Second COVID-19 Summit: Another Chance At Global Solidarity?

On May 12, the White House will co-host the Second Global COVID-19 Summit—alongside the governments of Belize, Germany, Senegal, and Indonesia. The (virtual) convening comes more than seven months after athe initial US-organized meeting last September that was intended to spur global action to bring an end to the COVID-19 pandemic.

Ahead of the first summit, the Biden-Harris administration released a set of commitments and sought to rally other donors to the cause. Since then, expanded access to vaccines, the development of new therapeutics, growing equity gaps, and the emergence and widespread transmission of new variants and subvariants have changed much about the fight against the pandemic. And while the administration and its partners have made meaningful progress toward the ambitions of the first summit, President Biden has been at loggerheads with Capitol Hill over the need for additional resources to tackle COVID-19 at home and abroad.

In the lead up to the long-awaited second summit, we look at the trajectory of the US international response since the fall—including progress toward the summit pledges—take stock of some of the challenges ahead and offer recommendations for what should come next and where the US is well-placed to contribute. We focus on the US response, but recognize that other funders and governments, especially in low- and middle-income countries have been on the forefront of this fight.

Progress on Vaccinating the World

The United States has led the world in vaccine donation. At the first summit, the US pledged to donate an additional half-billion Pfizer vaccines, bringing the total US commitment to more than 1.1 billion doses. At the time of this commitment, the US had shipped over 157 million vaccine doses to more than 100 countries. As of May 9, that figure is almost 540 million doses to over 110 countries.

Figure 1: US assistance for COVID-19 control has complemented US vaccine donations in order to get shots in arms. Past emergency COVID-19 supplemental spending has supported US priorities across pandemic response.

The map above shows country-level US funding for COVID-19 control (as defined by OECD DAC, which includes including vaccination information, education, and communication, testing, prevention, immunization, treatment, and care) and deliveries of US-donated vaccine doses per million. Pairing vaccine donations with other assistance is essential to turn vaccines into vaccinations. Initially, bottlenecks in vaccine manufacturing appeared to bear greatest responsibility for delays in delivery to lower income countries.

To address these constraints, last year the administration joined other countries and announced support for a World Trade Organization Trade Related Aspects of Intellectual Property Rights (TRIPS) waiver. Just last week the WTO circulated a draft proposal sketching out how the organization plans to waive intellectual property protections for COVID-19 vaccines. Moving forward, member states will now consider the (significantly narrowed) TRIPS deal, which is the outcome of negotiations between the US, EU, South Africa and India. In a welcome step earlier this year, the US also announced it would share NIH-developed tech with the WHO’s COVID-19 Technology Access Pool (C-TAP). Few donors or pharmaceutical companies have made similar commitments, but even this limited progress means that intellectual property concerns are no longer a major constraint to facilitating vaccine access.

With an eye toward addressing long-term needs, the US has also supported manufacturing capacity of COVID-19 vaccines in middle-income countries. For example, the US International Development Finance Corporation (DFC) is financing several global COVID-19 vaccine manufacturing deals. But the largest of these facilities—which also received resources from other bilateral DFIs and IFC—may soon reduce production due to a lack of sufficient demand.

Table 1: DFC investments related to global COVID-19 vaccine manufacturing

*Referred to as a US government financing arrangement. It is unclear what volume is attributable to DFC’s balance sheet

As vaccine supply constraints have eased, most middle-income countries and some low-income countries have rapidly increased vaccination coverage. But in the lowest-income countries, vaccination rollout has lagged—encountering myriad logistical challenges, vaccine hesitancy fueled by misinformation, and a lack of urgency (including on the part of some officials) in the face of relatively low transmission and hospitalization rates. To address critical access barriers, USAID launched its Initiative for Global Vaccine Access (Global VAX) in December 2021. Billed as a whole-of-government effort, Global VAX seeks to identify and tackle a range of impediments to the crucial goal of getting shots in arms, with a particular focus on countries in sub-Saharan Africa. A May 2022 USAID fact sheet estimates that following the first summit, between October and December 2021, USAID financed nearly 1,900 vaccination sites in the region. To date, the US has delivered over 155 million vaccine doses to countries in SSA.

Over the last two years, Congress has provided vital emergency spending that enabled this work to advance, serving as a down payment on US efforts to vaccinate the world. But that money has nearly run out. The White House request for supplemental resources, submitted to Congress in early March, included $1.8 billion for vaccine readiness and deployment through Global VAX. But despite strong public support for US leadership in helping to bring an end to the pandemic, the request for additional COVID-19 response funding has stalled—leaving the vaccination effort without the resources required to continue and raising the potential that donated vaccine doses could go to waste. 

What’s next

Experts are calling for sustained political commitment to manage the pandemic and close global vaccination gaps. Pledged COVID-19 donations—accompanied by doses purchased by countries through mechanisms like the African Union’s African Vaccine Acquisition Task Team (AVATT)—would be more than enough to vaccinate the populations of the poorest countries, but vaccines aren’t vaccinations. To date, less than 16 percent of people in low-income countries have received at least one dose of a COVID-19 vaccine. Successful vaccination campaigns in many of those countries could require a range of investments in areas from cold chain storage to public health communications. To make these campaigns a reality, Congress must deliver additional funding to support vaccination rollout in lower-income countries. Other donors must step up too—and we’re hoping to see demonstrated political will at the May 12 summit.

Donors will also need to coordinate support for vaccination manufacturing and distribution efforts, with an eye toward addressing demand-side constraints as vaccine technologies become more readily accessible. Few actors—pharmaceutical companies and public institutions alike—have provided technical details, data, and legal rights to produce and sell COVID-19 vaccines via platforms like C-TAP (as the NIH did). Some have offered voluntary licensing deals through the Medicines Patent Pool, and we hope to hear new sharing arrangements announced soon, but access to intellectual property alone isn’t a silver syringe to vaccinate the world.

This second summit must conclude with new commitments to deploy shared manufacturing know-how. Bilateral and multilateral donors will need to stabilize demand and support tech transfers for new vaccine component manufacturers to make use of collective knowledge. As clinical recommendations evolve alongside new variants, local and regional actors require both upfront subsidy to meet initial costs, and demand-side assurances to properly incentivize the scale of component manufacturing and distribution needed. Looking ahead, the US could push to establish a hub  for technology transfer and advance purchase contracting which would support regional and global entities like the Coalition for Epidemic Preparedness Innovations (CEPI). Leaders must also consider what financial mechanisms could allow producers to switch production between products as demand shifts—and be willing to pivot away from producing COVID-19 technologies if such manufacturing isn’t needed.

Progress on Saving Lives Now

A second priority area at the first summit focused on mitigating the harm of the pandemic in the immediate term through provision of testing, treatments, and therapeutics. To this end, US foreign assistance, deployed via several emergency spending packages, has been a cornerstone of the global effort to save lives and preserve health systems. The largest of these packages, the American Rescue Plan Act (ARP), provided a $3.5 billion contribution to the Global Fund’s COVID-19 response mechanism, lifesaving money to fund oxygen access through USAID, and complemented existing PEPFAR health system investments with new money to support testing and PPE distribution. According to USAID, over $400 million in ARP money has already gone to “urgent healthcare needs and critical components” in COVID-19 hotspots.

Figure 2: The American Rescue Plan Act included money for investments in COVID-19 treatments and therapeutics through both bilateral and multilateral channels.

Source: Account tables in FY23 and FY22 Congressional Budget Justifications for the State Department, Foreign Operations, and Related Programs.

Note: The American Rescue plan was passed via budget reconciliation and as such international affairs line items aren’t specified using the standard terminology. Some activities which would normally be programmed directly through specific budget accounts were instead allocated using Economic Support Fund money.

Ending the oxygen crisis was among the White House’s commitments unveiled at the first summit. Countries worldwide struggled with oxygen shortages amid surges in caseloads, but spikes in demand were most acute in low-income countries where oxygen is the first line of treatment for severely ill COVID-19 patients. Since September 2021, the availability of oxygen has significantly improved. In November 2021, 20 percent of countries globally were on the oxygen crisis list, compared to 7 percent today.

Table 2: More than two years into the pandemic, major access and financing gaps remain—particularly in low-resource settings.

Source: IMF COVID-19 Global Targets and Progress Tracker

After the first summit, the White House also sought to enhance testing capability, make PPE readily available, and limit morbidity and mortality. As the table demonstrates, low- and middle-income countries still face hurdles in financing these areas. While global vaccination campaigns advance at a slow (but steady) clip, continued support for cost-effective medical countermeasures is essential. An early ambition of the administration was to stand up the Center for Forecasting and Outbreak Analytics at the CDC. The center, which officially launched in April 2022, will support global variant analysis in cooperation with peer centers to better understand emerging threats and direct surge support where needed.

Despite best intentions, failure to deliver on new funding will constrain US-supported work to expand access to testing, PPE, and treatments, particularly for the most vulnerable to severe disease and healthcare workers in lower income countries.

What’s next

More funding is needed—from both the US and other donors—to deploy new, highly effective treatments and therapeutics such as oral antivirals. While not a replacement for vaccination, these medical technologies, along with diagnostics and PPE, have remained underfunded throughout the pandemic despite their important role in saving lives and reducing the likelihood of severe illness.

The second summit affords an opportunity for major purchasers of COVID-19 technologies to establish a dedicated forum to consult and coordinate on medical countermeasure procurement. Regular coordination will improve demand signals, in turn enabling adequate investment. The timeline for scaling up new, lifesaving technologies (including oral antivirals) is long, but with sufficient resources and urgency US regulators could speed the approval process. The US should also increase bilateral technical support for generic manufacturers and use existing platforms such as PEPFAR to develop country test-treat initiatives.

Progress on Preventing the Next Pandemic

COVID-19 isn’t the first pandemic, and it won’t be the last. But to date, efforts to finance investments in longer term pandemic preparedness have fallen short.

Speaking at last year’s summit, Vice President Kamala Harris voiced US support for a new financial mechanism to incentivize pandemic preparedness. Since then, the G20 established a Joint Finance and Health Task Force to enhance global cooperation on pandemic preparedness, which the US supported. And the concept of a Financial Intermediary Fund (FIF) has gained traction, with G20 Ministers recently reaching a consensus to establish such a mechanism to fill glaring gaps in the global system. But more urgent action is needed.

What’s next

This year the US and other donors will seek to rally support around a FIF at the World Bank to provide sustained financing to countries investing in pandemic preparedness. The FIF should mobilize both public and private sources to drive progress towards preparedness standards, incentivize domestic investments in preparedness, and provide subsidy for high-externality events. (See our brief on how to operationalize the proposed FIF.) We have our fingers crossed that donors will emerge from the summit having secured the political will to establish the FIF, and mobilized sufficient resources to fill preparedness gaps. Alongside this effort, we’re also looking to the World Bank to trigger the administrative process of setting up the FIF, and—in collaboration with WHO, G20 and G7, and all countries—iron out the details of governance, operations, and specific investment priorities.

The G20 announced that the new FIF would be finalized by June, and June is fast approaching. The summit provides a crucial moment to galvanize the financial commitments and political will to move this forward and quickly. But to leave the world better equipped to tackle the next global health threat, dedicated international preparedness financing must be accompanied by additional reforms and financing commitments across the global health system. The World Health Organization should see an incremental increase in assessed contributions from Member States, and other global health entities, including Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Coalition for Epidemic Preparedness Innovations (CEPI) must have robust replenishments to carry out their missions.

Now is the Time to Act

The WHO recently released estimates that between January 2020 and December 2021 almost 15 million people have died due to COVID-19, a harrowing reminder of the world’s collective failure to adequately invest in resilient health systems and prepare for infectious disease threats. (Excess mortality estimates like WHO’s often fall short where there are data gaps, but this number is still staggering.)

The US has led the charge on accountability (even if it remains difficult to assess what US money has been spent on and what was achieved with that money). Though under-utilized, the Global COVID-19 Access Tracker created after the first summit attempts to transparently track progress toward closing access gaps. And the Biden-Harris administration has doubled down on multilateralism, encouraging fellow G7 and G20 countries meet the moment and take action to end the pandemic and prevent—or mitigate the impacts of—future outbreaks.

It’s long past due for countries and organizations globally to step up to ensure a catastrophe of this scale does not happen again. And that means overcoming the creeping complacency when it comes to both COVID-19 and longer-term pandemic preparedness.

Countries must back up their pledges at the summit with substantial and sustained commitments to vaccinating the world, reducing deaths, protecting the most vulnerable, strengthening health systems, and financing preparedness against future pandemic threats. We’re looking forward to tuning in for the fully public, livestreamed summit—and we’ll be watching for the upcoming G7 and G20 meetings to deliver on promises made this Thursday.

Thanks to Amanda Glassman and Julia Kaufman for comments and suggestions on a prior version.