important thing is to start thinking now about the manufacturing costs. It will not help if we only have a few million doses of something successful. We need to build on this manufacturing capacity now”, added Cerrell. “We don’t want to throw money at candidates that don’t work. Portfolio management and coordination of capacity is important”.
Production is also central to make sure there is enough vaccines for everyone on the planet and to the ones that have the least ability to sustain the shock. “We need to put a system in place to make it available to everyone. A vaccine available at scale is important but we need a broad global framework”, said Smith.
3- Finance instruments and funding
Cerrell detailed tools that are currently under study by the Bill and Melinda Gate Foundation such as Advanced Purchase or Market Commitments (used for Ebola vaccine development) for a massive amount of capacity to develop and manufacture a vaccine at an unprecedented scale. He also mentioned the Innovative Finance Facility for Immunization as an interesting tool successful in securing long term financial commitments from donors. “It may be interesting for countries who may not be able to pledge big sums of money today, but can spread out some of those plans for longer period of time”, said Cerrell. Berkley said Gavi in the past had already used Advance Market Commitments to finance vaccines development and manufacturing, in addition to regular donor support. “These financial instruments secure [commitments for] large volumes from companies and good pricing arrangements in exchange. It allows scaling up”. Gavi also seeks direct finance support for companies to build facilities to produce the vaccine.
Gayle said the One Campaign was seeking funding in COVID-19 R&D and vaccine manufacture to the tune of at least US$ 8 billion, adding “it’s only part of what is needed.” At the same time, GAVI’s virtual replenishment conference, hosted by the United Kingdom, will take place on June 4. Said Berkley, “We need to secure at least US$ 7.4 billion for the next five years to protect 300 million children to the 760 already immunized since 2000 and prevent an additional 8 million deaths.”
Regarding the overall cost of developing and manufacturing a COVID-19 vaccine, Cerrell said that some US$ 20-US$ 25 billion might be needed in total. But the speakers cautioned that the ultimate cost would depend on a range of factors, including not only the speed of R&D but also whether this is a single or double dose vaccine; and the nature of the manufacturing process.
GAVI would be a “fundamental piece of the solution,” in terms of delivering a future vaccine to the poorest countries around the world, said Smith, adding, “We need to make sure GAVI is fully financed and ready when a vaccine is available.”
Five critical challenges:
Berkley referred to five critical challenges facing the global health community, in terms of any future COVID-19 vaccine as well as vaccines more generally, including:
Insuring adequate production capacity. to supply everyone with vaccines;
Global leadership to prioritize the most promising vaccine candidates with transparent criteria;
Global capacity to manage the complex deployment of billions of doses to the entire world;
Protection of health workers and existing health systems;
Insuring routine immunizations continue. On this last point, he noted that for every death avoided from COVID-19, health systems could face 100 times more deaths from vaccine preventable diseases,” as per the findings of a recent study from the London School of Hygiene and Tropical Medicine.
Profiles of the speakers
Dr Seth Berkley A medical doctor and epidemiologist trained at Harvard University, Berkley joined Gavi as its CEO in August 2011. Under his leadership, The Vaccine Alliance received the Lasker-Bloomberg Public Service Award for providing sustained vaccine access to more than 760 million children in the 73 poorest countries, saving millions of lives and highlighting the power of immunisation to prevent diseases. In 1996, Berkley founded the International AIDS Vaccine Initiative (IAVI), the first vaccine product development public-private sector partnership, where he served as President and CEO for 15 years. He was also an officer of the Health Sciences Division at The Rockefeller Foundation. Recognized by TIME magazine as one of “The TIME 100” – The World’s Most Influential People, he is also is a Professor at the University of Geneva’s Institute of Global Health.
Gayle E. Smith President and CEO of the One Campaign, a global movement campaigning and pressuring governments to fightextreme poverty and end preventable disease by 2030. One of the world’s leading experts on global development, she is former head of USAID and was an advisor to President Obama during the 2014 Ebola pandemic wither extraordinary network of relationships across the African continent and around the world. She also served as special assistant to President Clinton. Born in Bexley, Ohio, she started her career as a journalist and worked with NGOs in Africa for more than 20 years.
Joe Cerrell Managing director of Global Policy and Advocacy for the Bill and Melinda Gate Foundation. Since joining the foundation in 2001, he held a number of positions, including director for Europe and Middle East and director of Global Health Policy and Advocacy. His team is seeking to expand the foundation’s partnerships to increase global engagement and progress on global health and agriculture. He previously served in a variety of senior roles in government and strategy consulting practices, including positions in the Clinton White House under former Vice President Al Gore and at APCO Worldwide, an advisory and advocacy communications consultancy. Cerell currently is also on the board of directors for the ONE Campaign and Comic Relief.