What does the EU’s pledging event on May 4th, to fight COVID-19 actually mean for global health?

Originally Published May 2nd, 2020 on Geneva Health Files

DOCUMENTS SHOW HOW WORLD HEALTH ORGANIZATION IS BEING SIDELINED IN “THE COVID-19 GLOBAL RESPONSE FRAMEWORK”

World Health Organization is being weakened even as there are fervent calls to strengthen it, in order to protect multilateralism in global health. The pledging event, led by the EU, on Monday, May 4th, could be a sign in the shift in power away from WHO, observers say.

A range of interests is actively shaping global health, even as the world continues to bury its dead from the pandemic. Geopolitics; a fight for resources, including potential intellectual property gains around COVID-19 technologies; a bounty of health information for technology companies — all of these factors are converging in ways that could transform forever how WHO and global health will be governed — here and now.

It appears that WHO is systematically being side-lined at the height of the COVID-19 pandemic. And, it is not only the U.S. which has raised questions on the effectiveness of WHO — by freezing its contributions to the organization. Pending systematic review of WHO’s role in responding to the pandemic, other rich member states, seem to be making sure they direct crucial matters including on how resources that will be raised to fight COVID-19 should be spent. In effect, contributing to the overall weakening of multilateralism in global health.

Recent documents that have come to light, suggest that new initiatives such as the Access to COVID-19 Tools (act) Accelerator, essentially seek to take control of the resources that will be raised for “partnerships” for vaccines, therapeutics and diagnostics to fight the pandemic, without WHO having a lead role in these matters. In addition, the role of private actors, continues to expand.

On April 24, 2020, WHO along with its partners called for a global collaboration to hasten the development, production, while ensuring equitable access to diagnostics, therapeutics and vaccines to fight COVID-19.

Ursula Von Der Leyen, the President of the European Commission had said that a global pledging event will be launched on 4th May, 2020. “The aim is to raise €7.5 billion to ramp up work on prevention, diagnostics and treatment…” she had said.

So what does the EU’s pledging event next week actually mean for global health?

According to the summit’s website, “the European Union and its partners are hosting an international pledging conference starting on Monday 4 May 2020 where we aim to raise €7.5 billion in initial funding to kick-start the global cooperation.” Other co-hosts include France, Germany, UK, Norway, Saudi Arabia. And official partners include WHO, BMGF, CEPI, Gavi, The Global Fund, Unitaid, Wellcome and the World Bank are official partners. Further, it is understood that the fundraising window that opens on May 4th will culminate in an event on May 23rd.

So what is the problem with a noble pledging event? It potentially signals a change in who controls resources, not just in the way the pandemic will be addressed, but also for the future of the governance of global health.

One source, long familiar with teh workings of global health in Geneva, has called these efforts by rich member states and private entities — as a “tectonic shift” in global health, similar to the period when The Global Fund to Fight AIDS, Tuberculosis and Malaria, was created in 2002. The narratives sound familiar — “WHO is unable to address challenges effectively, so there is a need to carve out new forums”. As a result, “the few” can take decisions — outside of the multilateral system comprising 194 countries that make up WHO.

The problem is not merely, a pledging conference. As documents suggest, the structures that will govern how these potential resources will be deployed surely raises more urgent governance and accountability questions in the way some member states seek to shape WHO.

The reason why WHO has opted towards big “multi-stakeholder partnerships”, outside of its sacred multilateral space, at a time critical time like this, is hard to fully understand. One source said that “WHO is too weak” and as a result, others are setting the agenda.

Such partnerships in international development have been a concern for years. To be sure, the Tedros administration has been open to the approach to partnerships from the very outset. But these continue to be relevant questions.

“Why couldn’t WHO have waited for two weeks for the World Health Assembly on May 18th, to find the best way to raise resources and prioritize investments during the pandemic in consultation with all its member states? What was the hurry,” asks one negotiating expert, who works with developing countries.

The governing bodies of WHO, are the appropriate forums to discuss such issues on funding and strategy, the source added. There can be no “multilateral oversight” funds raised and used in such a manner — as the EU has sought to do.

WHO has the institutional power and the convening power. European member states — important donors to WHO, are effectively free-riding on WHO’s convening power — potentially at the expense of its poorer member states, who will have no say in the way these resources to fight COVID19 will be spent.

Actions by some rich member states, risk alienating others, one source said. In fact, this was an opportune time to come together to demonstrate solidarity with WHO, when the rug was pulled from under its feet, when the US, its largest donor, decided to freeze its contributions.

At this point in time, WHO is coping with mounting technical work on the pandemic, and finds itself in a quickly escalating geopolitical whirlpool of sorts.

Caught between the U.S. and China, WHO has spent weeks, defending its role in the early days of the pandemic. It appears that in order to quickly fill the impending vacuum left by the U.S., and the allegedly rising influence of China, EU countries are quickly moving in, and how.

A pandemic, is as good a time, as any other — to set agenda, define markets and secure commercial rights. (Read my earlier story here) Questions are also being raised on why is WHO lending its name to this initiative? This will contribute to the fragmentation in the innovation space, experts fear.

Documents seen by this reporter, shared by a credible source, reveal that WHO does not feature as a “lead actor” in the scheme of things as far as this “collaboration” is concerned. This is surprising given WHO’s role in existing efforts including on the R&D Blueprint on COVID-19 research and other efforts on international clinical trials, COVID-19 Emergency Listing Procedures and accelerating safe and effective COVID-19 vaccines among others. (On both these accounts, experts believe that WHO can do better on coordination and guiding innovation.)

(I am unable to upload the documents in their entirety here, but as before, I am sharing key information verbatim.)

In the interest of time, this blog is being published, ahead of the May 4, 2020 event. It was not possible to reach out to parties concerned given the limited opportunity.

• Some significant excerpts from a recent document titled “The Coronavirus Global response Pledging Event” says:

The aim of the 4th May event has the following aims:

• To respond to the 24 April 2020 call for action launched by international organisations and political leaders;

• To kick-start and lay the ground for an on-going pledging process;

• To mobilise pledges totalling 7,5 billion euro;

• To endorse the global collaboration framework to ensure that these vaccines or treatments will be produced at unprecedented speed and scale, and will be accessible, safe and affordable for everyone around the world.

The EU and its partners work on the pledging event with experienced and respected organisations, including the Global Preparedness Monitoring Board, the Bill and Melinda Gates foundation, the Wellcome Trust, the World Health Organisation, and many others.

Funding will be channeled into three strands, aimed at accelerating the development and deployment of 1) vaccination, 2) treatment and 3) diagnostics.

The pledging event will unleash a pledging marathon, with additional stages planned until the end of May and thereafter.

Key Communication Partners are listed as:

• EU Member States, especially Germany, France, Sweden, Netherlands, plus Norway and UK, other governments as co-leads
• CEPI, FIND, GAVI, UN, WHO, PAHO, UNICEF, Global Fund, Global Citizen Initiative
• Wellcome Trust, Gates Foundation, Zuckerberg Foundation, Mastercard, World Bank, IMF, Africa CDC, CARPH
• World Economic Forum
• Influencers from various sectors — from entertainment to NGOs, scientific community, business, political or social media influencers
• COM Representations, Delegations, implementing partners, research consortia

[Civil society groups have been concerned about the implementation of the Framework of Engagement with Non-State Actors (FENSA) — it is not clear how such an event will sit with these guidelines.]

• The May 4th event, also seeks to be platform for GAVI. (In the past, WHO has said that raising resources for global health, means coming together of all actors and that there is no competition while vying for the same resources.) But WHO member states are not obliged to raises resources on account of GAVI, one expert pointed out.

Gavi pledges

It is important to recognize that these efforts are ongoing while Gavi is looking to mobilize at least $7.4bn for its GAVI 5.0 strategy. If Gavi 5.0 is not fully funded the risk of outbreaks of other vaccine preventable diseases will increase. Some donors may wish to use the May 4th event as a platform for Gavi pledges in support of the Gavi 5.0 strategy.

Gavi will likely play an important role in market shaping and vaccine stockpiling for COVID-19 vaccines in the future, pledges to Gavi for COVID-19 vaccine market shaping/vaccine stockpiling are welcome on May 4th but should be additional to pledges for Gavi 5.0 (2021–2025), which is at least $7.4bn to fund access to other lifesaving vaccines.

• How will these funds be deployed

The version of a document dated April 29, 2020 says:

Overall funding for COVID19 tools (ACT Accelerator)

• The overall need to fund the development, scale up, and delivery of key COVID-19 response tools (Vaccines, Therapeutics, and Diagnostics) is significantly larger than $8 bn. Much of this financing will need to be committed in the next few months, not years, as investments needed to scale manufacturing capacity for vaccines, therapeutics and diagnostics at the levels needed to meet the challenge of a global epidemic need to be made in parallel with R&D investments. While this is a significant investment, it is dwarfed by the global economic impact of a prolonged pandemic.
• It will be important to use the May 4th event not only to gain pledges towards the initial $8bn ask, but also to gain political commitment from donors to collaborate to raise the additional money needed to fund the needs outlined by the ACT Accelerator over 2020–2021. In the near term, more resources will be needed particularly to finance and incentivize rapid scale up of manufacturing capacity for the three tools, which also requires credible funded commitments for procurement to assure manufacturers of demand in LMICs.

PLEDGES ON MAY 4TH

• Funding for the COVID 19 tools (ACT Accelerator) won’t be directed to a single fund or organization. Instead, several organizations doing the work ACT determines are important to the development, scale up, and delivery of key COVID-19 response tools (Vaccines, Therapeutics, and Diagnostics) will need to be funded. In some cases, the organizations are yet to be determined or will evolve over time.
• The EC will be recording pledges in support of the COVID 19 tools (ACT Accelerator) including (but not limited to) CEPI for Vaccine R&D and manufacturing investments, the COVID-19 Therapeutics Accelerator, which will support critical work on R&D and scaling manufacturing capacity for therapeutics and FIND which are coordinating the development of diagnostics for COVID-19, including diagnostic tests and simple technical platforms.
• The estimated overall costs for development, manufacture and procurement of Vaccines will be far higher than Diagnostics and Therapeutics and it is recommended that donors consider this when making pledges and apportioning their resources.
• The structures that will control this new architecture:

In a document titled: Schematic concept for ACT-Accelerator — COVID-19 Global Response Framework — details emerge on governance including “A light-touch oversight, in the form of a Global Stewardship, bringing together a mix of governmental and non-governmental organisations….The Global Stewardship reports to the G20 + AU + APEC + WHO + WBG…”

The framework envisions three partnerships on vaccines, therapeutics, diagnostics — WHO is not a lead actor for any of them.

Apart from “two high-level personalities”, the Global Stewardship will include co-leading governments (also co-hosts of the 4 May pledging event), and a consortium of partners including the Bill & Melinda Gates Foundation, the Wellcome Trust and the World Economic Forum.

This is concerning because of the money is expected to flow into the lead actors and not through the Global Stewardship. See below.

This how parts of this document reads:

Overall aim

To accelerate the development and deployment of universally available and affordable vaccination, treatment and diagnostics (the ‘three areas’).

Needs

• Coordination through an agreed division of work at global level with light coordination;
• Resource mobilisation to fill the gaps in funding and manufacturing, and seize the opportunities;
• Distribution and ensuring equitable and affordable access globally.

Principles

• A time-bound (two years, renewable) and transparent framework to encourage and facilitate collaboration;
• Capitalising on existing institutions; no new institutions or structures; minimum additional overheads;
• Coordination and alignment of efforts through global multilateral partnerships with clinical development, manufacturing and distribution adapted to regional needs and circumstances;
• Governments being accountable for public resources and regulations hold ultimate responsibility.

3 level-framework

• The core of the framework are the three partnerships (vaccines, therapeutics, diagnostics) which work as autonomously as possible, with a transversal work stream on health systems.
• A light-touch oversight, in the form of a Global Stewardship, bringing together a mix of governmental and non-governmental organisations.
• The Global Stewardship reports to the G20 + AU + APEC + WHO + WBG on (i) progress made in the three areas, (ii) identification of additional resources needed in the future and (iii) envisaged action to raise such resources (through pledging or otherwise).

The partnerships (note: to be expanded following 27–28 April discussions in the partnerships).

• Work in each of the 3 areas led by one lead actor, empowered and resourced to animate a partnership with relevant actors (public sector, industry, research, funders, regulators, international organisations).
• Each of the three partnerships form an ecosystem that aligns and valorises the actions of partners in a whole-value-chain approach (from research to delivery and universal access). The spirit is that of incentivising innovation and alignment instead of control and command.
• For vaccines, the focal point for the partnership will be CEPI, jointly with GAVI in view of vaccination deployment.
• For therapeutics, the focal point will be the COVID-19 Therapeutics Accelerator.
• For diagnostics, the focal point will be FIND (Foundation for Innovative New Diagnostics).
• A transversal work stream will deal with COVID-19-related aspects of health systems and cross-cutting issues such as open science and data-sharing.

The global stewardship

• The global stewardship is composed of two high-level personalities, a small number of co-leading governments and a consortium of partners with global reach.
• The role of the stewardship is:

Report on progress, notably to the Global Stewardship but also to other relevant. international fora; Communicate to and mobilise the public and to all actors and stakeholders; Organise outreach to and dialogue with civil society; Identify, justify and mobilise additional resource needs; Support the partnerships in overcoming obstacles they face and they escalate; Ensure information flows between the three partnership areas; Recommend improvements to health systemic framework conditions; Ensure transparency and accountability (including ensuring an ethical framework and managing conflicts of interest) but also protect the autonomy of the partnerships from undue influence that would endanger the speedy achievement of their mission.

• The Stewardship is in principle composed of entities that do not receive funding within or as part of the ACT-Accelerator framework.
• The two independent high-level personalities are the public face of ACT-Accelerator. They act as the co-chairs of the Global Stewardship. They are selected by a proposal from the co-leading governments and partners for endorsement for endorsement by the G20+. One personality is from the global south; the other one the global north. They work at least half of their professional time for ACT-Accelerator. They are supported by the co-leading governments and the partners, notably through the coordination hub at WHO. They can be deputised by representatives from the partners.
• The co-leading governments are the co-hosts of the 4 May pledging event.
• The partners are a small number of organisations with global reach, with complementary expertise and with a track record in establishing and facilitating cooperation for public goods. They include the Bill & Melinda Gates Foundation, the Wellcome Trust and the World Economic Forum.
• The Global Stewardship is supported in the fulfilment of its role by a dedicated and professional coordination hub housed at the WHO.

Third World Network had raised questions on the ACT Accelerator and its lack of detail on how it will make access to resources to fight COVID-19 more equitable. At the time of publishing, in the version of these documents that have come to light, there are scant details on how these big IP questions will be addressed including on the method of innovation.

“While there is promise of equitable access to the tools, there is no indication on whether the innovation would be governed through open innovation or through the conventional ways,” TWN said in its recent story.

On the ACT Accelerator, one expert said, “There is no qualitative change on R&D issues. It is a massive exercise just to prolong the status quo.”

“Why should developing countries contribute to this EU initiative — without having any guarantee on issues around access to COVID-19 technologies? It is like writing a blank cheque to rich countries and other entities” a source said. (In fact, in the EU resolution on COVID-19 response currently being negotiated by member states, there is a push for a greater role for governing bodies in this matter. Read my earlier story here, section 5.17)

Contributing directly to WHO is another matter — since it is run by member states. WHO is accountable to countries — but such initiatives are not, the expert cautioned.

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