The development of COVID-19 diagnostics, treatments, and vaccines is the endeavor that everyone around the world is watching with bated breath.

But the development alone of tools to prevent, test, and treat COVID-19 will be insufficient to halt the pandemic’s devastation of global health systems and economies. It is both a moral and practical imperative that the tools reach everyone, everywhere. As the World Health Organization (WHO) is leading the coordination of clinical trials for vaccines and therapeutics with extreme urgency in more than 100 sites around the world, it is working with a landscape of global partners to ensure that the race for tools has one principle as its bedrock: equitable access.

“The ultimate measure of success will not be how fast we can develop tools — it will be how equally we can distribute them,” said WHO Director-General Tedros Adhanom Ghebreyesus.

Global partners including WHO; the Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance; the Global Fund; the Coalition for Epidemic Preparedness Innovations (CEPI); and Wellcome Trust are engaged in a collaboration called the Access to COVID-19 Tools Accelerator, also known as the ACT Accelerator, to help make the rapid and equitable development and distribution of tools to combat COVID-19 a reality.

The ACT Accelerator is a revolutionary – and rapidly expanding – partnership made up of governments, and multilateral organizations, with private sector and civil society partners. It will help coordinate, fund, develop, and deploy COVID-19 diagnostics, treatments, and vaccines while also working to ensure health systems are strengthened so that these tools can reach developed and developing countries alike.

The ACT Accelerator is built on three main pillars, underpinned by the crosscutting imperatives of providing equitable access and strengthening health systems:

Pillar I: Vaccines

With over 200 vaccines in varying stages of clinical development, and 15 vaccines currently undergoing human clinical trials, a first licensed vaccine could potentially be available as early as the end of 2020. However, initial supply will likely be limited. To help speed research and development, while also building in access from the beginning, an estimated $18.1 billion will be needed until the end of 2021. Of that total, $11.3 billion is urgently needed within the next six months to continue to accelerate efforts. This funding will help achieve the goal of having at least 2 billion vaccines available by 2021, without prejudice for low-resource countries or vulnerable communities’ ability to pay. Partners driving the vaccine development pillar are WHO, CEPI, and Gavi, the Vaccine Alliance.

Photo: WHO

Pillar II: Therapeutics

New treatments have the potential to reduce COVID-19’s high rates of severe disease and mortality. ACT Accelerator partners are working to ensure that a wider range of therapeutics is developed across all levels of disease severity and that these therapeutics are readily available at affordable cost. Wellcome Trust, the Bill & Melinda Gates Foundation, Unitaid, and others coordinate this pillar of the ACT Accelerator, with a target of 245 million courses of therapeutics for use by all populations in low- and middle-income countries within 12 months. An estimated $7.2 billion total will be needed, of which $3.8 billion is urgently needed to assess early treatment candidates.

Pillar III: Diagnostics

Along with an expansion of technology, innovative diagnostics will help assist the global response and safe reopening of economies and societies by ensuring people can easily and accurately be tested for COVID-19. Research and development will be vital to ensure tests are readily available and utilized. The Foundation for Innovative New Diagnostics and the Global Fund are key partners driving Pillar III. An overall $6 billion will be needed for next 12 months to accelerate research, development, and market preparedness. Of that total, $2 billion is urgently needed to help accelerate access to diagnostics around the world of up to 85 million tests in the next six months, scaling to 500 million tests in 12 months, for low- and middle-income countries.

Crosscutting Imperatives: Providing Equitable Access and Strengthening Health Systems

While the spirit of the ACT Accelerator is motivated by speed and scale, the most important principle of the collective effort is equity in access. Left to the market alone, it is highly likely that only high-income countries — and even inside high-income countries, only the wealthiest — would have access to these vital new tools. It is therefore an imperative that there be a process for global alignment and agreement on allocation of the tools, prioritizing frontline health workers and other essential workers, most vulnerable communities, and other key populations. WHO will lead this allocation and access workstream across the whole ACT Accelerator partnership.

Just as important, local health systems must be strengthened to improve the delivery of COVID-19 tools. Some of the beneficiaries of the COVID-19 Solidarity Response Fund — WHO, UNICEF, the UN World Food Programme, and UNHCR, the UN’s Refugee Agency — will be vital to ensuring that vulnerable populations are protected with stronger, more resilient health systems to introduce and deliver these lifesaving treatment, diagnostic, and prevention tools. These agencies will also work with the World Bank and Global Fund to support these efforts.

Coming Together to Accelerate Efforts

The scale and urgency of need may be unprecedented on these new COVID-19 tools, and the return on investment will be monumental. ACT Accelerator partners have been working diligently to marshal sufficient resources to achieve their goals, totaling at least $31 billion for the next 12 months. Donors have begun to step up to fill that funding gap, including through the European Commission’s pledging conference on May 4 and the Global Goal: Unite for Our Future pledging summit and broadcast on June 27. The events helped stimulate initial investments in the ACT Accelerator’s work, but a funding gap of $27.9 billion remains, of which $13.7 billion is urgently needed.

While the work of the ACT Accelerator is vitally important to equipping the global community with the tools needed for the future, today’s needs for dealing with this pandemic cannot be overlooked. The COVID-19 Solidarity Response Fund is working to support the WHO and its partners with the challenges of today: getting vital commodities and personal protective equipment to those on the frontlines in more than 130 countries, protecting vulnerable communities, and ensuring that the world has up-to-date guidance and information. It has raised more than $224 million to help support this lifesaving work, but significant gaps remain, and needs grow as COVID-19 spreads.

We’ve seen donors already stepping up in a big way through both the Solidarity Response Fund and now through the ACT Accelerator. But it’s clear we must address the needs of today as well as the needs of the future if we are going to beat this virus.

It’s not an either/or. It’s a both/and.

Country governments, private sector donors, and multilateral organizations must all come together in global solidarity and make significant commitments, both financial and political, to create stronger, more equitable health systems that can not only fight back against this virus, but leave the world better able to deal with the next global health threat that may come along.