Gates Foundation’s Total Commitment to Global COVID-19 Response

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The Gates Foundation recently pledged additional $250 million to accelerate development and equitable distribution of COVID-19 tests, treatments, and vaccines to end the pandemic, thus bringing the foundation’s total commitments to the global COVID-19 response to $1.75 billion. The CEO, Bill & Melinda Gates Foundation, Mark Suzman, who recently held a virtual media roundtable with some select journalists, sheds more light on the COVID-19 Phase III funding by the foundation in response to the pandemic and measures to ensure equitable delivery and distribution. Chiemelie Ezeobi brings excerpts

What are you up to now?

In Africa, we are preparing to announce the latest set of investments by the Gates Foundation in response to the COVID-19 crisis, an initial tranche of $250 million in grants that brings the total that we’ve committed this year through both grants and through investments in what we call our Strategic Investment Fund – which are tools like volume guarantees – and other financial tools, to around $1.75 billion. This is a very significant amount for us, on top of our ordinary health and development work.

The reason I think is obvious: that COVID-19 has been an unprecedented global crisis. The expertise we have as the Gates Foundation, working from what we call “upstream,” which is the research and development around infectious diseases; to the “downstream”, how we make sure that any treatments, vaccines, diagnostics, get to those who need them most is critically important. So that’s what we’ve been working on through the course of the year, and now we’re reaching the end of this year, with actually a lot of good scientific news. We now have the first vaccine which has actually been rolled out approved and put into its first recipient yesterday in the United Kingdom, the Pfizer BioNTech vaccine.

We have at least three vaccines for which we have broadly good results and that are being looked at for regulatory approval and several more in the pipeline in coming months.

We’re very encouraged by the science behind those vaccines because the fact that the first vaccines seem to have been successful means that it’s highly likely that most of the next wave – which actually target the same part of the virus – will also be successful. But, and it’s a big but, the movement from actually getting those vaccines produced and developed to reaching those who need them is huge.

We need to produce – and by we, I mean the world, – needs to produce literally billions and billions of doses of these vaccines. They need to manufacture them, they need to distribute them, they need to procure them. But then we need to get them to those who need them.

And from the perspective of the Gates Foundation it’s incredibly important we get them in an equitable way globally to everyone, everywhere. That means to developing countries at the same time as wealthy countries. That means certainly to the continent of Africa at the same time it goes to Europe and North America. And so a lot of our initial investments have been aimed toward that and certainly this next tranche of money is something that we will be looking to help both on the continued development of the vaccines, but also the therapeutics and diagnostics.

We will also be really helping countries with the preparation – what do you do in terms of the vaccine delivery infrastructure that’s needed, how can you help build that in a way that’s actually going to help support wider primary health care needs across Africa and Asia, and other parts of the developing world. We know that, while COVID-19 is an acute crisis, it is certainly not the only crisis, and Africa in particular still suffers from a range of continued health challenges. From HIV/AIDS to tuberculosis, we’ve seen a drop off in regular vaccination rate and we’ve seen the wider economic impact of COVID and we need to be tackling all of those at the same time.

That said, we are optimistic. This is unprecedented. To get to the vaccine in less than a year from a disease that had barely been identified at the beginning of the year. We’ve been very impressed overall with African leadership and the African response. We have also worked very closely since January, long before there was a single case anywhere outside China, with the Africa CDC and WHO AFRO – who are close partners of ours in the response – and we expect to continue to do so in the year ahead.

You say that we need billions and billions and billions of this vaccine to produce. How long will it take for the vaccine to get to Africa and why are we only getting it in about six months’ time when the UK is already accessing it?

So, there are multiple answers to that question because it’s complex. The first is, what is the primary mechanism by which Africa and most of the world will get access to the vaccine, as quickly as possible. That vehicle we hope is the COVAX initiative. That is an initiative that part of our money is supporting. It is hosted by the GAVI Vaccine Alliance, which we are a longtime supporter of, and works across Africa on vaccine rollout, and CEPI the Coalition for Epidemic Preparedness Innovations, and also the World Health Organisation.

This is a pooled vehicle that most African countries are participating in, where there are both donations from philanthropies like ours, from wealthier countries and down payments from some of the middle-income countries to help cool financing and to help procure the vaccines. These include the vaccines that we’re seeing being rolled out in the UK, and hopefully the US.

So our first order of business is how do we maximize the resources going into that – currently $2 billion have been raised but that we need at least $5 billion in order to get to at least a first tranche of 20 per cent coverage in developing countries. This is something we’re working very hard on but one of the constraints is certainly financial. We need to raise those resources. That said, with the initial payments, that $2 billion that has been raised.

COVAX is already working on developing partnerships with different vaccine manufacturers. One of our initial investments from our Strategic Investment Fund was with the Serum Institute of India, which is the world’s largest vaccine manufacturer, where our resources are going in as basically a guaranteed down payment with GAVI to produce doses of what will be the AstraZeneca vaccine. That’s one of the vaccines that has reported initial trial results but has not yet received regulatory approval, and another one from a company called Novavax.

So, why it is complex is essentially because what we’re trying to do is maximise the amount of money raised so that we can start manufacturing as many doses as possible, and ensure that the procurement, the purchase and then distribution happens in an as equitable way as possible. What you’re seeing in the UK right now, and in some other wealthy countries, is a result of bilateral deals that individual countries have made with individual companies. While we respect the right of countries to do their own bilateral deals, our preference and what we are urging to the world for both, equitable reasons, but also for what is going to be the best possible outcome socially and economically, is to work through pooled mechanisms like the COVAX one. That is the way Africa is going to get the fastest possible access to vaccines.

In terms of the actual timing, a lot of that does depend on first regulatory approval. Remember at the moment the UK has only approved the one vaccine, Pfizer BioNTech. The US FDA has not actually approved any, although we’re expecting there might be approvals as soon as tomorrow. And so you need to wait for the science, you need to wait for these vaccines to go through their regulatory, their phase three trials, to go through regulatory approval and for that to be approved by the World Health Organisation and then for that to then be rolled out. So it’s a lot of interlocking steps but the bottom line is we certainly hope we can accelerate the number of vaccines coming to Africa and other developing countries if we can raise the resources now.

According to the World Health Organisation’s draft, there are currently 52 vaccine candidates and 13 of them are put into the phase three trials. How many of these candidates, the vaccine candidates, are being funded by the foundation. And if the funding, like you said, is about $5 billion needed to get this out to Africa and the funding doesn’t come, what happens? And lastly, if you had to put a realistic date to things, how soon do you think Africans can get vaccines at say maybe the 20 per cent that we need to start with?

In terms of the direct funding of vaccine candidates, our primary support has been through CEPI, the organisation I mentioned, the Coalition for Epidemic Preparedness Innovations, which is a joint effort that we helped set up a few years ago with the Wellcome Trust, another other big foundation, with some governments like Norway, Germany and the UK. So we’ve made a number of direct contributions to them and they pool that financing again and try and make the investments for Global Access. I believe they have funded at least nine different vaccine candidates to date, and so indirectly, we’ve been part of that effort.

In terms of the money and the resources raised, the hope is that we can get to the initial 2 billion, payment which COVAX is using to try and procure doses, and the $5 billion is designed to try to get enough vaccines for 20 per cent of the population to be covered in Africa and other developing countries and that would be high risk groups, healthcare workers, essential workers, and other high risk groups.

Exact timing will depend on some of those regulatory and manufacturing bottlenecks. As you say, only one vaccine is currently approved and in use. And that’s only in one country in the UK and that’s the Pfizer Biontech, which is a very complicated vaccine because it requires a so-called ultra-cold chain. It needs to be transported at minus 70 degrees centigrade, it’s difficult to distribute, and it probably is not going to be the ideal one to scale up into the billions of doses that we need.

It’s more likely that some of the next wave of vaccines by companies like Johnson & Johnson, Novavax, and potentially the AstraZeneca when we get clearer clinical trial data. Rhose should be easier to manufacture at the larger scale and more cheaply. But there is a sequence, you need to wait for the regulatory approval, and you need to do the manufacturing scale-up. For some of those we’re already manufacturing at scale in anticipation of what we hope will be regulatory approval. But realistically, you know, at best, it’s probably some gradual rollout for those 20 percents in the first half of next year. Hopefully we can do fast, but for full global coverage, especially if we can keep the resources going and the distribution going, you’re likely looking at, you know, possibly the end of 2021, early 2022 before you get sort of widespread global vaccination.

But again, treat those as speculative. There are so many steps on the route, in terms of the phase three trials, the regulatory approval, the manufacturing, the procurement, the scale up, the role of governments and being able to do that. And if there’s anything we can do to accelerate that we will and that’s part of what our funding today is designed to do: to help governments and global entities and regional entities like the Africa CDC to help accelerate that.

Are you concerned that some poor countries may not be prioritising the vaccine and that’s why it appears as if they can’t afford it?

Again, that’s a very common question because across the continent so many countries are facing significant economic setbacks as a result of COVID, and there are other ongoing health and development crises, as I mentioned such as HIV and TB and malaria. And so it is important – we don’t want to focus on COVID to the exclusion of all other things. It’s important that African governments do remain attuned to the needs of citizens across all their regular work and that’s why we as the Gates Foundation have continued our support across all those other areas.

That said, clearly, the fastest route out of the COVID crisis is going to be vaccination. And so, just for simple economic and related reasons, it is important for governments to prioritize COVID vaccination where they can, both as a political priority and an economic priority. That’s going to be key to, you know, engaging, to allow travel again between countries and so on.

As I said at the start, at the Gates Foundation we believe it is appropriate that the world should be trying to subsidize a lot of this work for developing countries, not just in Africa but in other parts of the world, because the needs are so great and it’s important for Africa to be spending on strengthening domestic health systems which is an underfunded part of most African governments anyway. There are ways in which you can strengthen the health systems to help accelerate a COVID vaccine rollout or treatments for COVID which will actually strengthen them for future vaccine distribution, and for other vaccines and other treatments down the road.

So, for us it’s really a ‘both and’, rather than ‘either or’. We believe it is critically important that countries do stay engaged. In fact, we’ve seen it because the vast bulk of the countries have all agreed to participate and have signed up with the COVAX AMC, which requires a country to actively sign up for it. And then, I do think it’s appropriate and necessary that the rest of the world should be using this as a global public good that they’re helping to support. It’s not pure charity, it’s in everyone’s self-interest to tackle this globally, and to bring the COVID crisis to an end in an equitable way. That’s part of the case we’ve be making everywhere because people can be so preoccupied with their own countries, they often
lose sight of what a global necessity this is.

Are you funding the local manufacturer of syringes within some of the African countries that do benefit from COVAX?”

I don’t believe we’re directly funding the local manufacturer of syringes. I would have to check so we’ll check and come back to you. Really we’re more about funding or supporting the governmental responses and the regional technical response, as I say, working with partners like the African CDC and, where appropriate, with national governments and national health authorities because those are the framework. This really is less about individual investments here and there, it’s more about the framework and the system and the structure by which governments are able to think about the procurements, the rolling out the supply chain, the logistics, the follow up, etc. That’s really appropriate for national authorities. That’s not a role for philanthropy like ours – we play a much more supportive role. But our direct investments really focus more on the therapeutics, which are the treatments, the diagnostics and the vaccines and a little less on the underlying equipment, in terms of direct investments.