The current response to the coronavirus disease 2019 (COVID-19) pandemic involves
aggressive implementation of suppression strategies, such as case identification,
quarantine and isolation, contact tracing, and social distancing. However, models
developed by the Imperial College COVID-19 Response Team suggest that “transmission
will quickly rebound if interventions are relaxed”.
1
WHO warns of multiple simultaneous outbreaks of COVID-19 worldwide.
2
The development of COVID-19 vaccines that can be used globally is therefore a priority
for ending the pandemic.
This vaccine effort should be guided by three imperatives: speed, manufacture and
deployment at scale, and global access. In February, 2020, the World Bank and the
Coalition for Epidemic Preparedness Innovations (CEPI), which funds development of
epidemic vaccines, co-hosted a global consultation on these goals.
3
This consultation led to the launch of a COVID-19 Vaccine Development Taskforce that
is now working on how to finance and manufacture vaccines for global access.
CEPI estimates that developing up to three vaccines in the next 12–18 months will
require an investment of at least US$2 billion.
4
This estimate includes phase 1 clinical trials of eight vaccine candidates, progression
of up to six candidates through phase 2 and 3 trials, completion of regulatory and
quality requirements for at least three vaccines, and enhancing global manufacturing
capacity for three vaccines. This estimate does not include the costs of manufacture
or delivery. Progress has been rapid. A phase 1 trial of a vaccine candidate, supported
by the US National Institutes of Health and CEPI, began on March 16, 2020,
5
and 2 days later a clinical trial began in China.
6
Clinical trials for other candidates will start soon.
Use of existing financing systems to support this work offers the benefits of speed
and lower transaction costs than for new financing approaches. CEPI is supported by
a World Bank financial intermediary fund that brings together public, philanthropic,
and private funding to respond to global priorities.
7
Through this fund, CEPI can act as a global mechanism for funding vaccine development
until vaccines can be licensed or used under emergency use provisions. Mobilising
$2 billion in funding will require funding from all sources. Given the enormous health,
social, and economic consequences of COVID-19, there is a strong case for all governments
to invest in vaccines.
In addition to direct government contributions, innovative finance mechanisms have
been successful in raising funds for vaccines in the past and should be used to fund
the development of COVID-19 vaccines.8, 9 The International Finance Facility for Immunisation
(IFFIm) raises funds with vaccine bonds, which turn long-term contributions by donors
into available cash.
8
IFFIm was created to support Gavi, the Vaccine Alliance, but could be used to finance
CEPI's COVID-19 vaccine efforts. With advanced market commitments, donors make funding
commitments to vaccine manufacturers and, in exchange, companies sign a legally binding
commitment to provide the vaccines at a price affordable to low-income and middle-income
countries. Gavi's board expressed support for the use of Gavi's IFFIm and advanced
market commitments to improve COVID-19 vaccine development and access.
10
The need for COVID-19 vaccines is global, although the need is differentially distributed
within populations. Vaccines would likely be prioritised for health-care workers and
people at greatest risk of severe illness and death. High-income countries must not
monopolise the global supply of COVID-19 vaccines. This risk is real: during the 2009
influenza A/H1N1 pandemic, rich countries negotiated large advance orders for the
vaccine, crowding out poor countries.
11
Such an outcome would result in a suboptimal allocation of an initially scarce resource.
© 2020 Joseph Campbell/Reuters
2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information
in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre
is hosted on Elsevier Connect, the company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related research that is
available on the COVID-19 resource centre - including this research content - immediately
available in PubMed Central and other publicly funded repositories, such as the WHO
COVID database with rights for unrestricted research re-use and analyses in any form
or by any means with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
A far better solution would be for governments to ensure there is a globally fair
allocation system. With sufficient political will and public sector financing, such
a system could be established using existing instruments and institutions. The rudiments
of the system would require a global purchasing agent or agents, a substantial but
limited-term advanced purchase commitment, and access through the system to financial
instruments such as concessional loans or grants and indemnification from liability
to offset the risks taken by participating private sector partners. Vaccines purchased
through the system should be free at the point of care worldwide for prioritised populations,
with national allocations determined through a fair and objective process.
On March 16, 2020, the G7 committed to supporting the launch of joint research projects
for COVID-19 treatments and vaccines.
12
High-level dialogue is needed on ways to ensure complementarity of efforts and global
access to COVID-19 vaccines. Investments should proceed in tandem to build national
systems for delivery of potential vaccines—eg, using domestic financing and external
financing from the World Bank Group's $14 billion COVID-19 Fast Track Facility
13
and reallocations from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi,
and Global Financing Facility grants for service delivery.