In addition to the severe economic and social disruptions generated by COVID-19, the world now faces dangerous inequality in the access to and distribution of vaccines to populations in developing countries.  Access to healthcare has always been a global challenge, but the requirement to expeditiously deliver billions of COVID vaccines in countries with limited hard and soft infrastructure requires a new scale of public-private partnership.  One of the most critical areas to achieving success in vaccine delivery will be the development and mobilization of new financing and risk mitigation tools that protect and support the vaccines and the companies that are called upon to deliver and administer them.  Developing working capital finance facilities, insurance and other risk mitigation tools, and the harnessing of technology and data will be key to closing existing gaps in COVID response health delivery for COVAX and beyond, as well as improving preparedness for future global health challenges. 

This Concordia Live — as part of our webinar series which brings together leaders from across the public and private sectors to address the most pressing issues of our time — featured representatives from various sectors who discussed the importance of developing finance and risk mitigation policies and structures that enable and enhance global health delivery.

• This Concordia Live focused on how to mobilize health delivery for the global COVID response and the important need for public-private partnerships in overcoming major challenges and constraints in the delivery of the COVID-19 vaccine and other critical health services. 
• While there has been a significant increase in vaccine availability and manufacturing, there are growing disparities around the world.
• The overall goal of achieving equitable global access to vaccines is rooted in the understanding that the global population is not safe until the virus is under control around the world.
• Porter Delaney opened the session with a review of the current facts and figures around the state of COVID-19 response and the on the ground perspective. 
  • A recent Duke University Report indicated that 12 billion vaccines can be manufactured by the end of the year.
    • 11 billion vaccinations are needed to reach global herd immunity. 
    • At the same time, many lower and middle income countries may not have access to the vaccine for 2-3 years.

• The goals of COVAX are to provide 1.3 billion vaccines to 92 low and middle income countries. 
• • This would result in a 20% immunization rate. 
  • So far, 67 million vaccines have been delivered to 124 countries. 
• There is a growing disparity in the access to vaccines.
  • On average 1 in 4 people in high income countries have received the vaccine, while only 1 in 500 have in low income countries. 
  • Only 2% of the globally produced vaccines have been delivered to the continent of Africa. 
• The delivery of vaccinations is not the only issue. Vaccination administration is also of great importance.
  • In Malawi, 16,000 AstraZeneca vaccine doses expired because they could not be administered in time. 
  • The Democratic Republic of the Congo returned 1.3 million AstraZeneca vaccines because they were set to expire before they could be administered. 

• Sibusiso Hlatjwako echoed Delaney’s message that no one is safe until we all are and that resources must be made available to all countries.
  • Hlatjwako explained that not being able to administer the vaccines will continue to cause significant economic damage and put economic advancements at risk, specifically in low and middle income countries.
  • To combat this, world leaders must put more resources into the administration of vaccinations and support the WHO. 
  • Manufacturing is one of the most prominent constraints facing African countries because less than 1% of vaccines needed are produced there.
    • To increase manufacturing needs, conversations on technology transfer and vaccine development must be amplified. 
    • Countries with manufacturing capabilities need to make meaningful plans on how they can best share their strategies with African countries. 
    • Specifically, support is needed on how to create manufacturing hubs. 
    • Hlatjwako points out that there are currently conversations underway on this and other similar topics between the African CDC, WHO, and other organizations. 
    • These manufacturing hubs must also be sustainable to ensure they can be used in the long-term. 
  • While COVID-19 has exposed many gaps in the world, allowing for countries and organizations to better understand what must be done. 
    • One such way is for developed countries to collaborate with low developed countries on manufacturing and investments into health care systems.
  • The health care disparities were expanded because of the uncoordinated and inadequate data management and health care systems.
    • Systems were not in place to assist with vaccine administration.
    • The purchasing power of developing countries must also be supported to fill the gap left by COVAX.
    • Ben Hubbard explained how Parsyl is assisting with vaccine delivery. 
      • Parsyl is a technology driven insurer of essential supply chains (vaccines or perishable foods).
      • They use data from low cost sensors to understand the quality conditions that vaccines and other materials go through. 
        • The data they use allows them to better understand, lower, and underwrite the risk.  
      • Parsyl and the Global health risk facility work to overcome the market failure which leaves goods such as vaccines, perishable foods, and other necessary items uninsured. 
      • Hubbard also explains how they are working to address the information gap by gathering information on the transportation, storage and distribution of these items. Local risk adjusters are used to gather the information. 

• Syndicate 1796 is another way in which the insurance capacity has been expanded. 
  • Syndicate 1796, is backed by the DFC and assumes 50% of the risk associated with insuring these products. The other 50% is backed by other major global insurers. 
  • The insurance covers all aspects of vaccination administration, such as from the manufacturer to the country or the country to the patient. 

• • • During the pandemic, countries are spending 1-3% of their GDP to finance COVID response, with many of them having to borrow. Parsyl allows for additional protection of the borrowed capital or tax payer investment into these products. 
    • This support also directly links the private sector to the supply chains allowing for needed improvements. 

• Sean Keogh also spoke on the role of the private sector in vaccine administration. 

• • • During massive government mobilizations, the money tends to move slower.
    • With vaccine distribution often being carried out by private sector entities who are charged with the logistics, the cash flow becomes limited creating a need for working capital. 
    • The private sector effectively assists in this by creating a blended capital perspective to leverage larger amounts of money for vaccine distribution at global scale. 

• Nafisa Jiwani explained that the COVID-19 crisis has created an opportunity to respond to both the immediate and long term needs of countries made evident by the growing disparities in vaccine availability. 

• • There is an opportunity to create diversity around vaccine manufacturing, both from a regional approach and the technology used.
  • For progress to be made, there must be a multi-pronged approach around the legal and regulatory environment. 
  • Jiwani highlighted that the DFC is currently in conversations with the global manufacturers to better understand the roadblocks  and how DFC can use their tools around debt financing, political risk insurance, and technical development programs.
  • With sustainability in mind, the DFC is also in conversations with biotech and pharmaceutical companies to understand how they can be supported around vaccine supply chains. Supply chain support would be needed at all times, from access to the raw materials needed for drug substance, to the distribution of vaccines. 
  • DFC is working in collaboration with Biological E, a vaccine manufacturing company based in India. 
    • Together, they are working to produce 1 billion vaccines by the end of 2022. 
  • Additionally, they are pursuing investments to support increasing liquidity for small-medium sized businesses and women owned businesses. 
• During the Q&A, Hlatjwako explained that inorder to ensure refugees and other displaced people also have access to the vaccine, governments must include them in the stages of vaccine distribution. 

• • Jiwani also explained the Global health and prosperity initiative which will be investing $2 billion across 3 years into health systems. The initiative accepts proposals from across the health care system spectrum. Two areas of focus highlighted were WASH and vaccine manufacturing.

• Partnering to Support COVAX
• Leadership in Global Digital Health – A Call to Action

• WHO & the Shifting Role of Multilateral Institutions
• Investing in a Healthier Tomorrow

FOR MORE INFORMATION on HOW TO ATTEND OR Host a Concordia LIve EVENTS or WEBINARS, PLEASE EMAIL MEMBERSHIP@CONCORDIA.NET