TWN Info Service on Health Issues (Aug20/07)
14 August 2020
Third World Network

WHO: Multi-stakeholder governance framework for ACT-Accelerator facilitation council

Geneva, 14 August (TWN) – The World Health Organization Secretariat has proposed a multi-stakeholder governance framework for the facilitation council of the Access to COVID-19 Tools Accelerator (ACT-Accelerator).

This was presented on 6 August and the Secretariat is currently seeking comments from WHO Member States.

[ACT-Accelerator was launched on 24th April 2020 to facilitate the development and equitable distribution of the tests, treatments and vaccines for the COVID-19. This initiative has three pillars for vaccines, therapeutics and diagnostics. The lead organisations for the vaccine pillar are Gavi, the Vaccine Alliance, Coalition for Epidemic Preparedness Innovations (CEPI) and WHO. Wellcome Trust and Unitaid are leading the therapeutics pillar, while the Foundation for Innovative New Diagnostics (FIND) and the Global Fund are the leads for diagnostics. Apart from the three pillars there is a Health System Connector Pillar working to ensure the tools reach the people. WHO also hosts the ACT-Accelerator secretariat known as ACT-A Hub. Each pillar has its own work streams with participation of industry and civil society organisations.]

According to the proposal, the council has primary and secondary functions as follows:

Primary functions

  • Assist the ACT- A in addressing key strategic, policy & financial issues;
  • Actively engage in and champion at the highest levels, the political advocacy and mobilization of resources needed for ACT- A to deliver.

Secondary functions

  • Act as a sounding board;
  • Provide political guidance and inform ACT-A work;
  • Monitor, track and communicate the ACT-A progress;
  • Communicate ACT-A progress to donors and relevant global fora (e.g. G20, World Health Assembly, UN General Assembly);
  • Mobilize the broad community of stakeholders and engage with civil society;
  • Monitor the best use of resources pledged by donors and risks.

The first meeting of the council is to finalize the above functions.

However, it is to be noted here that the main function of the council is to address the strategic, policy and financial issues and political advocacy for the ACT-Accelerator. There is no mandate for the council to take any substantive decision with regard to the ACT-Accelerator, as this is the purview of each pillar consisting of a few actors including certain donors. Thus the Council will act as a group to garner the political support from WHO Member States.

The council consists of governments (20-25), founding donors, market shapers, regional political and economic cooperation groups, co-hosts (WHO and the European Commission), non-government ACT-A partners (Bill & Melinda Gates Foundation, Wellcome Trust), as well as standing invitees (ACT-A Envoys, CSOs, industry).
The Secretariat proposes the following 10 regional groups to be members of the Council: the Arab League, the Association of South East Asian Nations (ASEAN), the African Union, the Caribbean Community (CARICOM), the Commonwealth of Independent States (CIS), the Forum of Small States (FOSS), the New Partnership for Africa’s Development (NEPAD), the Organization of American States (OAS), the Pacific Island Forum (PIF), and the South Asian Association for Regional Cooperation (SAARC).

The following 9 countries are named as Founding Donors: Canada, France, Germany (for the European Union), Italy, Japan, Norway, Saudi Arabia (for the G20), Spain, United Kingdom. Another 6 countries are also offered representation under the category of Market Shapers (countries having manufacturing capacities): Brazil, China, India, Russia, South Africa, USA.

Further, the council will have representation of ACT-A Special Envoys, 2 civil society organisations CSOs and 2 industry members. Other three non-governmental entities offered representation in the Council are the World Bank, Bill & Melinda Gates Foundation and Wellcome Trust.

The new proposed governing structure does not envisage any role and representation for the majority of WHO Member States.

Member States that do not fall into the category of donor countries of market shapers in medical products (vaccines, medicines and diagnostics) are represented through regional organisations. Thus the proposed governance mechanism undermines multilateral health governance leaving the majority of Member States without an effective say in the decision making with regard to their peoples’ health.

The guiding principles terms the council as “small, agile and time limited” with an expected duration of 12 to 18 months to enable and facilitate without any decision making powers. The decision making powers are with the boards of the respective partner.

The council is expected work through monthly or quarterly virtual meeting with inputs from ACT-Accelerator Hub in WHO, the WHO Strategic and Technical Advisory Group on Infectious Hazards, CSOs, donor facilitation groups and international organisations and Member States. WHO Member States are expected to interact through the weekly COVID-19 briefing. Industry and private sector participants would be identified by the product pillars and health system connector.

The council is expected to conduct its first meeting during the first week of September.

The ACT-A Hub presentation also highlighted the huge financial gap to meet the ACT-Accelerator needs. The estimated financial requirement is USD31 billion (USD18 billion for vaccines, USD7 billion for therapeutics and USD 6 billion for diagnostics.). However, as of 4 August after two pledging sessions, the ACT-Accelerator could raise only USD 3.8 billion and thus requires another USD 28 billion to achieve the target.

The presentation further revealed the slow intake for ordering vaccines under the advanced purchase scheme of the COVAX Facility (the ACT-Accelerator vaccine pillar), which is to facilitate fair and equitable access. Only 300 million dosses were secured through the COVAX facility while the target is 2 billion doses. Meanwhile a handful of developed countries have secured more than 1 billion doses and regional groups have secured more than 400 million doses.

Echoing these concerns, the WHO Director General in his concluding remarks stated that the framework will end up being a piece of paper at the end of the day unless there is political commitment from countries to make any product like vaccines a global public good. He stressed that political commitments and consensus are important and the allocation framework will not work if there is vaccine nationalism. He further emphasised that there should be global political commitment to make sure that any product which we can produce to help us better fight this pandemic should be a global public good.

Against this background the council’s task is to drum up political support for the ACT-Accelerator initiatives including the COVAX.