The Bill & Melinda Gates Foundation not only spearheaded the global community’s efforts to develop a Covid-19 vaccine, but also to guarantee a fair and equitable access to the vaccine across the globe. “It’s the right, but also the smart thing to do,” Joe Cerrell, the managing director of the foundation, tells fDi

Q: Why is it important for the global community to guarantee fair and equitable access to a Covid-19 vaccine?

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A: Equity is at the heart of everything that the Gates Foundation does. In terms of our health work, we believe that where a person lives shouldn’t determine whether they live. Too often we’ve seen that there are gross inequities when it comes to accessing life-saving medications and healthcare. So, when it comes to the rollout of Covid vaccines, we believe that there should be equity and fairness. It shouldn’t be a small number of rich countries that are primarily able to get some of these tools.

We should have an ability to think on a more global basis. That’s the moral case. I think there’s also a self-interest, more economic case that’s starting to emerge. There’s a huge challenge in restoring, rebuilding and restarting the global economy. If you have pockets where this pandemic is still raging, it’s going to be much more difficult to restart the economy.

More recently, with this emergence of variant strains of the virus, if we have places where we’re just neglecting coverage of the vaccine, we’re going to see more mutations and more challenges. So, from the moral, the economic, and epidemiological standpoint, it really makes sense to be thinking in a much more global way about distribution of these tools.

Q: How would you assess the global response to these challenges so far?

A: We’ve seen a big gap between the rhetoric and the reality. Many leaders are agreeing that there needs to be a more global rollout of some of these tools. The reality is that it’s been slower.

It’s challenging. We knew that the logistics of trying to distribute vaccines to billions of people is unprecedented; we knew that it was going to be a challenge that was almost as difficult as the scientific discovery of the vaccine in the first place. It’s not a huge surprise. When it comes to multilateral platforms, Covax and Gavi, and the ability to get the vaccine to low-income countries, we’re going to start seeing a lot more activity in the later part of this quarter and in the early second quarter.

The goal is to get 1.3 billion doses into the lowest income countries by the end of the year. It’s an ambitious but realistic target. And it’s more a floor than the ceiling, so I hope we can do better than that. 

Q: What is the real incentive for countries to deal with platforms like Covax, rather than seeking their own bilateral agreements?

A: One reason is for their own vaccine supply and Covax provides an ability to hedge the risks. Perhaps they can get access to more vaccines than they would through the bilateral deals that some countries have been able to. It’s a wider platform of potential vaccines.

And the second incentive is to just be part of this platform that helps make sure that there’s adequate provision of vaccines to more countries around the world. Beyond this being the right thing to do, it’s a smart thing to do. 

Q: Where is the Gates Foundation focusing its efforts at the moment?

A: We are fighting a multi-front battle here. There’s still work that we’re doing on the upstream side of research and development (R&D). We’ve been funding the development of some of the treatments — monoclonal antibodies, for instance. We’ve been funding more rapid diagnostics that can help some countries just get a better handle on the epidemiology and make it easier for people to diagnose cases of Covid-19 more quickly.

On the vaccine side, we’ve been pretty active in trying to assess whether some of these variants are going to mean that these vaccines are less effective in the future. But the biggest part of what we’re doing is the advocacy that we think is going to be needed to help make sure that the tools available today get distributed to people that need them in poor countries.

We worked actively with the last US administration to see if there was a way through some of the stimulus measures that were passed to include some funding that would support vaccine distribution. The Trump administration approved a $4bn investment in Gavi to help some of those efforts. We’re working with the new administration to try to make sure that this nearly $2tn measure that president Joe Biden is putting forward includes a substantial amount for international efforts to make sure these countermeasures are made available. We’ve been working with representatives at G7 and G20 to make sure that Covid-19 and its vaccine are both significant priorities.

Q: What is the private sector’s role? 

A: I’ve seen some efforts underway to get the private sector to be more engaged in helping with the rollout of the vaccine. They can provide a lot of logistical support. Companies like FedEx, and UPS can help with some of the distribution efforts in richer countries. I think there’s a huge opportunity for the biotech and pharma sectors to make sure they continue to be on the front line, whether it’s on these variants or discovering new therapies, and help the world to make sure we’re prepared, no matter the direction that this pandemic takes.

I’m hopeful that more private sector companies will step up in terms of direct contributions to supporting vaccine efforts. A lot of companies have done extremely well in the past year or so. Maybe there’s an opening for some of those companies to now be a part of ending the pandemic. 

Q: What are the lessons to be learned from the global response to Covid-19?  

A: One of the first legacies is just the recognition that local health is global health. Until recently, I don’t think it really resonated, or people didn’t make the connection, just how interconnected the world is, and that an otherwise isolated incident in a small part of China can very quickly morph into a global health crisis. That is fundamental.

One of the great stories coming out of Covid-19 is the co-operation that took place on the R&D side, and the fact that we were able to develop a suite of vaccines in a little under a year is a scientific breakthrough for the ages. I hope it’s with same kind of ingenuity that we’re able to think about other diseases: vaccines for cancers and other diseases that have long plagued people, particularly in poor countries. If we can take that know-how and apply it against other things that have affected millions of people for a long time, but also to make sure that we’re prepared in the future, that would be enormously beneficial for the world.

The pandemic has also really brought to light the inequity that existed in R&D. A lot of biotech priorities are focused on conditions that represent a tiny share of the global burden of diseases. And that’s typically been where more of the money in the profit is — extending a person’s life in a rich country by a few months has much more of a profit margin than trying to develop new tools that could benefit millions of people. So, I hope we have a rebalance of some of those priorities in the future. Specifically to the mRNA vaccine platform, it really gives us an ability to think in a more creative way about how to develop and use that platform for other diseases and vaccine preventable diseases, but also vaccines as therapies for cancers and other conditions.

I think there’s also just a real kind of reckoning when it comes to the process by which some of these tools were developed and approved. I think there’s going to be a new way of thinking on how regulators can really support a more rapid way of approving use in a safe way, but perhaps in a new way, that is less time consuming. And we’ve also seen a lot of cooperation among companies. We’ve seen the second sourcing agreements whereby products that are developed by one company may be manufactured by another. That’s also a good precedent for future collaboration.

And finally, I would say it just really underscores the need to get to get busy working on things that haven’t yet become health threats. There are organisations like CEPI that are working on pathogens that could one day become epidemic or pandemic. It’s really important that this notion of a world being better prepared through investments like CEPI, but also surveillance and understanding the connection of zoonotic diseases to human health, is appreciated more than ever.

Joe Cerrell is managing director of the Bill & Melinda Gates Foundation.

This article first appeared in the February/March print edition of fDi Intelligence. View a digital edition of the magazine here.