Did Mr. Berkley call for more global surveillance?

Dr. Berkley – “We need stronger disease surveillance systems. With more people living in closer proximity to each other, and over a billion people crossing international borders each year, the transmission of disease is not only easier, it’s harder to stop. In the absence of a vaccine, our best chance of doing so is to catch outbreaks as early on as possible. That means better disease surveillance. Infectious disease surveillance networks already exist across the globe, but they can be highly porous and of varying effectiveness. One cost-effective way of widening the net is through improved access to primary healthcare, particularly in lower-income countries, where often these infectious diseases emerge undetected.”

How do you explain Israel’s success in terms of vaccination? And why do other countries not follow your example? On the other hand, why has it not been created in the most vulnerable countries to have structures for themselves to produce the vaccine and thus bring more equity and not dependence on northern (more developed) countries?

Mr. Collins – “Israel’s success can largely be attributed to its universal healthcare system which has enabled them with the infrastructure to rapidly administer vaccines and immunize its population. On the contrary, limited access to finance, mounting debt, access to capital and well-developed health systems make it difficult for the most vulnerable countries to achieve the same success.”

Some countries were able to squash COVID-19 early on by using therapies and implementing strict lockdowns. Countries like the US were obsessed with vaccines since day 1 and wouldn’t let other research reach mainstream news sources while ventilators literally killed people. What are COVAX and GAVI’s relationships like with the U.S. government and mainstream Western media?

Dr. Berkley – “The United States is a long-standing Gavi partner and has recently approved US$ 4 billion over 2021 and 2022 for Gavi’s COVID-19 related work. This support will help shorten this crisis, save lives and help restart the global economy. In today’s interconnected world, no one is safe until everyone is safe.”

Beyond the science, how are you achieving baseline coverage, particularly in the Global South. Volunteers are often the core of last-mile delivery. How are you using them to achieve base coverage?

Mr. Collins – “Gavi, WHO, and UNICEF have been working together to support in-country readiness efforts and help prepare participating economies for vaccine delivery. CSOs also play a critical role in program monitoring and implementation to ensure COVAX reaches the most vulnerable given their deep experience and understanding of realities on the ground. Through these partnerships, COVAX is able to ensure effective deployment of doses to achieve last mile delivery.”

I would like to know if COVAX is also providing Technical Assistance to countries?

Dr. Berkley – “Yes. Participants in the Gavi COVAX AMC, the financing mechanism that supports the participation of 92 low- and middle-income economies, are eligible to request support for technical assistance.”

How do we tackle vaccine resistance? This seems key if we want to ensure sufficient vaccine coverage across all countries? And must also be a global priority?

Dr. Berkley – “The key to addressing vaccine hesitancy is to build trust and the way to foster trust is engagement with communities. Facts alone don’t make this happen. Building trust is an everyday action, and it requires understanding and respecting the concerns people have.”

The risk of a black market is that there will be fake vaccines and this will put everybody in a high risk. How could philanthropy help most vulnerable Countries with this challenge? How could civil society join the challenge?

Mr. Collins – “CSOs have years of experience in public health and a breadth of community knowledge that can be leveraged to complement government efforts during the crisis. Recognizing this expertise, COVAX has engaged CSOs in facility planning and operations. CSO engagement can help improve the implementation effectiveness of COVID-19 programs through helping authorities with program monitoring, building trust, gathering feedback, and more.”

• COVAX has already rolled out over 30 million COVID-19 vaccines to 60 countries. Regarding the multi-stakeholder collaboration that underlies the scale of this initiative, Jay Collins pointed out the complexity that has been managed with a great number of participants at the table and at a considerable speed. He stated that the cooperative mechanisms displayed, both in terms of policy and execution, have not been seen on this scale other than in times of war. Similarly, Dr. Seth Berkley highlighted that COVAX is the largest multilateral new effort since the Paris Climate Accord. 
• According to Dr. Berkley, several scientific questions regarding COVID-19 vaccines are still unsolved, and one of those is how long the vaccines last for. To shorten the lifespan of the pandemic, the need to ensure baseline coverage as soon as possible is critical—the more vaccinated people, the less variance, and the less risk. As explained by Gayle Smith, to achieve the speed of vaccine distribution that is required, countries need to move systemically and globally, rather than sequentially. Collins believes that COVAX’s approach is the best tool against variance and mutations of the virus. 
• All three participants agreed that a major challenge facing the COVAX Facility, whose aim is to equitably distribute COVID-19 vaccines, is “vaccine nationalism”. Smith highlighted the relevance of education to overcome this issue by making people understand that if vaccine access is equitable and fair, it is also smart. Dr. Berkley spoke about the importance of getting a global consensus around the idea that “no one is safe unless everyone is safe”.
• According to Collins, when it comes to solving global issues, it is important to think of equitably allocating resources, funds, and risks. This is exactly what the buffer designed by Gavi and the COVAX Facility does. As demand for vaccines in the developed world rises, the COVAX vaccine supply makes it possible to reallocate vaccines to poorer countries and populations in humanitarian settings. 

• Flexibility has been fundamental to fulfilling COVAX’s mission. As explained by Dr. Berkley, Gavi is an alliance that was already working with the World Health Organization, World Bank, civil society, governments, and vaccine manufacturers before the COVID-19 pandemic. Since Gavi co-leads COVAX, the initiative takes advantage of its network model, as opposed to an institutional one, which facilitates scaling up and bringing in different types of expertise as needed. Citi, the financial and risk advisor to the COVAX Facility, is also taking a flexible approach to its work. Collins shared the company’s strategy, which includes a plan A, plan B, and plan C in order to mitigate against potential risks. This has enabled Citi to make firm commitments with manufacturers on behalf of countries. 
• Smith outlined two key lessons that should be used to build on the COVAX model going forward: i) investments need to be consistent, predictable, and more regular; and ii) transparency and pricing in the market are critical.
• As stated by Dr. Berkley, infectious diseases have to be addressed through global scientific collaboration, long-term investments in global health and resilient health systems, and smart and strategic multilateralism. Although in statistical terms we are doing much better now than during the last H1N1 crisis, we have to learn from history and not repeat mistakes: a pandemic should be considered as a continuous threat, so we should keep preparing during “peacetime” to face it. The model that is being demonstrated by the COVAX Facility, Gavi, and Citi shows the importance of global solidarity, flexibility, scalability, and cross-sector partnerships. These lessons should be taken to address other global issues such as climate change and food insecurity.