The COVID-19 pandemic is a wake-up call for multilateralism. As leaders from around the globe convened for the first-ever virtual World Health Assembly (WHA), it has never been clearer that every country has been touched by this horrible disease, as evidenced by delegates highlighting their countries’ actions and response efforts in their interventions. The COVID-19 crisis has demonstrated just how crucial multilateral conveners like the World Health Organization (WHO) are to our collective health, prosperity, and security and the need for enhanced international cooperation and worldwide solidarity.
Innovation is our exit strategy for defeating COVID-19 and combating the pandemic calls for a robust, coordinated, large-scale, and science-based global response. Governments and foundations are pouring billions into scientific research efforts to develop new tools to detect, treat, and prevent COVID-19. Yet these new initiatives and efforts need to be aligned. The World Health Organization (WHO) has been called on to coordinate several of the R&D response efforts to accelerate the development of diagnostics, vaccines, therapeutics, and other health technologies to combat this novel coronavirus, and the organization’s ability to effectively help support these efforts will be vital to their success.
Accelerating research to develop new tools
The global response will have to be well coordinated. With so many new mechanisms being developed to fight COVID-19, it is essential to ensure that efforts are not counterproductive. It will also be important that there is a holistic approach to tackling this crisis because there will be no silver bullet. We can start with WHO’s creation of COVID-19 Target Product Profiles (TPPS), which outlines the product gaps to be filled. Building on that, WHO launched a new program, called the Access to COVID-19 Tools Accelerator, or the ACT Accelerator. This collaboration between WHO and dozens of governments, nonprofit organizations, and industry leaders seeks to facilitate partnerships, provide technical guidance, and provide support to health systems and strengthen countries' capacities to enable the delivery of new COVID-19 tools. The global initiative will draw on the expertise and infrastructure already put in place by organizations that work across the globe, including Gavi, the Vaccine Alliance; CEPI, the Coalition of Epidemic Preparedness Innovations; FIND; the Global Fund; and Unitaid.
Speed is a key factor to quelling the pandemic. As scientists around the world race for a cure for COVID-19, international cooperation is critical for accelerating research. One of the ways WHO has supported these efforts is by designing a large international randomized controlled clinical trial, called the Solidarity Trial, to enable the simultaneous evaluation of the benefits and risks of different vaccines at sites with sufficiently high rates of the disease. This will ensure a faster turnaround of results and ensure that sufficient data is being captured to make more robust assessments of the efficacy and safety of these treatments. While the trial is currently only being leveraged for the most severe cases, with few trials in resource-poor settings, this approach should be broadened and connected to initiatives like the COVID-19 Clinical Research Coalition in order to have a more complete assessment of how R&D treatments for COVID-19 are progressing.
Assessing new technologies quickly will also be a major factor in how rapidly they can be deployed. In order to ensure quick access to high-quality, safe, and effective new health technologies for COVID-19, WHO has activated its Emergency Use Listing (EUL), a procedure that allows for rapid assessment of diagnostic and labrotary technology. This is crucial for countries that have weaker regulatory systems or lack local infrastructure such as laboratory capacity to evaluate new tools. EUL helps accelerate access to these innovations, but this should only be the first step. Beyond emergency approvals, full technology assessments such as the WHO Prequalification process should also be leveraged as new products are realized. For example, we saw the new Ervebo Ebola vaccine go through WHO Prequalification within 48 hours of the European Medicines Agency’s recommendation, and GHTC would like to see that approach mirrored for products developed to respond to COVID-19 as well as other health threats.
Tackling supply challenges and access
What happens once vaccines, treatments, diagnostics, and other technologies receive emergency use authorization or full regulatory approval? A global pandemic means these life-saving tools have unprecedented global demand with herculean scale-up requirements. Manufacturing could be slow, expensive, and vulnerable to export controls. We have already witnessed conflicts over raw materials and reagents for diagnostics, and meeting global demand for a COVID-19 vaccine would require an unprecedented effort to utilize the world’s current capacity to produce, package, and deliver these products. Countries like China and India control major stakes in supply chains for active pharmaceutical ingredients, glass vials, and adjuvants. These challenges represent a significant threat to lower-income countries as they may be unable to access scarce medical technologies or component parts if wealthy countries dominate the global bidding wars for essential equipment. Some countries will also be unable to administer and scale-up the response on their own and will need support in building the health systems and managing the supply chains required to provide access to these life-saving tools. WHO has already started working on ways to ensure that key technologies and equipment will be available to frontline health workers and the most vulnerable populations, helping marshal essential resources and equipment, and looking for ways to secure the supply chain for key medical products. Service delivery systems need to be strengthened with the support of international donors, and new commitments and resources should be made to existing global health mechanisms like Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Access was also a central focus of the European Union led resolution on COVID-19 that was adopted at the virtual WHA. It included far-reaching provisions, including the creation of a voluntary pool of patents for COVID-19 treatments and language highlighting the rights of countries to legally override international patent rules during a health emergency. While some of the specific items remain hotly debated, it is clear that there is a growing consensus that more needs to be done to ensure equitable access for safe, quality, effective, and affordable COVID-19 diagnostics, therapeutics, and vaccines to ensure that in the fight against COVID-19, no one is left behind.
Global response and scientific research hampered by politics
While it is clear that a global approach is crucial to stemming the worldwide spread of the disease, global cooperation has been strikingly absent in many multilateral forums, including G7, G20, and WHA. The rift between China and the United States endures, and this tension was also on full display during WHA. While many countries reiterated their support for WHO, the US took a different approach, delivering a fiery rebuke of the organization and accusing WHO of failures in responding to the pandemic while also alleging that China was not open and transparent at the outset of the crisis. Coupled with President Trump’s continued threats to cut funding to the organization, key functions of WHO in responding to the pandemic are in jeopardy. It will be paramount in the coming weeks that leaders push to ensure that key initiatives being led by WHO are not derailed. They must be able to continue their work supporting response efforts and coordinating disease incidence surveillance and COVID-19 R&D efforts around the world.
The role WHO is uniquely qualified to play
WHO is uniquely qualified to coordinate global research and development efforts, marshal equitable allocation of resources, and provide technical guidance to fight the pandemic. We know this pandemic will not be the last. The important question now is whether the battle against COVID-19 will strengthen or exhaust our ability to respond again in the future. While this crisis presents unique challenges, it also presents the world with an opportunity to reimagine the architecture of global health systems including new ways to advance and coordinate R&D to address future health threats in a more holistic and sustainable way.
Now more than ever, leaders from around the world must look to our multilateral institutions like WHO to drive the global effort that is required to develop the health technologies we need to defeat the coronavirus and enhance our global health security capacity to respond to future outbreaks.