By Evan Lee, Yvette Madrid and Jon Bastow
A 5-part series which delves into the challenges and solutions of getting diagnostics, drugs, and vaccines for Covid-19 to all who need them.
Part 1: Context and historical perspective
The unprecedented scale of the COVID-19 pandemic has triggered an expanding range of initiatives to drive the discovery and development of the diagnostics, drugs, and vaccines that will be needed and made available throughout the world. Numerous partnerships between government, academia, established industry and startup companies have been created. Several resources have been created to track these: Milken Institute, Policy Cures, and FIND have set up dedicated websites to learn more.
The world’s leading example of an effort to drive and coordinate this is the ACT-Accelerator, created with the bold ambition of “launching a landmark, global and time-limited collaboration to accelerate the development, production and equitable global access to new COVID- 19 essential health technologies.” Importantly, over and above just being a vehicle to drive innovation, a founding principle of ACT-Accelerator includes a clear intention ”to accelerate equitable global access … and thus to ensure that in the fight against COVID-19, no one is left behind.” The scope and size of this ambition far exceeds any of the many previous efforts intended to increase equity in global health.
To achieve the ambitious access goals, the ACT-Accelerator builds on the wealth of knowledge and organizational expertise that has been built up over more than 2 decades to meet the challenges specific to access for vaccines, drugs, and diagnostics that are encounteredin Low and Lower-Middle Income countries (LMICs).
There is a wealth of approaches to improve access that have been used over the past 2 decades. Donor funded initiatives such as The Global Fund, GAVI,and UNITAID have used pooled donor funding and scale to enable procurement and delivery of drugs, diagnostics, and vaccines while ensuring high quality standards. Other efforts range from delivery of existing products, the most recent example being the Campaign Uniting to Combat NTDs, with 1.7 billion treatments donated by the pharmaceutical industry in 2018, to providing funding support to stimulate R&D for new products where market incentives alone are insufficient. The fights against TB and malaria have benefited from having new drugs and drug formulations, and new diagnostics through this approach. Between these two extremes, efforts have included licensing deals to make product more available and affordable; social business models and access pricing; and the use of tools such as advanced market commitments for vaccines. (Table 1)
These approaches have generally been targeted, and in many cases initiated and driven by either one organization (non-profit, for-profit); centered around 1 product or class of product; or targeted at specific geographies, although there are instances where multiple approaches have been tried, such as the recent agreement to improve access to the drug Bedaquiline (MDR-TB) featuring an agreed price for 135 eligible countries.
Together, they provide a set of proven tools that could be deployed by the ACT-Accelerator, as the scope and scale of the pandemic makes it imperative to go beyond siloed approaches. However, each class of product — diagnostics, therapeutics, and vaccines — have their own specificities which we will explore more in the next few posts.
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Yvette Madrid is a Swiss-based, global health consultant with expertise in immunization and health product access. She has worked for the International AIDS Vaccine Initiative (IAVI), PATH, UNITAID, and the World Health Organization (WHO), and has also served as an advisor to the latter. With a background in biomedical engineering, she holds a doctorate from the Massachusetts Institute of Technology.
Evan Lee is a Geneva-based consultant and an expert in global health policy. He has previously worked for pharmaceutical company Eli Lilly, the Foundation for Innovative New Diagnostics (FIND), Management Sciences for Health and Medicines Sans Frontieres. A medically qualified doctor by training, he has a BA in chemistry and physics from Harvard University, a medical degree from New York University School of Medicine and an MBA from Massachusetts Institute of Technology.
Jon Bastow helps organisations accelerate innovation across R & D and Access in healthcare. He brings over 30 years of experience, having led R&D and access projects across multiple diseases. He has held senior roles in pharmaceutical companies and international organisations such as FIND and The Global Fund, building partnerships between private sector healthcare and tech companies, NGO’s and governments addressing major problems of poverty. Jon is a member of the Chartered Institute of Marketing, holds degrees in Biochemistry and Philosophy and has given lectures at IMD, London Business School, INSEAD and the Graduate Institute in Geneva.
