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Experts working with the Access to COVID-19 Tools Accelerator welcome the conclusions of a key report on pandemic preparedness. Ann Danaiya Usher reports. The Independent Panel for Pandemic Preparedness & Response, co-chaired by former President of Liberia Ellen Johnson Sirleaf and former Prime Minister of New Zealand Helen Clark, raises alarm about the persisting global inequity in access to COVID-19 tools and the slow pace of reforms in the global health system that they say are needed to end this pandemic and prepare for the next. The panel calls for a high-level event at the UN General Assembly to ensure that interest in improving pandemic preparedness does not flag, and to agree on a political declaration and a “roadmap for coherent and transformative reform”. It also recommends an independent evaluation of the Access to COVID-19 Tools Accelerator (ACT-A), which has been welcomed by those involved in the scheme. The panel, established by WHO in September, 2020, delivered its first report 1 year ago. A follow-up report published last week acknowledges that, although some important changes are under way, they will take years to take effect and political resolve is waning. The report points to positive developments; for example, the US$1 billion announced by donors at President Joe Biden's summit on COVID-19 earlier this month for a new pandemic fund to be hosted by the World Bank, a proposal to increase assessed contributions to WHO from 16% to 50%, and the delivery of 1·5 billion doses of COVID-19 vaccine by the ACT-A.

lopments; for example, the US$1 billion announced by donors at President Joe Biden's summit on COVID-19 earlier this month for a new pandemic fund to be hosted by the World Bank, a proposal to increase assessed contributions to WHO from 16% to 50%, and the delivery of 1·5 billion doses of COVID-19 vaccine by the ACT-A. Although positive, these developments are insufficient, the report states. The money promised to the fledgling pandemic fund so far is nowhere near the $10 billion that will be required annually. If approved, increases in funding to WHO will take a decade to materialise. As for the ACT-A, the alliance of international organisations—including WHO, Gavi, the Global Fund, UNICEF, and the Bill & Melinda Gates Foundation—set up in the spring of 2020 to ensure global equitable access to COVID-19 tools, it has not achieved any of its targets and remains desperately underfunded. “We largely have right now the very same tools and the same system that existed in December 2019 to respond to a pandemic threat and those tools just weren’t good enough,” Clark said. The report urges donors to fully finance the ACT-A so that COVID-19 vaccines, treatments, and tests can be made available in low-income countries where the virus continues to spread and mutate. Meanwhile, the Independent Panel for Pandemic Preparedness & Response strongly criticises the way in which the ACT-A was conceptualised and calls for an independent evaluation to find out what went wrong with the initiative.

s can be made available in low-income countries where the virus continues to spread and mutate. Meanwhile, the Independent Panel for Pandemic Preparedness & Response strongly criticises the way in which the ACT-A was conceptualised and calls for an independent evaluation to find out what went wrong with the initiative. “We continue to be concerned about the overall charity-based approach that has beleaguered the pandemic response. This leaves low-income countries dependent on decisions by wealthier countries. That's too precarious [and] it's inequitable. We don’t want to see reliance on official development assistance for pandemic preparedness and response, which after all is a global public good,” said Clark. She stressed that this was especially acute given that cuts are being made in development budgets and aid is being diverted to finance domestic support for refugees. Ayoade Alakija, the Nigerian doctor who was appointed WHO Special Envoy for the ACT-A earlier this year, concurs with the recommendation of the report on the need for an evaluation. She underlines that it must be truly independent and delve into the reasons why the ACT-A was unable to achieve equitable access to COVID-19 tools. “I posit that part of the reason for ACT-A's challenges in achieving equitable access to COVID tools was that there was a profound lack of understanding of the political economy of the environments in which they were trying to work”, she said.

sons why the ACT-A was unable to achieve equitable access to COVID-19 tools. “I posit that part of the reason for ACT-A's challenges in achieving equitable access to COVID tools was that there was a profound lack of understanding of the political economy of the environments in which they were trying to work”, she said. However, acknowledging the huge commitment of time and energy invested by global health leaders in the alliance over the past 2 years, she said: “It is currently the only global mechanism we have…We should not throw out the baby with the bathwater.” Alakija hopes that the ACT-A can shift to become an entity with greater inclusion, clearer governance, and a degree of independence “so that we are in a dynamic state of readiness and can deliver more effectively and equitably”. Norway's Ambassador for Global Health, John-Arne Røttingen, who co-chairs the Facilitation Council of the ACT-A, confirms that planning for the evaluation is already underway. A reference group for the review is being established with eight country representatives and four representatives from communities and civil society. He expects the evaluation to be complete in autumn this year, such that its findings can feed into the deliberations about the future system for pandemic prevention. “I believe there is a need to develop better models and mechanisms for the future to deliver equitable access in health emergencies. It will be an important goal of the evaluation to contribute learning and insights that can help inform policy options”, he said.