“Without the ACT-A, it’s all but guaranteed that lower income countries will be left without adequate supplies of vaccines, diagnostics, and treatments that can save lives,” said Jenny Ottenhoff, senior policy director of global health at the ONE Campaign. “The ACT-A was never intended to be a long-term solution but it does not make sense for it to wind down until the whole world is ready to transition to a longer-term sustainable response to the virus.”
In a series of recent calls, representatives of the consortium have discussed the likelihood that the current ACT-A will fold or transition in September, according to the two people familiar with the matter. The calls have focused on the future of the distribution of Covid tests, vaccine and therapeutics, and whether some portion of the program would exist after that time, the people said. One of the people described how ACT-A is already transitioning with fewer meetings among those involved in its coordination. There are also questions about whether something similar to ACT-A would be created to prepare for the next health crisis.
“There seems to be a pretty clear consensus that the ACT-A that we have known will not exist next year,” one of the people familiar with the matter said.
A spokesperson for the ACT-Accelerator said the support that ACT-A agencies provide will continue, though likely in a different form.
“As the pandemic isn’t over, ACT-A’s work to enhance equitable access to COVID-19 tools will continue. As countries are moving from managing COVID-19 as an acute emergency to integration into longer-term disease control programs,” the spokesperson said in a statement, adding that the consortium’s strategic plan was always supposed to end in September. “In this context … work is underway to develop a plan to manage this transition.”
The WHO — along with the European Commission, France and the Bill & Melinda Gates Foundation — launched the consortium in 2020, with organizations like Gavi, the Vaccine Alliance, the Coalition for Epidemic and Preparedness Innovations, and the Wellcome Trust tasked with taking the lead on ensuring access to vaccines, diagnostics and therapeutics.
The questions about ACT-A’s fate come at a time when funding for the global Covid fight is winding down and as governments and major global health organizations turn their attention to other health issues, including pandemic preparedness. This spring, Congress failed to approve $5 billion in funding for the U.S. Agency for International Development to help ramp up vaccination rates in low-income countries. In the EU, work has pivoted to readying the bloc for the next crisis, with a consultation on a new global health strategy launching Monday.
An agenda for a Wednesday meeting of the ACT-A council that provides political leadership for ACT-A states that the last meeting of the council will be in September. Participants are asked to discuss how they want to keep abreast of ACT-A activities “during the transition phase” and how ACT-A can transition to “long-term COVID-19 control.”
Since the beginning of 2022, several countries, including Canada, Norway and Sweden, have pledged billions more to ACT-A — some of which will not be available for use until later in the year, raising questions about what will happen to the money should the consortium sunset.
Over the last two years, the ACT-A consortium has raised more than $23 billion to fund its efforts. And in February, representatives of the consortium asked the world to donate $16.8 billion in 2022 to help end the Covid pandemic. So far, Germany, Sweden, Norway and Canada have promised to pay the amount requested of them. WHO Director General Tedros Adhanom Ghebreyesus on Monday called on others to follow their lead, warning: “Our job is not over. We must ensure that all countries are equipped to fight future waves of Covid-19.”
While wealthy western countries have achieved high rates of distribution and administration of tests, vaccine and therapeutics, many low-income countries have fallen far behind. In Africa, the vaccination rate is 19 percent, according to the Africa Centres for Disease Control and Prevention. In addition, about 22 million tests have been administered in low-income countries — less than 1 percent of the global total, according to ACT-A data. Out of the projected demand of $1.7 billion, only $13 million in Covid drugs have been shipped, according to the latest figures.
Those percentages have been a source of controversy within ACT-A and in the large global health community as people have raised concerns about the consortium’s ability to scale distribution during the pandemic. The Bill & Melinda Gates Foundation recognized those shortfalls in a report almost a year after Covid first emerged.
“This effort is still well short of meeting its goals,” Bill & Melinda Gates Foundation CEO Mark Suzman wrote.
Members of the ACT-A ethics and governance working group also have raised concerns about ACT-A’s governance and accountability. “The roles of the various organizations in ACT-A decision making are unclear, obscuring who might be accountable to whom and for what,” states a January paper in the Lancet, authored by the Graduate Institute of International and Development Studies’ Suerie Moon and other members of the working group.