ACT-A: half empty or half full?

We thank Ann Usher1Usher AD ACT-A: “The international architecture did not work for us”.Lancet. 2022; 400: 1393-1394Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar for the World Report about the independent external evaluation of the Access to Covid-19 Tools Accelerator (ACT-A).2ACT Accelerator Facilitation CouncilExternal Evaluation of the Access To COVID-19 Tools Accelerator (ACT-A). Oct 11, 2022. World Health Organization, Geneva2022Google Scholar We agree that the findings show ACT-A did not deliver fully–that was evident given inequities in vaccine coverage and access to diagnostics and therapeutics. However, the evaluation demonstrated that stakeholders were satisfied with ACT-A. Most government representatives from low-income and lower-middle-income countries (LMICs) reported that ACT-A's mandate was very relevant to them, and the partnership facilitated an unprecedented level of coordination and collaboration between global health agencies, enabling a rapid response to address the COVID-19 pandemic. More than 1.6 billion vaccines have been delivered to Advance Market Commitment countries, and 75% of the COVAX vaccines were delivered in low-income countries. More than 145 million tests, 40 million treatment courses, and personal protective equipment worth US$2 billion have been delivered to LMICs. Prices of rapid tests have been halved and voluntary licenses for oral antivirals agreed. As co-chairs of the ACT-A Facilitation Council, we thank all ACT-A partner agencies for their unprecedented efforts. We conclude that ACT-A was an innovative and useful initiative, but that it was insufficient. We believe the World Report1Usher AD ACT-A: “The international architecture did not work for us”.Lancet. 2022; 400: 1393-1394Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar did not sufficiently emphasise the findings suggesting the need for systemic changes ahead of future global health emergencies.2ACT Accelerator Facilitation CouncilExternal Evaluation of the Access To COVID-19 Tools Accelerator (ACT-A). Oct 11, 2022. World Health Organization, Geneva2022Google Scholar We highlight five functions identified by the evaluation that is needed: (1) mechanisms for coordination, priority setting, and investment in research and development of medical countermeasures; (2) day one at-risk financing based on agreed advance commitments and ability to coordinate resource mobilisation; (3) international norms and instruments that ensure timely sharing of data and information (including genomic sequences), technology transfer, regulatory support, and handling of liabilities; (4) distributed manufacturing capacities for vaccines, diagnostics, and therapeutics that make regions more self-reliant while part of global supply chains; and (5) pre-defined structures with inclusive governance, transparent decision-making, and accountability towards leaders and the public. All these systemic changes need to stand on a foundation of strong national health systems that are trusted and used by the entire population. Countries must be encouraged and supported to strengthen health systems based on platforms of primary health care and universal health coverage and with strong public health capacities and national surveillance systems. Governments, agencies, and other stakeholders should now discuss how we best can take the recommendations forward to ensure more rapid development, scale up, and timely equitable distribution of vaccines, therapeutics, and diagnostics in future emergencies. This will be an important part of the architecture for better pandemic prevention, preparedness, and response. OS is the South African President's Special Advisor on Social Policy. J-AR is Norwegian Ambassador for Global Health. Both serve as ACT- A Facilitation Council co-chairs. ACT-A: “The international architecture did not work for us”A new evaluation has delivered a devastating verdict of the global mechanism to provide the tools to control the COVID-19 pandemic. Ann Danaiya Usher reports. Full-Text PDF