Amanda Glassman and Erin Collinson
The global COVID response effort has been in desperate need of a shot in the arm. Yesterday’s US-hosted Global COVID-19 Summit, on the sidelines of the UN General Assembly, aimed to provide just that. President Biden kicked off by unveiling a set of new US commitments to fight the current pandemic and bolster future health security—alongside the obligatory reminder of previously announced support and commitments.
The convening featured more than a dozen heads of state alongside leaders of key international institutions and multilateral health organizations, representatives from major foundations, and chairs of recent independent health panels. What’s more, the event showcased engagement from all corners of the US administration—underscoring President Biden’s assertion that this is truly an “all-hands-on-deck” moment.
While vaccine supply is still constrained, particularly in sub-Saharan Africa, the summit’s commitments have the potential to bring the acute phase of the pandemic to an end, barring the spread of vaccine-evading variants. But there is still much work to be done to translate commitments into reality—and to deliver on a new target to vaccinate 70 percent of the world by next September, even as the international community is falling well short of the previous one (40 percent by the end of the calendar year).
A few highlights:
Expanding vaccine access
While news that the US would make another major purchase of Pfizer vaccines for donation began to circulate ahead of the summit, President Biden delivered the official announcement. US officials inked a deal for yet another 500 million doses for low- and lower-middle income countries—though shipments under the latest agreement aren’t expected to begin until January 2022. The European Union also committed an additional 500 million doses. If low-income countries are prioritized as is likely, these donations—on top of existing purchases from COVAX and the African Union’s AVATT with support of the World Bank—would be more than enough to fully vaccinate the populations of all low-income countries (1.3 billion doses for 665 million, assuming the entire population needs two doses). While there are major issues to sort out—earlier delivery dates, product suitability, getting shots in arms—it is the right level of ambition to vaccinate the whole world.
Indian companies were the big suppliers to COVAX accounting for 305 million of the doses initially forecast to be available in 2021; earlier this month, COVAX removed these doses from its forecast due to the Government of India’s ban on exports in place since the country’s Delta wave. Among the best news related to the COVID Summit was the Modi announcement that the export ban would end, and doses would begin to ship in October. Alongside the announced donations, Modi’s decision to lift the ban is profoundly consequential for vaccination in low- and middle-income countries.
This week also brought related good news. With the support of CEPI, Novavax—which has manufactured and is set to provide 130 million highly efficacious doses to COVAX via the Serum Institute of India—finally filed for emergency use listing at the WHO. And Clover Biopharmaceuticals—also supported by COVAX for 45 million doses—announced the results of its large, late-stage trial showing very high efficacy against the Delta variant.
Meanwhile, the United States and the European Union are also investing in ramping up vaccine manufacturing globally, including through the US International Development Finance Corporation (DFC). A White House factsheet promised recent deals in India and Africa would collectively expand COVID-19 vaccine production by 2 billion doses by next year while laying groundwork for the future. (For more on DFC’s COVID response and future investment opportunities in the health sector, check out this CGD paper. And hear from DFC’s Managing Director for Health, Nafisa Jiwani, and other experts at a recent CGD event on the potential for development finance institutions to address critical gaps in the health sector, shoring up health supply chains and promoting innovation amid the current pandemic and beyond.) DFC is also providing risk insurance to Gavi, the Vaccine Alliance, safeguarding shipments of vaccines around the world.
And recognizing the logistical challenges ahead in managing vaccine distribution, the United States also promised $370 million in new assistance for vaccine readiness and to cover costs of deployment, a good start and an indicator of priority to the effort.
Supplying the near-term response to save lives now
President Biden also highlighted the importance of other tools—including medical oxygen, testing, and PPE—in the near-term fight against COVID-19. Even as the world works to expand access to vaccines, increasing the availability of testing kits and PPE will be vital to slowing the spread of the disease and saving lives now. He also repeatedly referenced the importance of addressing critical oxygen shortages driven by increased demand amid the pandemic, though the response here was a modest contribution: USAID announced an allocation of $50 million to expand access to oxygen, for example. Our colleagues previously outlined guidance for how to ensure effective oxygen use as supply is scaled.
Likewise, diagnostics, therapeutics, and other supplies remain underfinanced; Global Fund chief Peter Sands highlighted that the Global Fund’s C19 Resource Mechanism was short $1 billion to supply countries’ demands for tests, PPE, and medicines. While some (new?) funding was announced, here again the ambition seemed to fall short of needs. Meanwhile, this week’s earlier meeting of the Facilitation Council of ACT-A, the initiative that COVAX is part of, set out a new $52 billion fundraising goal “to end the acute phase of the pandemic.”
Strengthening global health security
Truth be told, this was probably the announcement about which we were most excited. Attention to the near- and medium-term COVID response is vital, but it will be an utter failure of policymakers, advocates, and health experts the world over if we exit this pandemic without a plan for the next one. The White House has been forecasting designs for a global health security financing mechanism since the early days of the administration, but today brought a firmer commitment. In her remarks, Vice President Kamala Harris outlined the United States’ intent to partner with the European Union and like-minded nations and philanthropists to establish a new financial intermediary facility hosted by the World Bank. The Vice President referenced a $10 billion per year goal as laid out in the recommendations of the G20 High Level Independent Panel, and she announced an initial US contribution of $250 million and plans to request an additional $850 million from Congress. Heads of state from Italy, Norway, South Africa, and Sweden also underscored the need for the financial facility in their statements (all the statements can be found here).
The administration’s proposal mirrors the recommendations of the G20 High Level Independent Panel of which we have been a part, and signs are positive that a new multilateral financing facility will finally become reality. Since 2016, we have been recommending ways to enhance the measurement and financing of global health security and to generate more virtuous incentives for every country to allocate more resources to this important shared objective (here and here).
The moves forward mean that it’s time now to focus on practicalities—how will a new financial intermediary facility (FIF) interact with the World Bank as host and the organization’s own mission? How will it relate to existing regional and global multilaterals and health entities? Will the new Global Health and Finance Board mentioned by multiple countries oversee and use financing as a tool to drive results? How will the FIF be governed (see some of our ideas here) and how can we reach the aspirational goal of a fund that is financed “beyond aid,” limiting crowd-out of other global health priorities (our ideas here)?
What was missing?
Amid the good news, we did note two conspicuous omissions from yesterday’s proceedings.
The World Bank: Also absent was live participation from a representative of the World Bank—apparent host to the newly announced Global Health Security Financial Intermediary Fund. In published remarks, Bank President David Malpass highlighted the institution's response to date and reiterated calls from the Multilateral Task Force for countries to donate excess vaccines and ease trade barriers impacting critical medical supplies. But the World Bank’s role in supporting countries to deliver vaccines and its expected future role in the fight against pandemic risks received too little attention, even as World Bank financing for COVID-19 response within the health sector totals more than $44 billion to date—dwarfing most bilateral aid contributions as well as the spending of the global health organizations represented at the event. With the big gaps in funding identified by ACT-A, the role of the World Bank and the other multilateral development banks needs closer attention. The upcoming World Bank-IMF fall meetings and the replenishment of the World Bank’s low-income lending arm (IDA20) represent golden opportunities to reset and more clearly define the Bank’s role in supporting countries’ vaccine delivery as well as its relationship with the global health organizations on COVID-19 and future pandemic risks.
China: As they have in the past, President Biden’s remarks included thinly veiled references to the importance of donating vaccines rather than selling them and doing so with “no political strings attached.” But the event was devoid of real discussion of the role of world’s second largest economy in fighting the pandemic, a missed opportunity given the reality that China is currently the world’s largest COVID-19 vaccine manufacturer. It’s no secret that the US-China relationship is fraught, but narrow cooperation to end the pandemic is in everyone’s interest given that the Chinese vaccines—are safe and “good enough” to significantly reduce mortality associated with COVID-19. And indeed, the new vaccine candidate from China’s Clover Biopharmaceuticals actually performs better against the Delta variant compared to existing vaccines, if press releases are accurate.
US officials sought to characterize the summit as a turning point—a chance to harness new momentum to gain control of the COVID-19 pandemic and invest in our collective ability to combat future health threats. And the summit was promising – both the additional commitments and the impressive new leadership and cooperation on display. But shots in arms, not promises, will be what ends the pandemic, and the international community’s ability to deliver on these commitments over the months ahead will be the real measure of its success.