Four reasons why this week was a turning point in the fight against COVID-19

History has moved at a fast clip during this pandemic, but perhaps never faster than the past week.

Last month, our foundation released its 2020 Goalkeepers Report. Embedded in the document were some new and troubling projections: Researchers at Northeastern University had analyzed different methods of distributing vaccines for COVID-19 once they’re ready. They looked at two scenarios: In one, vaccines were distributed equitably to all countries based on their population size. The other scenario was more unequal; Distribution was based on wealth with the 50 richest countries receiving the first two billion doses.

Northeastern researchers found that this second, more unequal scenario led to a much longer, deadlier pandemic for both wealthy and poorer nations. The virus, they project, would continue to spread unchecked for four months in three quarters of the world. Almost twice as many would people die.

Our foundation’s leadership—Bill and Melinda, especially—found this second projection so worrying because it was the one that came closest to reality: Wealthy nations had spent the summer making deals with pharmaceutical companies to pre-purchase vaccine doses, but poorer nations didn’t have the economic clout. Vaccines, as well as drugs and diagnostics, flowed to where the money was.

This dynamic hasn’t completely reversed itself yet. (The latest data: High-income countries have secured enough doses to cover up to two-and-a-half times their populations; Low- and lower-middle income nations, just 14%). But that inequality is narrowing now.

Within the last week, there were four major developments that give me hope:

1. On Friday, Canada donated $220 million to the COVAX AMC, the ACT-Accelerator’s initiative to procure vaccines for low- and middle-income countries (a category that includes everywhere from South Sudan to Peru). The next day, the UK committed £500 million to do the same.
2. On Monday, a group of global health organizations, including our foundation, announced a deal to make available 120 million rapid COVID-19 tests to lower-income nations.
3. On Tuesday, our foundation, Gavi, and the Serum Institution of India expanded the vaccine deal we made in August.
4. And on Wednesday, 16 life science companies (and our foundation) signed a “global access communique,” making a range of commitments, including scaling up the production of vaccines and other medical supplies for low-income countries.

Individually, none of these announcements seem particularly historic. But when you connect and piece them together, it’s easy to see why they are.

That’s what I try to do below.

Note: The easiest way to explain these announcements isn’t in the chronological order. Instead, Bill provided a good framework when he wrote on Wednesday that to eliminate the threat of the pandemic, the world needs “the capacity to produce billions of vaccine doses, the funding to pay for them, and systems to deliver them.” Each of these four announcements advances one of those goals.

Expanding capacity to make billions of vaccine doses

The best way to close the vaccine gap isn’t to take doses away from high-income nations and give them to low- and lower-middle-income ones. Instead, it’s to dramatically increase the world’s manufacturing capacity so that everyone, everywhere can be covered. 

Two major agreements this week paved the way for more vaccine production.

On Tuesday, our foundation expanded its deal with Gavi, the Vaccine Alliance—a group that finances vaccines for low-income nations—and the Serum Institute of India, the world’s largest vaccine manufacturer by volume.

In August, we had made the original deal to fund the production and delivery of 100 million COVID-19 vaccine doses. They would go exclusively to low- and middle-income countries. Now, we’re giving more money so Serum can double the production—another 100 million doses. 

The next day, our foundation and a collection of 16 life sciences companies—Pfizer, Novartis, Merck to name a few—signed another agreement. Some of these companies had previously committed to partner on drug-making. If one company had an effective COVID-19 therapeutic, another would let them use their factory to make it. (Right now, remdesivir, which was developed by Gilead, is being made in Pfizer factories).

Very rarely has a pharmaceutical company let a competitor use one of its factories in this way, and now we’re seeing this level of collaboration when it comes to diagnostics and vaccines as well. In Wednesday’s agreement, the 16 companies committed to scale up manufacturing at an unprecedented speed, ensuring that approved vaccines are broadly distributed as early as possible. The agreement is far broader, effectively ensuring that everyone around the world will have access to the latest COVID-19 vaccines, drugs, and diagnostics, regardless of where they live. 

Raising $ (and €, £, ¥) to buy vaccines

In addition to the capacity to produce COVID-19 vaccines for low-income countries, the world needs the money to buy them. COVAX, the ACT-Accelerator’s initiative to procure vaccines for poorer nations was set up to do exactly this. It is led, in part, by Gavi, the Vaccine Alliance, which has helped immunize 822 million of the world’s poorest children over the past two decades. 

Last Friday, Canada donated $220 million to COVAX, and they were joined over the weekend by the UK, who directly donated £250 million and pledged to match other donations up to £250 million. This is likely enough funding for Gavi to procure hundreds of millions of doses of vaccines for poorer nations. 

Building the system to deliver vaccines

Once vaccines are made and paid for, the world must turn its attention to delivering them. Places that are home to new and growing clusters of the disease will take priority but spotting those clusters won’t always be easy—especially in low-income nations where health infrastructure can be weak.

More—and more affordable—testing is needed, and now. On Monday, a group of global health organizations including our foundation agreed to provide it.

The agreement is to finance and deliver 120 million antigen rapid diagnostic tests (Ag RDTs)—priced at a maximum of US$5 per unit—over a period of six months. These tests are designed to provide results in 15-30 minutes, rather than hours or days, and will enable expansion of testing, particularly in countries that do not have extensive laboratory facilities or trained health workers to implement molecular (polymerase-chain reaction or PCR) tests.

For this initiative, we are collaborating with the Africa Centres for Disease Control and Prevention, the Clinton Health Access Initiative, the Foundation for Innovative New Diagnostics, the Global Fund, Unitaid, and the World Health Organization.

Looking ahead

Taken together, this week’s announcements amount to four steps in the right direction, but we have much farther to go. 

Even if the world’s poorest countries only wanted to vaccinate high-risk people—health workers and the elderly—they still don’t have enough pre-secured supply. They would need about 1.6 billion doses and are up to 50% short.

The collection of governments, pharma companies, and global health organizations that made news this week will need to make history over the next several months to close that gap.