Countering the Pandemic Threat Through Global Coordination on Vaccines The Influenza Imperative (2022) / Chapter Skim
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5 Influenza Vaccine Access and Financing
5 Influenza Vaccine Access and Financing
Pages 115-154
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From page 115... ...
, a similar pattern will likely undermine the rollout of vaccines during a future influenza pandemic. THE COVAX FACILITY AND ITS SHORTFALLS In April 2020, COVAX was formed jointly by WHO, the Coalition for Epidemic Preparedness Innovations (CEPI)
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, enough to protect 40 percent of all adults in the 92 AMC countries, with the exception of India. The COVAX experience highlights the difficulty facing global health coordination, particularly around broadening global access to vaccines in an era of geopolitical transformation and increasing nationalism.
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To create a global procurement mechanism to ensure equitable access to COVID-19 vaccines to all countries in the world.
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Limited buying power had serious ramifications for inter- and intra-country equity in vaccine allocation and further limited the ability to support supply chains and manufacturing required for effective vaccine scale-up. In response to this vaccine shortage and the vastly inequitable distribution of the limited supplies available, the "Financing Pandemic Preparedness and Response" paper commissioned by the Independent Panel for Pandemic Preparedness and Response (IPPPR)
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It is important to consider three questions when approaching issues of equity in access to influenza vaccines: (1) which strategies can be employed to improve equitable access, (2)
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The pandemic illustrated how paying for overcapacity to deliver vaccines during a pandemic is an inexpensive and cost-effective strategy. If there were a single decision-making entity for the world, it would likely maintain that spending several billion dollars per year on pandemic preparedness is highly rational.
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-- was spent on strengthening pandemic preparedness in low- and middle-income countries (LMICs) (Figure 5-2)
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The African Risk Intended With funding from The Rockefeller Foundation and Swiss Unknown Capacity (ARC) first issue of Agency for Development and Cooperation and strategic Outbreak and Epidemic Cat bond or and technical support from the Africa Centres for Disease Insurance Programme reinsurance Control and Prevention and the WHO Regional Office cover in 2021 for Africa, the ARC developed a sovereign parametric insurance product to address the financing needs of member countries to contain public health emergencies arising out of common infectious diseases in Africa.
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financing, influences market shaping through new market $1.5 billion entrants and price reductions in vaccine manufacturing, (2026–2037) and mobilizes advocacy of civil society networks while involving a wide range of partners.
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Partner contributions, which can fluctuate annually, are used to fund inter-pandemic preparedness efforts at the country and regional levels (70 percent) and response activities during a pandemic (30 percent)
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Rapid Financing Instrument and Rapid Credit Facility, which provide emergency lending to eligible countries, and, according to a paper commissioned by the IPPPR, largely fulfilled their stated objectives to contain an outbreak with pandemic potential. However, the major barrier was the lack of facilities that were ready to fill the financing gap during the earliest days and weeks of a pandemic (Radin and Eleftheriades, 2021)
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. In the United Kingdom and the European Union, the Oxford-AstraZeneca vaccine development was funded almost exclusively by governments or foundations.
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FINANCING PPR: ECONOMIC PRINCIPLES Our recommendations for expanding and coordinating investment in PPR do not require arcane economic reasoning but are based on broad lessons from the COVID-19 pandemic and basic economic principles. The key economic lessons are that pandemics can still happen in modern times despite medical and communications advances, they can explode rather than sputter out, and exploding can lead to almost incalculable social costs.
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They argued that incorporating these risks in influential macroeconomic analyses, such as the reports from IMF's Article IV consultations, rating agencies, and risk consultancies, would improve economic risk forecasting and reinforce government and donor incentives to mitigate infectious disease risks. Another reason for historically low spending may be that investment in pandemic preparedness has aspects of a global public good.
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Momentum may also be an issue. As described in Chapter 1, the window of political will for rethinking global investment strategies may close quickly after the world's recovery from the COVID-19 pandemic.
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The report notes that PPR benefits are experienced globally, so it is insufficient to manage a global public good exclusively at a national level. However, the international system lacks the financing architecture to adequately coordinate and accelerate investment in the global public goods required to contain outbreaks.
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$50–$100 billion in a crisis distributed by an international pandemic-financing facility High-Level Independent Panel on $15 billion/year increase in international Financing the Global Commons for financing (public funding) for pandemic Pandemic Preparedness and Response preparedness and response (HLIP, 2021)
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: $62 billion total The IPPPR report proposed an International PPR Financing Facility to raise additional reliable financing for pandemic preparedness and rapid surge financing for response in a pandemic (Radin and Eleftheriades, 2021)
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This would represent at least doubling current spending levels and be targeted to four gaps: infectious disease surveillance, resilience of national health systems, global capacity to supply and deliver vaccines and other medical countermeasures, and global governance. The High Level Independent Panel underscores that these costs are "negligible" compared to those of a major pandemic.
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Instead, it may be best for HICs to adopt a system of assessed contributions to a major fund. The proposed International PPR Financing Facility would raise additional reliable financing for pandemic preparedness and rapid surge financing for response (Radin and Eleftheriades, 2021)
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. The World Bank's Regional Disease Surveillance Systems Enhancement (REDISSE)
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This funding led to a number of smaller regional networks, including the Mekong Basin Disease Surveillance network, East African Integrated Disease Surveillance network, and Southern Africa Centre for Infectious Disease Surveillance (The Rockefeller Foundation, 2013)
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Dedicated push funding is required because the pull from seasonal influenza vaccines is not sufficient to drive pandemic vaccine development. Current Funding for Influenza Funding for platform technologies and next-generation influenza vaccines is small relative to their potential to transform the vaccine landscape (see Chapter 4)
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. In 2018, BMGF launched a $12 million Universal Influenza Vaccine Development Grand Challenge with the goal of identifying novel, transformative concepts that will lead to the development of universal influenza vaccines offering protection from morbidity and mortality caused by all subtypes of circulating and emerging (drifted and shifted)
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A 2016 WHO consultation on Global Action Plan on Influenza Vaccines (GAP I–II) identified a host of challenges related to current financing mechanisms, which underscore the need for the industry to create stronger incentives -- and secure substantially more funding -- to push the development of platform technologies and universal vaccines (Røttingen, 2016)
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. Economic modeling has demonstrated that pull incentives awarding advance purchase agreements to bidding firms were effective for late-stage vaccine development (i.e., Phase III clinical trials and manufacturing)
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Current Funding for Influenza It is critical to explore strategies for keeping mRNA and other platform technology manufacturing processes warm between pandemics for both influenza and coronavirus vaccines. The Pandemic Preparedness Partnership, launched by the UK government, prepared a report for the 2021 G7, mapping a 100 Day Mission to respond to future threats by embedding pandemic-ready manufacturing processes and capacity into business as usual (PPP, 2021)
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One strategy is to subsidize dormant capacity directly; however, maintaining facilities on standby is an expensive option. Another approach is to use manufacturing capacity for seasonal influenza to produce pandemic vaccines, although relying exclusively on this option is less viable as the system transitions away from egg-based technologies.
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Self-procurement was heavily associated with HICs -- nearly 99 percent of vaccines in the European region were acquired through self-procurement, compared to just 6 percent in Africa. In a case study of vaccine procurement during the 2009 pandemic, Eccleston-Turner maintains that these methods were ineffective for developing states and predicts that during the next influenza pandemic, global demand for vaccines will exceed the worldwide supply, which is dominated by developed states with existing APAs (Turner, 2016)
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For instance, through two separate agreements, Moderna secured a $3.2 billion contract to provide the United States with 200 million doses at roughly $16 per dose; the European Union secured doses from Moderna at $18 per dose. Pfizer also received two separate contracts for a total of 200 million doses at $19.50 per dose, while the European Union paid just under $15.15 (Ramachandran et al., 2021)
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. Considerations for Future Financing The global distribution of seasonal influenza vaccines remains highly inequitable across regions.
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However, it is difficult to predict the type of pandemic that is likely to strike next and important to design a platform specific to the immediate situation. Financing Structures to Generate Incentives Appropriate financing structures can generate procurement incentives and promote equitable access worldwide.
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. This provides a model for how future equitable access clauses may be built into AMCs for influenza vaccines.
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Health systems in LMICs typically lack capacity to deal with infectious diseases -- particularly providing adult vaccines. In HICs, infectious disease control also tends to be a weak point in otherwise strong health systems.
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at a minimum and, ideally, include other respiratory pathogens with pandemic potential. • Surveillance is primarily a global risk mitigation -- not a development -- issue.
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• Universal influenza and platform technology push and pull instruments should include equitable access provisions, in line with CEPI's model during the COVID-19 pandemic. Markets and Deployment • The scalability of influenza vaccines is limited by the number of companies and production processes and by limited markets where the burden of this illness is uncertain.
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https://www.readkong.com/page/enabling-equitable access-to-covid-19-vaccines-summary-of-4837506 (accessed October 25, 2021)
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2021. A global deal for our pandemic age: Report of the G20 High-Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response.
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Independent Panel for Pandemic Preparedness and Response, Background Paper 14. https://theindependentpanel.org/wp-content/uploads/2021/05/Background-Paper-14 Financing-Pandemic-Preparedness-and-Response.pdf (accessed October 25, 2021)
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2020. Funding pandemic preparedness: A global public good.
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