First, do no harm: spending the Global Coronavirus Response pledges properly

In a significant public display of global solidarity, on 4 May 2020 the European Commission, Germany, France and other EU member states pledged US$8 billion for health technologies to combat COVID-19.

The Coronavirus Global Response pledging conference answered the World Health Organization’s call for a global accelerator (known as Access to COVID-19 Tools, or ACT) that will develop, produce and ensure equitable global access to essential coronavirus health technologies. The pledged funds will be divided into four pillars: vaccines, therapeutics, diagnostics and health systems.

This increase in funding has the potential to greatly support efforts to develop COVID-19 technologies. However, good intentions don’t always lead to the desired outcomes and there are still many unknowns around this new initiative. If it is to truly deliver global common goods that are accessible to all, these issues must be addressed transparently. Otherwise, there is a risk that significant pledges of resources will be undermined and underutilised.

Here, we highlight six key questions that need to be answered.

1) Who will ensure that donor pledges become real financial commitments?

The European Commission will be responsible for registering and keeping track of pledges until the end of May 2020. After that, it is not clear which, if any, body will be responsible for ensuring that all pledges turn into actual funding commitments.

2) How will pledges be funded and will any development assistance be cut to pay for it?

The timeline for pledges has been backdated to 30 January 2020, allowing donors to re-pledge funds. Therefore, it is not clear whether donors have all pledged additional funds, or whether funds previously dedicated to other projects have now been re-prioritised as COVID-19 funding. This raises the risk that projects in other areas of work, notably in development cooperation, may face termination or may not be started.

In this global and multi-faceted crisis, it is essential that donors think holistically to ensure that national accountability mechanisms are strong enough to protect limited resources from being lost to corruption.

3) How will potential conflicts of interest be managed and what public reporting requirements are in place?

Each pillar of funding has co-convenors who will be expected to form partnerships with relevant experts. These partnerships “would work as autonomously as possible”, according to the European Commission, and decide how funds will be utilised. Donors will be able direct their funds to individual members of the partnership, meaning that a donor could send their pledge directly to a particular industry partner.

The European Commission says that partnerships will be “expected to report all donations received… and report to the global community and the public at large on resources pledged, received, used and further required”. While it is encouraging to see that reporting will be ‘expected’, it is unclear how or if this will be enforced and whether any due diligence will be conducted to mitigate the very real risks of conflicts of interest between the facilitation group, donors and partners.

4) How will open access to data and clinical trial transparency be enforced?

Given the low methodological quality of research currently being used as the basis for strong claims about possible treatments for COVID-19, it is imperative that the results of research and clinical trials are fully transparent. This will allow rigorous review and analysis to ensure that any new technology is effective and safe.

Poor transparency and quality of research has both fiscal costs and health impacts. Resources are wasted on developing and purchasing a medical technology that is potentially ineffective and might be unsafe for patients. Whilst the European Commission already calls for open access to results for publicly funded research, this should be expanded to industry-funded research as well.

It is also unclear how the publication of publicly funded research will be enforced. In the European Union, only Denmark is using penalties to enforce the EU Directive that mandates the publication of results of all clinical studies within a year.

All research funding associated with this initiative must mandate full transparency of any results, regardless of the sponsor. It would also help to add additional review processes; urgency is key, but it must not be to the detriment of robust scientific evidence.

5) What concrete mechanisms are in place to ensure global equitable access to COVID-19 technologies?

The described goal of the ACT-Accelerator is “to develop safe vaccines, tests and therapeutic products at an unprecedented speed and scale and make them accessible and affordable in an equitable way for everyone around the world”.

However, industry partners will be able to retain intellectual property rights over any technology. This would allow a pharmaceutical company to retain exclusivity and gain a market monopoly over a new vaccine, for example. Whilst funding will be “accompanied by commitments from donors in support of global access”, there is no transparency as to what these commitments involve. Without a stronger directive these commitments risk becoming meaningless and there is no guarantee that a vaccine will be accessible for all.

6) Will civil society be engaged in the monitoring of this initiative?

There seems to be no inclusion of civil society within the partnership, nor were there any civil society interventions during the online announcement of the ACT-Accelerator or the pledging conference. This lack of representation is worrying. The voice of civil society is imperative for accountability and ensuring that needs and expertise of all stakeholders are accounted for in decision-making. In contrast, major public-private-partnerships and industry partners such as the IFPMA were given a platform.

What do we want to see?

At this early stage the main focus is on research and development. However, known corruption risks in procurement and deployment must also be proactively addressed. Globally, up to 25 per cent of all health procurement spending is lost to corruption. Transparent and accountable contracting can help reduce the risk. Deployment, which refers to the supply chain and delivery of healthcare, is also vulnerable to corruption, including theft or patients having to pay for medical products that should be free of charge. The partners responsible for overseeing these stages must develop transparent policies in order to address these risks.

The ACT-accelerator framework is still being drafted. There is still time for its governance and accountability mechanisms to be improved. There should be a commitment to increased transparency and accountability across this new initiative. If not, then there is a real risk that its potential will not be reached and that new COVID-19 health technologies will not be accessible to all.

That would be a tragedy for people and our health systems as a whole.

Photo by Vincent Ghilione on Unsplash