NATIONAL

‘Initial vaccine support will cover 92 low- and middle-income economies’

Seth Berkley , CEO of Gavi the Vaccine Alliance, says over $2 billion has been raised for the Gavi COVID-19 Vaccines Advance Market Commitment (COVAX AMC) so far. A public-private global partnership, GAVI aims to increase access to immunisation in poor countries and has extended its services to handle the biggest immunisation crisis imminent, he says.

Gavi’s COVAX AMC is an effort to jumpstart countries’ ability to deliver COVID-19 vaccines. Do we have details of the assistance programme that aims at equitable access, yet? When do you plan to roll it out?

Initial, catalytic support will be made available to 92 low- and middle-income economies eligible for participation in the Gavi COVID-19 Vaccines Advance Market Commitment (COVAX AMC), to assist them in planning for delivery of COVID-19 vaccines, including support for technical assistance and strengthening cold chain equipment, according to a decision taken at the Gavi Board in October. This amount builds on the $200 million re-allocated by Gavi in the initial stages of the pandemic to help Gavi-eligible countries respond and protect health systems.

Following briefings with AMC-eligible participants, Gavi and its Alliance partners — WHO and UNICEF — are finalising details on the operationalisation of this support, to be implemented as soon as possible, as well as planning for longer-term support for country readiness and delivery.

What will be the specifics with reference to India? Also, what is your requirement from the Indian government?

We are currently in discussions with economies, including India, that are eligible for the Gavi COVAX AMC on detailed terms of participation in the COVAX Facility including their need for technical assistance — we will be able to provide more specifics on India’s engagement later this year.

In the estimation of Gavi, how have nations been performing, in terms of their response to the pandemic, in particular in LMIC countries. Are you looking at a certain robust response or demonstration of a commitment before countries get on the COVAX bandwagon?

It is not Gavi’s role to grade countries on their performance in these unprecedented conditions: what is important is that we make sure that every country in the world that needs access to COVID-19 vaccines is able to access them for their most at-risk populations at the very earliest opportunity.

In addition to the 92 economies eligible for AMC support, another 94 have joined as self-funding members of the COVAX Facility. This brings us up to 186 economies around the world.

At the same time, we are negotiating deals with manufacturers for doses to be supplied upon licensure or prequalification: here, we have already secured up to 200 million doses of a vaccine for lower-income countries with the support of the Bill & Melinda Gates Foundation, under their tech transfer agreements with AstraZeneca and Novavax, to be produced at the Serum Institute of India.

A Memorandum of Understanding between AstraZeneca and Gavi, announced in June also commits an additional 300 million doses of AstraZeneca’s candidate vaccine to the wider COVAX Facility. We have recently announced an additional agreement with GSK and Sanofi for 200 million doses. We will be announcing future deals and doses secured in due course.

In terms of access to regular vaccines, as part of the immunisation programme, has there been a disruption the world over as a result of the pandemic? Would you care to point to nations where there seems to be a deep impact? What are the ramifications in terms of child health?

The COVID-19 pandemic is having a major impact on continuity of primary health care services, particularly immunisation. Disruption of immunisation services due to COVID-19 increases the risk of vaccine preventable diseases and outbreaks. Existing health and economic inequities are being exacerbated, putting the most disadvantaged and poorest communities at even greater risk. Despite the variable trajectory of COVID-19 in different countries, it has adversely impacted immunisation programmes nearly everywhere.

Out of 68 Gavi-supported vaccine introductions and campaigns projected to take place in 2020, several have been impacted due to COVID-19: 39 are confirmed delays, and a further four are at risk of delay. A number of Gavi-eligible countries have resumed campaigns and vaccine introductions: Burkina Faso, Central African Republic, Ethiopia, Eritrea, Nepal, Solomon Islands, Uganda, Uzbekistan, Yemen and Zambia.

Eighteen Gavi-eligible countries have reported shipment delays, while approximately six countries are reporting stock-outs at central or subnational level due to COVID-19. UNICEF has been reporting that the overall the shipment trend has been stabilising, with approximately 45–50 vaccine shipments delivered per week. Both the number of shipments and the number of countries reached per week are within the range of pre-COVID-19 pandemic levels. This has led to a progressive reduction of the backlog of shipments, with only a handful of long-standing shipments pending; these are being booked and consolidated as required.

There are some delays in cold chain equipment optimisation platform (CCEOP) implementation. Where additional costs have been incurred due to COVID-19, these costs have been covered under the CCEOP buffer.

Immunisation is an essential health service that should be prioritised for the prevention of communicable diseases and maintained during the COVID-19 pandemic. A recent study suggests that if people were to avoid going to the health centres and miss immunisation to avoid COVID-19, for every death prevented from COVID-19, over 80 vaccine-preventable deaths would occur, highlighting the importance of identifying strategies to continue to deliver immunisation.

The pursuit towards SDGs — is the journey going to be disrupted? Are there going to be setbacks in the achievement of goals, as a consequence of the pandemic?

If we do not rise to the challenge, there is a substantial risk — COVID-19 has taken an unprecedented toll on health systems and economies. We must do everything we can to ensure that our world’s path towards sustainable development remains on track.

COVID-19 has adversely impacted immunisation programmes nearly everywhere