Dr Ayoade Alakija, humanitarian leader, WHO Special Envoy for the ACT-Accelerator, Chair of FIND and Co-Chair of the G7 Impact Investment Initiative on Global Health, outlines the negative effects of vaccine nationalism and emphasizes the importance of countries collaborating to enhance preparedness and medical countermeasures in the face of public health threats
Here we are again. Transmission of a virus with a significant fatality rate has spread to all global regions and a PHEIC has been declared. This time, however, the virus has been known for over 50 years and has been active in Africa for decades.
While vaccine nationalism is what grabbed our attention during COVID-19, the global health world must broaden the focus beyond a fixation on vaccination development as the silver bullet for pandemic prevention and response. In the same way that the spread of HIV-AIDs has been curtailed through appropriate non- pharmaceutical interventions such as testing, public health messaging and community engagement, so too are these ‘public health 101’ interventions a far more cost-effective means of stopping the transmission of Mpox. Further, we need health systems strengthening at the community level and regional self-reliance – the ability to develop and manufacture medical countermeasures which are appropriate for low- resource settings and the populations being served.
On that note, the Pandemic Agreement proposed the establishment of a robust Pathogen Access and Benefit Sharing (PABS) system ‘in recognition of the catastrophic failure of the international community in showing solidarity and equity in response to the coronavirus disease pandemic.’ Such a proposal further supports the improvement of surveillance but would also underpin the ability of regional development and manufacturing of medical countermeasures. When the Pandemic Accord negotiations adjourned in May, countries did not reach an agreement on provisions for PABS. An agreed PABS which facilitates African countries receiving an equal share of medical countermeasures, including vaccines, in any future pandemic is critical. Any taking of genetic material or data from LMICs without commensurate benefits is extractive and negates any incentive for countries to share surveillance data. As negotiations for the Pandemic Agreement reconvene, Member States must work to reach a consensus on PABS provisions with our common humanity at the front of our minds.
Vaccine hoarding
In a truly equitable world, the knowledge that vaccine hoarding is causing the unnecessary deaths of people in LMICs would be reason enough to avoid it. But as recent events have demonstrated, significant rather than tokenistic resources are more likely to be deployed if and when there is a direct threat to wealthy nations. Vaccine hoarding is not only morally reprehensible, it is also, as Dr Tedros put it, ‘epidemiologically self-defeating and clinically counterproductive’. Even if existing vaccines do prove to be effective against the new Mpox clade 1b, the number of donations pledged is a drop in the ocean of the ten million needed to curb further spread and the price at $70-$100 per person remains prohibitively high.
Monumental efforts are being made to ensure the rollout of vaccines and medical countermeasures with concentrated outbreaks happens as quickly and efficiently as possible, but it should never have come to this. To ensure medical countermeasures reach those who need them most, we need more ‘ports to arms’ strategies to reach those in communities.
COVID-19
It is widely acknowledged that further health crises are inevitable, but even so, the Pandemic Treaty negotiations were postponed until the end of the year. In the recent report, ‘No Time to Gamble’, Helen Clark and Ellen Johnson Sirleaf ask, ‘In a world beset by complex problems, averting another pandemic is one challenge that can be solved. Why would leaders make any other choice?’ But with the economies of LMICs hit by COVID- 19-incurred debt being repaid with soaring interest rates alongside increased costs associated with climate catastrophes and the current geopolitical landscape, resources are so taken up with firefighting current crises that there has been little left to put towards health systems strengthening and pandemic preparedness.
While there are many lessons learned to be implemented from COVID-19, it is important to note that the Access to COVID-19 Tools Accelerator (ACT-A), which I co-chair, has reconvened to bring together key agencies with an overview of the development, production and access of medical countermeasures. Meeting again on a regular basis, this platform can provide strategic recommendations and provide a platform for multistakeholder discussion. Those around the ACT-A table are now the brains trust and are now referred to as the overall policy coordination body for Mpox. With a proven track record, ACT-A is well-positioned to provide a framework for financial logistics to coordinate efforts and maximize outputs. ACT-A’s Funding Commitment Tracker ensures transparency and fosters trust at a time when global health funders and leaders must embrace the true spirit of equity.
I’m glad that following the identification of a new clade of Mpox and pulling together an emergency committee, WHO Director-General Dr Tedros immediately called a public health emergency of international emergency and sped up the process of getting vaccines to where they’re needed most.
Working together in partnership
Going forward, I want to see all countries working together in partnership – not through piecemeal charity – to ensure that diagnostics, vaccines, and therapeutics reach where they are needed.
Furthermore, agencies such as FIND will work with the private sector, multilateral agencies, African governments and health agencies like WHO to speed up research and development of rapid diagnostic tests for Mpox so that governments can track the virus and deploy countermeasures where they’re needed most to stop the spread and save lives and livelihoods.
As WHO ambassador, Gordon Brown said, ‘The rich world often waits too long to intervene. There’s no doubt we have ways to keep everyone safe if we have the will.’ We must summon the will, we tarry at our own peril.
