Gavi’s overwhelmingly successful Global Vaccine Summit (Gavi replenishment) secured over US$8.8 billion to support their life-saving work – nearly 20% more than their US$7.4 billion pledging target! This is an incredible achievement that will not only help to vaccinate more than 300 million children, but the additional US$1.4 billion secured by Gavi could make an important contribution towards the US$2 billion in seed funding required to kick-start their newly launched Advance Market Commitment for COVID-19 Vaccines (Gavi Covax AMC).
Alongside pledges from more than 32 donors to support Gavi’s mission, the donors of the pneumococcal conjugate vaccine (PCV) Advance Market Commitment (AMC) announced that they would rollover their remaining shares from the PCV AMC, totalling US$177.5 million (US$187.5 million if you factor in Russia’s portion), to the new Covax AMC. Critical funding is certainly needed to support a future COVID-19 vaccine, while ensuring equitable and affordable access when it becomes available. However, this should not be taken out of the funding pot that was set up to unleash vaccines for the world’s biggest killer of children, pneumonia. We need increased investment in COVID-19, but this should be NEW money, not money repurposed from other critical health priorities.
Unfinished business of the Pneumonia vaccine
We must not lose sight of other vital priorities, such as pneumonia, which killed over 800,000 children under the age of five last year. There is still a distance to go address pneumonia, including through equitable access to the PCV vaccine. The PCV vaccine is one of the most expensive vaccines in Gavi’s portfolio. It is even more expensive for countries not eligible for Gavi support, with some middle-income countries reporting paying up to three times the Gavi price. A new report by Every Breath Counts highlights that 54 countries have yet to introduce the PCV vaccine and globally one child in two is unimmunised. PCV affordability and access is still very much unfinished business.
A glimmer of hope entered the PCV landscape when the Serum Institute of India’s (SII) PCV vaccine entered the market at the end of last year after receiving pre-qualification from the World Health Organization. More good news emerged last week as Gavi awarded SII a supply agreement under the PCV AMC. Save the Children, together with other partners, had been advocating for the remaining AMC funds to be reserved for the entry of an additional PCV supplier, so this was very welcome news. Under the new supply agreement, SII has confirmed a price of US$2 per dose (US$6 for the full course) – 30% lower than the previous lowest price – a game-changer in improving vaccine affordability. SII will be awarded US$75 million from the AMC pot, just 5% of the total amount. Meanwhile the other two manufacturers benefitting from the AMC have already received 82.5% of the US$1.5 billion AMC funding over the years. The latest decision from AMC donors to reallocate funding to the Covax AMC will now wipe out the remaining funding.
In our rush to fund a COVID vaccine, we must not divert funds away from other critical priorities and mechanisms. The PCV AMC has finally seen the entry of a new supplier that should be financially supported through this mechanism – set up to “to make effective and affordable pneumococcal vaccines available for children in developing countries” – just as the other suppliers in the mechanism have, especially as this new supplier offers the lowest PCV price on the market. The AMC should continue to support this lower vaccine price, thereby incentivising improved vaccine affordability and access. This has the potential to improve PCV introductions and coverage, allowing more children to be reached and protected from the biggest infectious killer of children.
Guaranteeing an equitable and affordable COVID-19 vaccine
There is certainly wide commitment to ensure an equitable and affordable COVID-19 vaccine when it becomes available. This must be translated into sufficient (new) funding and global access guarantees, in addition to having the right mechanisms in place to break down any barriers to deliver this. With COVID-19, we are in unchartered territory and there is no magic bullet to guarantee equitable and affordable access. Therefore, we must exhaust all available tools and mechanisms at our disposal to help make this happen. This includes the newly launched Covax AMC, in addition to tools to address intellectual property barriers, pooled procurement options, etc. We also need guarantees from all stakeholders that are in a position to really ensure that any future vaccine is made available to countries and people based on need, rather than ability to pay. This will require governments and vaccine suppliers adhering to the WHO’s allocation framework for what will inevitably be a finite supply.
As the world focuses its energy on a COVID-19 vaccine – which it certainly should – we must not ease off on other vaccines, particularly those that still face equity and affordability challenges. Yes, critical new funding is needed, but this should not be diverted from other priorities, such as the unfinished business of pneumonia and the PCV vaccine, along with other vaccines critical for child survival.
