2. Global R&D Roadmap and Equity
The COVID-19 pandemic has mobilized the largest global research effort in history.[30] Within weeks of first discovering the SARS-Cov-2 virus, its genome was sequenced while diagnostic tests have been developed at unprecedented speeds. By May, over 1,000 scientific papers were being published every day, as journal publications enabled open and rapid dissemination of critical epidemiological trends and clinical public health guidelines.[31] Despite the scale and speed of the global scientific response, there is still no treatment or vaccine for COVID-19. In addition to persistent uncertainties regarding transmission pathways, the type and duration of immunity is not yet known, while the emergence of viral mutation is a certainty, and can emerge anywhere.[32] The truth remains that countries that adopted public health interventions quickly and aggressively were able to control transmission: one study estimates that shutdowns in Europe averted 3.1 million COVID-19 related deaths, while another analysis of the six countries with the highest reported cases in June 2020 suggests the public health and containment measures likely prevented or delayed an estimated 62 million cases.[33],[34]
In the first six months of 2020, billions in public funding have poured into research, contributing to at least 38 COVID-19 vaccine candidates in clinical trials and another 93 preclinical vaccines in actively studies in animal hosts, as of September 10, 2020.[35] While wealthier countries continue to sign agreements to secure advanced access to vaccine – a kind of ‘Vaccine Nationalism’ that is now being condemned – there is an urgent need for new arrangements at the global level to facilitate the development, finance, production, and equitable distribution of COVID-19 vaccines.[36] The international community must ensure that COVID-19 related diagnostics, therapeutics and vaccines are treated as global public goods, and access must be equitable to ensure appropriate containment, control and mitigation of the COVID pandemic.
WHO activated the COVID R&D Blueprint and established the Solidarity international clinical trials aimed at rapidly assessing the relative effectiveness of COVID- 19 treatments. As awareness grew of the need for strengthened international coordination of the COVID-19 R&D efforts – and in response to a call from G20 leaders – WHO, together with CEPI, FIND, GAVI, the Global Fund, UNITAID the Wellcome Trust and the World Bank, established the Access to COVID-19 Tools (ACT) Accelerator with support from governments, manufacturers and funders.[37]Through its extensive network of global collaborators, the ACT Accelerator aims to improve the speed and scale of development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It the largest and most diverse COVID-19 vaccine portfolio in the world with ten candidate vaccines under evaluation, with 9 of them in clinical trials, and over 170 countries engaged in the new COVID-19 Vaccine Facility (COVAX).
COVAX allows countries to pool resources, share vaccine development risks, allow procurement of sufficient volumes of vaccines to support equitable access materials and medical equipment globally, and where there is oversupply, to donate surplus doses to a central pool.[38] Among the 170 countries that have signed on to COVAX, 55 would finance the vaccines using domestic budgets, while partnering with up to 90 lower income countries that would be supported through the COVAX Advance Market Commitment coordinated by GAVI. While these initiatives hold much promise, it remains to be seen whether they will achieve their goals, and they remain limited to COVID-19.[39] To date, less than 10% of required funding for the ACT Accelerator has been contributed, with US$35 billion urgently needed to ensure its viability. On September 10, 2020 UN Secretary General António Guterres appealed for a “quantum leap in funding,” warning that “without an infusion of US$15 billion over the next 3 months, beginning immediately, we will lose the window of opportunity.”[40]
Lessons from previous pandemics show that without mechanisms and procedures to facilitate the equitable sharing of limited medical countermeasures, low- and middle-income countries may be unable to secure access to vaccines and treatments until after wealthier countries have secured enough doses for their populations.[41] Challenges with the financing and coordination of R&D for COVID-19, fragile supply chains and trade restrictions on essential medical goods, and concerns regarding equitable and effective allocation of vaccines have highlight the need for adequate governance frameworks around R&D, trade and access to medical countermeasures.
While the WHO focuses on the immediate health response, the UN Research Roadmap will address longer-term downstream socio-economic consequences of COVID-19. Launched in April 2020, the UN Research Roadmap for the COVID-19 Recovery seeks to identify research priorities that will support an equitable global socio-economic recovery from this pandemic and continued progress towards the UN Sustainable Development Goals.[42] The Roadmap aims to transform COVID-19 recovery into a rapid learning initiative, where national and international responses can be informed by rigorous social scientific evidence generated in the anticipated recovery period. It is also intended to ensure national and international strategies are informed by rigorous social scientific evidence generated in anticipation of, and during, the COVID-19 recovery period.[43] It will seek alignment in support of priority areas identified in the UN Framework for the Immediate Socio-Economic Response to COVID-19.[44]Environmental sustainability and gender equality are part of a research Roadmap aimed at building a greener, more inclusive, gender-equal and sustainable world, with specific attention to at-risk populations experiencing greater socio-economic marginalization.