- Lisa Menning– Team lead (acting), Demand and behavioural sciences, Department of Immunization, Vaccines, and Biologicals (IVB), WHO
- Brian Tisdall– Lead, Communities and civil society, Access to COVID-19 Tools Accelerator’ (ACT-A) hub, WHO
- Andy Seale– Advisor, WHO and co-lead, Working Group on Community and Civil Society Engagement on the Global Action Plan on healthy lives and well-being for all.
- Karrar Karrar– Access to Medicines Advisor, Save the Children UK
- Anna Marriott– Health Policy Advisor, Oxfam GB and the People’s Vaccine Alliance
Moderators: Gunjan Veda, Movement for Community-led Development and Nelly Mecklenburg, Institute for State Effectiveness
The eighth global call hosted by the Movement for Community Led Development brought together health experts from the World Health Organization (WHO) and grassroots and civil society organizations in a discussion regarding the status of COVID-19 vaccine development, safety issues, rollout plans, and the possible issues of equity surrounding dispensation.
CURRENT STATUS AND CONCERTED INTERNATIONAL ACTION
Since its designation as a pandemic in March of 2020, COVID-19 has affected vast swaths of the global population. At least 46 million individuals worldwide have been infected thus far, and 1.2 million people have died. In response, the WHO formed a global coalition of over 186 countries to accelerate the development of new diagnostics, treatments, vaccines, and general crisis response capacity. Since April 2020, The Access to COVID-19 Tools Accelerator (ACT-A) has been working with national governments, philanthropic foundations, civil society organizations, businesses, and scientific experts around five key pillars: diagnostics, treatment, vaccines, access and allocation, and health system strengthening. It has developed and ordered 120 million COVID-19 tests for distribution in lower- and middle-income countries. At $3-5 per test, these tests cost only a fraction of the current market rate. It is working on life-saving therapeutic treatments, such as Dexamethasone and monoclonal antibodies. At the time of this call, Pfizer and Moderna have both developed early-stage vaccines with greater than 90 percent effectiveness. There are currently 200+ vaccines in different stages of development with varying characteristics and safety profiles.
Yet, even as good news on the vaccine front trickles in, we are already facing the challenge of “vaccine nationalism.” Lisa Menning, Team lead (acting), Demand and behavioural sciences, Department of Immunization, Vaccines, and Biologicals (IVB), WHO noted that the bulk of the vaccines developed by Pfizer and Moderna have already been purchased by wealthy countries. Advocating for a people’s vaccine which is not kept out of reach by intellectual property barriers, Anna Marriott, Health Policy Advisor at Oxfam GB and part of the People’s Vaccine Alliance noted, “The Pfizer and Moderna vaccines illustrate very well the huge access challenges the world faces right now. One of the huge supply constraints we face is the monopoly control over vaccines, where pharmaceutical companies get to decide how much gets made and how much gets charged, despite the billions of dollars of public money being invested into these companies and into the research and development that has led to these successes.”
To address issues of access the WHO formed the COVAX subgroup – covering 90% of the world’s population – under the vaccines pillar. Under the COVAX plan, high priority groups would be targeted worldwide for immediate vaccination; 3 percent of every country’s population for the first round (enough to cover health care and social workers), then up to 20 percent (targeting vulnerable populations/high-risk adults), and then (depending on available dosage and need), over 20 percent of the population, starting with remaining unvaccinated high-priority groups. Buffer vaccinations will also be set aside for high risk refugee populations and humanitarian affairs – situations in which populations may not have access to government resources. Brian Tisdall, Lead, Communities and civil society, ACT-A hub reiterated that, although COVAX is a remarkable achievement thus far, equitable distribution of vaccines will require continued political support. In addition, ACT-A/COVAX also needs to meet an immediate funding gap of USD $4.5 billion and a gap of USD$ 23 billion for next year. Tisdall expressed hope that assistance from the private sector and the incoming administration in the United States – which is currently not a member of COVAX – could fill this funding gap.
ROADBLOCKS TO EQUITABLE DISTRIBUTION
As discussed above, early versions of the vaccines are serving as examples of the roadblocks to equitable distribution. Intellectual property restrictions, technology and know-how exclusivity, and companies’ willingness to sell to the highest bidder all work to prevent the quick, just, and equitable allocation of any potential vaccine. The world’s most vulnerable, marginalized populations (i.e. women, children, the poor, indigenous and rural communities) are the ones who have been the hardest hit by this pandemic but are generally the people who will have the least access to resources, medicines, or vaccines.
Furthermore, as WHO panelists Menning and Tisdall noted, belief and trust in vaccination and health systems are also largely contextual. A key factor driving uptake for a COVID-19 vaccine is the immensely high expectations and visibility surrounding global public health effort. However, uptake will be negatively impacted by both equity concerns and an “infodemic” of anti-vaccine messaging. “We know from public health experience that for vaccines to be widely trusted and administered,” said Menning, “several factors must be present: confidence in vaccine benefits and safety, confidence in the provider, and accordant cultural beliefs. All of these factors must also be present and communicated at the community level.” Individuals must be knowledgeable about and have access to the vaccine administration sites, be able to afford the vaccine, and have confidence in the quality of service. Unfortunately, large portions of the world’s population will not have all, or even most, of these factors working in their favor. The target audience for COVID-19 vaccinations is also different from others; while other vaccines are administered primarily to children, the initial stages of the COVID-19 vaccine are going to be focused on adults. As a result of changing target populations, evolving contextual factors, and pre-existing challenges, new strategies for delivery, equity, and communication will have to be developed. Constant feedback loops, regular data monitoring, supply chain and logistics networks will all be needed.
Menning iterated that for the world to meet these uptake factors, there is no single solution. However, to meet the enormous design, distribution, and acceptance needs of what will be the world’s largest and most rapidly implemented vaccine campaign, working with communities and involving them in service design, service delivery and informational strategies is paramount. CSOs are the channels that carry community voices to decision-makers. Karrar Karrar, Access to Medicine Officer at Save the Children UK noted that there were issues with civil society organizations getting access in the initial phases. However GAVI, the Secretariat of the vaccine pillar, heeded the call for civil society representation in July and this has resulted in civil society representation at the macro level in all the ACT-A working groups. Karrar is the civil society representative on the Access and Allocation Working Group. While this is a good starting point, Tisdall noted that questions remain around who is civil society, who should be at the table and how to reach organizations from the global South. The WHO team expressed hope that the Movement could bridge this gap and bring in more voices from Africa.
VACCINE SAFETY AND VIABILITY
The WHO panelists explained that while there are understandable safety and viability concerns about a vaccine, the historically fast development should not be equated with increased risk. The speed of the COVID-19 vaccine development is due to many more actions than usual being taken in parallel, with nations across the world working together in unprecedented ways. Moreover, pharmaceutical companies and regulators alike do not want to risk the existing enterprise of vaccine development and distribution with an unsafe product. There will be strict safety precautions and surveillance measures for vaccine rollout and medical professionals will be focused on communicating that the risk of adverse effects is vastly outweighed by the benefit of vaccination. However, as with any vaccine, there is always the possibility of a few adverse events. The discussion also addressed the need to capitalize on the current massive global cooperation effort around COVID-19 to strengthen healthcare systems for the future. Andy Seale, Advisor at WHO and co-lead, Working Group on Community and Civil Society Engagement emphasized the need to look at the unfinished business of health, noting that community engagement is the critical missing piece. This includes both improved and sustained dialogue with communities on meeting their needs and building resilience, as well as creating and sustaining new ways of working across global health agencies.
ROLE OF CSOs IN VACCINE ACCEPTANCE AND ROLLOUT
It is in bridging the gap between large foundations, national governments, and the people that CSOs may be best-equipped to take the lead. Sia Nowrojee, Executive Director of the 3D Program for Girls and Women, said that civil society organizations (especially those led by women) have been on the frontlines of the crisis, distributing necessary supplies, disseminating crucial information, and dealing with misinformation. “Civil society organizations must be brought in as a primary resource, and not just when national governments fall short,” she emphasized.
Rowlands Kaotcha, the Southern Africa Regional Coordinator for MCLD pointed out that the people in grassroots civil society organizations are usually the ones who community members know and trust the most, and are therefore best suited to communicate decisions or information. CSOs know their communities and people well enough to understand how to foster positive associations and feelings around vaccine acceptance and should take the lead in these situations. They are also most likely to know about specific situations and populations in their regions who are less likely to receive the vaccine without targeted intervention. Diana Delgadillo from The Hunger Project Mexico pointed out that CSOs know how to reach indigenous and rural populations and women, who are less likely to have access to resources at the physical and social level. Moreover, they can play a critical role in monitoring vaccine distribution, helping to ensure that national governments are meeting the equity and prioritization guidelines from WHO.
The call concluded with a recognition that:
- CSOs will be essential sources of information on how to customize distribution plans and equity, as they know best how to reach their own marginalized populations.
- CSOs will be instrumental in ensuring that accountability mechanisms (for national government and international foundations/organizations) are present and plentiful.
- CSOs will be key sources of cultural expertise and trust-builders for health care systems and providers.
The next call in the Covid series will be held on December 9 and will focus on country level vaccine rollout plans and the strategy for CSO engagement. It will include a delegation from the African Union CDC, representatives from the Community Health Workers Impact Coalition, and other CSOs.