On 24 April 2020, the Global Fund, the World Health Organization (WHO) and a range of global health actors launched the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration to speed up the development and production of vaccines, diagnostics, and therapeutics for the coronavirus disease 2019 (COVID-19) for all who need them globally. The other global health actors in the partnership include the Bill & Melinda Gates Foundation (BMGF), the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, Unitaid, the Wellcome Trust, the World Bank, and private sector partners.
The ACT Accelerator has four pillars, which are the diagnostic, therapeutics, vaccines, and health systems connector pillars. The Global Fund and Foundation for Innovative New Diagnostics (FIND) jointly lead the diagnostics pillar, which seeks to develop simple, accurate, and affordable tests to detect the virus and to save nine million lives while preventing 1.6 billion infections. The diagnostics pillar aims to distribute 500 million tests in low and middle-income countries (LMICs) by mid-2021. The Wellcome Trust and Unitaid lead the therapeutics pillar, which seeks to develop and distribute 245 million treatments to people living in LMICs by mid-2021. CEPI, Gavi, and the WHO lead the vaccines pillar, which aims to rapidly develop, manufacture, and deliver two billion vaccines to those who need it most globally, by the end of 2021. The Global Fund, together with the World Bank, leads the health systems connector pillar, which works across the other three pillars, to ensure that the developed tools reach the populations that require them.
The ACT Accelerator partnership needs $31.3 billion to reach the goals of the four pillars. About 58% of the funds, amounting to $18.1 billion, will support investments in the vaccine pillar, which aims to deliver vaccines in 18 months. The diagnostics and therapeutics pillars need $6 billion and $7.2 billion, respectively, to deliver new tests and drugs to the world in 12 months, each. The investments for the health systems connector are still under development.
Figure 1: The ACT Accelerator investment needed
Source: Aidspan, using data from the ACT Accelerator investment case
For the initial six months, the ACT Accelerator partnership immediately requires $17.1 billion to deliver their mandates: $11.3 billion for vaccines, $3.8 billion for therapeutics, and $2 billion for diagnostics.
On 4 May and 27 June 2020, the European Commission led a financial pledging event to raise funds for the ACT Accelerator partnership. As of 26 June 2020, governments, foundations, companies, individuals, and other stakeholders pledged a total of $11 billion. Of these funds, 54%, amounting to $5.9 billion, was allocated for COVID-19 response activities. The remaining $5.1 billion was allocated as follows: $3.4 billion to the vaccines, therapeutics, and diagnostics pillars, while $1.7 billion was allocated to the health systems connector pillar.
In the absence of a vaccine, mass testing remains a critical component of the COVID-19 response. This pillar was founded on the need to urgently scale up the capacity of countries to test for coronavirus. The $6 billion investment required to meet the targets of this pillar are separated into four streams:
Research and development of tests and digital tools
The Act Accelerator diagnostics partnership requires a total of $300 million to speed up the development of affordable diagnostic and digital tools. Part of these funds are for research and development of rapid point-of-care and at-home tests and tools, as well as digital diagnostic tools, to enable early detection and surveillance of COVID-19. The funds will also be used to transfer technology to local and regional manufacturers and build their capacity to offer innovative solutions.
A total of $100 million is required to meet the targets of this stream. The partners will use part of the funds to scale up manufacturing of quality tests and ensure their sustainable supply through advanced market commitments (to subsidize the purchase of a vaccine which is yet to be made available) as well as support pooled and large-volume procurements. The funds will also support the creation of sample banks for COVID-19 and facilitate speedy regulatory approval and subsequent performance evaluation studies of new tests.
Supply, pooled procurement, and equitable distribution of tests
A total of $5 billion is needed to procure 500 million tests: three-quarters are rapid tests and the remaining quarter are molecular tests, for deployment in LMICs over 12 months. This stream, however, immediately requires $1.3 billion to procure and deploy 85 million tests, half of these being rapid tests, while the other half are molecular tests, for six months.
A total of $600 million is required to reinforce the health systems of countries, build their capacity, and prepare them to perform testing. However, half of these funds are required immediately to fund these activities for the next six months. The specific undertakings of this stream include the hiring and training of healthcare workers (including laboratory technicians), supporting the expansion of laboratory infrastructure, and strengthening storage and distribution channels. Additionally, it will support testing and contact-tracing efforts by building digital contact tracing and communication tools, and fund focused operational research.
The vaccines pillar
This pillar leverages the expertise of the co-leading organizations: CEPI finances and coordinates new vaccine development, Gavi increases access to new and underutilized vaccines, while the WHO plays an oversight in the regulation (through policy provision) and allocation of vaccines. An estimated $18.1 billion is required to develop, manufacture, and deliver two billion vaccine doses to LMICs by the end of 2021. Additionally, high-income and upper-middle-income countries will self-finance the procurement of an additional 950 million vaccine doses through the COVID-19 Vaccine Global Access (COVAX) Facility. The ACT Accelerator partnership established the COVAX Facility to prevent a chaotic scramble for COVID-19 vaccines. Investments in this pillar are in the following streams:
Research and development
A total of $2.4 billion is required to fund vaccine-related research. This includes ensuring that regulatory conditions are in place to offer a seamless process for all stages of the development of a vaccine.
Market preparedness and manufacturing
A total of $7 billion is required to prepare markets and make enhanced products available to those who need them. Of these funds, $1.7 billion is for scaling up and enabling technology transfer. The cost of manufacturing vaccines is estimated at $5.3 billion.
Procurement and delivery
A total of $8.7 billion is required to guarantee volumes of sales for vaccine suppliers and advance the procurement of vaccines for all. These funds include $5.5 billion for immunization of high-risk populations in LMICs and to secure 200 million vaccine doses as an emergency stockpile. The remaining $3.2 billion is to cover the cost of the vaccine supply chain and campaigns.
The therapeutics pillar
This pillar seeks to develop, manufacture, and distribute 245 million treatments to LMICs. The $11 billion investment in this pillar is divided into three streams:
Rapid evidence assessment of candidates
A total of $2 billion is required for research and development of therapeutics for 12 months. This includes the coordination of clinical trials and meeting the cost of developing new drugs. However, $1 billion is urgently required to achieve the targets of this stream within six months.
A total of $700 million is required to meet the cost of market preparedness activities. This includes the cost of manufacturing 245 million therapeutics. The partners urgently need $300 million to cover operations for six months.
Adequate deployment in all countries
This area, which the Global Fund leads, utilizes a huge proportion of funds allocated to this pillar. In total, $8.9 billion is required for the procurement and delivery of 245 therapeutics. Of this amount, $2.5 billion is immediately required to cover activities for six months. Already the Board of the Global Fund has approved the use of wambo.org, an online procurement platform, to facilitate the procurement of COVID-19 health commodities, as discussed in a separate article in this GFO issue.
The health system connector
This pillar was established to complement the work of after the three other pillars. It aims to identify health and community systems bottlenecks impeding the delivery of diagnostics, therapeutics, and vaccines pillars. It aims to build the health system capacity, such as increasing the capacity of laboratories, and ensuring the necessary systems are in place for the rollout of the developed tools. The pillar has several streams:
Health financing to assist countries to mobilize resources
Community-led responses that enable a community- and a people-oriented approach to fight COVID-19
Protection of frontline workers through ensuring the availability of personal protective equipment for healthcare workers
Integrated data management that assists countries to strengthen the health information systems required to address COVID-19
Supply chain that focuses on forecasting the demand for COVID-19 related products and landscaping assessments
Private sector engagement
The involvement of the civil society in the ACT Accelerator
Through a letter to the leadership of Global Health Institutes, on 5 June 2020, signed by representatives of civil society and communities on the Boards of Global Fund, Unitaid, Gavi, and the Civil Society Engagement Mechanism of UHC2030, communities and civil society requested their engagement in all stages of the ACT Accelerator. This request was granted, and community and civil society representatives are now represented in the various workstreams of the ACT Accelerator pillars.
The diagnostics pillar, "Access to COVID-19 Tools (ACT) Accelerator Diagnostics Partnership: Investing in Diagnosis to Manage the Course of the COVID-19 Pandemic", May 2020.
The vaccines pillar, "COVAX, the ACT-Accelerator Vaccines pillar: Insuring Accelerated Vaccine Development and manufacture" May 2020.
The therapeutics pillar, "ACT Accelerator Therapeutics Partnership: COVID-19 Therapeutic Investment Case" May 2020.