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Reviews | The next pandemic could be worse than Covid. We are not prepared.

For more than two decades, my organization, Gavi, the Vaccine Alliance, has been on a mission to protect the world’s poorest and most vulnerable children, immunizing more than a billion more children to date and providing vaccines to more than half of the world’s children each year. This led to a 70% reduction in deaths from vaccine-preventable diseases. We also support stocks of epidemic vaccines. So when Covid-19 arrived, we knew billions of people might not be vaccinated unless immediate action was taken. That’s why we helped create COVAX.

During the Covid pandemic, COVAX was the only initiative that had global equitable access for high-risk groups as its primary operational objective; for hundreds of millions of people most at risk in the poorest countries, it has been the only source of Covid vaccines. Despite facing immense hurdles every step of the way, COVAX is the main reason why 75% of healthcare workers and 63% of older people in low-income countries are now fully protected, while as an average of 50% of their population. So if we’re going to have any chance of being prepared for the next pandemic, it makes sense to have something like COVAX already in place and funded in advance – especially before the Big One hits – to ensure that the next time the response is faster and more efficient. Yet there are currently no plans for this.

It is true that global governance frameworks and funding are being developed to better prepare countries for the next pandemic. But there is also a need for an operational response on standby, particularly in terms of vaccines.

With infectious diseases, no one is safe until everyone is safe, so the role COVAX has played in ensuring people everywhere have access to vaccines has been undeniably important. Given that it has delivered 1.7 billion doses and is responsible for 76% of the Covid vaccines received by low-income countries, this raises the question of how people in these countries will have access to vaccines next time around. unless something like COVAX is in place to secure and deliver billions of vaccine doses to them?

This does not mean that we have to create a new organization or institution in the event of a pandemic. In fact, the reality is that no organization has all the knowledge, resources, or infrastructure to achieve this end-to-end approach anyway. The only reason COVAX has been so successful is that it is built around a networked approach that was able to leverage the strengths of existing global health organizations. From its main partners, the Coalition for Epidemic Preparedness Innovations, Gavi, the World Health Organization and UNICEF, to civil society organisations, the private sector and ministries of health, each partner has pivoted when the crisis struck to allow COVAX as a whole to react quickly, adapting and innovating when necessary.

All of this is necessary because achieving vaccine deployments on the scale we have seen with COVID – the largest and most complex global deployment ever – involves much more than just delivering vaccines. It also involves accelerating vaccine development, increasing manufacturing so that larger volumes can be produced, securing doses, negotiating lower prices, and putting in place all the logistics needed to deliver the vaccines. , including supply chain, cold storage, data systems, surveillance networks and trained healthcare workers, as well as all important legal safety nets for compensation, liability and liability. ‘compensation.

As daunting as it sounds, the fact is that we now know it’s possible and ultimately we need to improve it. Because despite everything it has achieved, COVAX could have done better. Faced with vaccine hoarding, export restrictions and a lack of transparency from manufacturers, COVAX experienced severe supply constraints last year that led to delays. If COVAX had existed before the pandemic, rather than being created on the fly, and if risky emergency funding had already been in place rather than having to be raised in the midst of a global crisis, then it could have reacted more quickly, reached agreements with manufacturers earlier and distributed larger volumes of doses to people more quickly.

We don’t know what form the next pandemic will take, or whether it will be possible to develop vaccines against it. But what we at least know is that if we don’t put all this in place now, the response will be slower and less effective. And if the next one is another Big One, it could come at a frightening and devastating cost.

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