Open Letter to G7 Leaders: A G7 Action Plan to Ensure the World is Vaccinated Quickly and Equitably
The G7 member states have historically been the leading group of democracies to drive forward ambitious visions to confront global crises. Such high-level leadership two decades ago led the world out of the then runaway HIV/AIDS crisis. COVID-19, a crisis on a scale and complexity even greater than HIV/AIDS, demands no less.
G7 member states have struggled with their own internal challenges in responding to COVID-19. But thanks to their unprecedented efforts to advance the development, manufacturing, and delivery of highly effective and safe vaccines, they are on a path to containing the pandemic in their respective countries.
The G20 Global Health Summit highlighted the need for stronger efforts to expand that progress globally; the World Health Assembly resounded with statements in support of global solidarity; and the COVAX Advance Market Commitment Summit secured an additional $2.4 billion in funding and country commitments to donate 54 million excess vaccine doses. In addition, the US has announced distribution plans for 25 million doses of the 80 million doses it intends to donate over the course of June. These events and actions are supportive, but fall far short of what is truly required to meet the urgency and vast scale of the global vaccination gap. As Prime Minister Johnson recently called for, it is time for the G7 to lead the way to vaccinate the world.
This vaccination gap is a problem of vaccine supply as well as a massive challenge of vaccination capability and vaccination demand. It is also a matter of financing – better using existing commitments and urgently mobilizing additional resources to meet the $50 billion or more in emergency financing needed in the next 18 months, especially to ensure that countries are able to translate vaccines into vaccinations. Indeed, delivery capabilities and vaccine hesitancy, not supply, are likely to be the critical bottleneck to vaccinations in most low- and middle-income countries within the next 6 months. Recent findings from vaccine readiness assessments in 128 countries have revealed that only 30% of them have processes to train the large number of vaccinators required, and even fewer have undertaken significant steps to address vaccine uncertainty and hesitancy in their populations. In the absence of significant, urgent increases in country and multinational capabilities to distribute and administer vaccines, we anticipate an excess supply of vaccines globally, likely by the fourth quarter of 2021.
G7 members must use their unparalleled political and financial might, their combined vaccine expertise and manufacturing capacities, and their proven ability to shape the world’s response to global public health emergencies, to accelerate global equitable access to highly effective vaccines.
We call for a G7 Action Plan that includes five immediate actions.
- Create a G7 Vaccine Emergency Task Force to ensure transparency, accountability, coordinated urgent mobilization of resources, and shared planning in the vaccine marketplace;
- Develop and commit to a path to share at a minimum 1 billion doses, with the aim of 2 billion doses, of G7-authorized vaccines before the end of 2021, and ensure the availability of enough doses to enable broad vaccination in every country as soon as possible in 2022;
- Implement a coordinated G7 strategy to immediately increase production of high-quality, well-regulated vaccines, with the goal of further increasing access to these vaccines across the rest of the world;
- Accelerate development of high-quality globally distributed manufacturing capacity by bringing together public and private sector stakeholders and using voluntary licensing agreements; and
- Increase bilateral and multilateral support to low- and middle-income countries to increase their vaccine distribution and delivery capabilities and address vaccine hesitancy, with three specific goals: achieve demonstrated vaccination preparedness in each country by the end of 2021; strive for at least 60%, and ideally 70%, vaccination coverage in every country in 2022; and avoid significant excess vaccine stockpiles ahead of pandemic control in all nations.
1. Create a G7 Vaccine Emergency Task Force to ensure transparency, accountability, coordinated urgent mobilization of resources, and shared planning in the vaccine marketplace.
The current global vaccine marketplace is confusing, opaque and chaotic. It contributes to widespread lack of public confidence and trust. G7 countries have brought more predictability to their own vaccine markets, and have the capacity to bring about more transparency and accountability and permit shared planning through a Vaccine Emergency Task Force supported at the ministerial level. Through the Emergency Task Force, the G7, other countries, and international organizations should share projections and best practices for domestic vaccination needs, and implement coordinated, effective, and systematic plans for sharing doses with other nations. The Emergency Task Force should also facilitate greater transparency and predictability in the timing of global vaccine deliveries, to allow for improved country-level preparation and financing.
As G7 nations continue to prepare for COVID-19 contingencies, they project increasingly large vaccine stocks that greatly exceed the most likely domestic requirements. To maximize the benefits of these excess supplies, there is a need for reliable and predictive forecasting of scenarios that map domestic vaccine use and more accurately define the ability of G7 countries to meet global demands. Supply and demand factors will remain dynamic as the pandemic evolves. This concerted G7 effort to provide accurate supply projections based on the latest country data will build public trust and facilitate more effective and coordinated global vaccination access.
To support equitable sharing of doses, the Emergency Task Force should develop and transparently implement public health-driven criteria for decisions on the routes and distribution of sharing. As the primary global multilateral platform for vaccine access for the poorest countries, COVAX should be a major recipient of shared doses. Other important regional bodies, national partners, and multilateral institutions will also play valuable roles. Allocations should maximize impact, ensuring that vaccinations have the most impact on averting deaths, stabilizing vulnerable health systems, and stopping rampant transmission. They should also include consideration of COVID-19 burden and vaccination capacity in countries. Clear, consistent criteria across the G7 can build upon the recent US announcement of criteria for dose-sharing and align with COVAX’s efforts to meet urgent needs.
2. Develop and commit to a path to share at a minimum 1 billion doses, with the aim of 2 billion doses, of G7-authorized vaccines before the end of 2021, and ensure the availability of enough doses to enable broad vaccination in every country as soon as possible in 2022.
The G7 and affiliated European Union (EU) countries currently control access to most of the supply of these high-quality vaccines, both through purchase agreements with options for additional purchases, and regional manufacturing capacity. We urge the G7, along with the EU and its member states, to approach dose-sharing with far greater urgency and intensified systematic planning. Doing so will have a far faster impact on current and evolving global vaccine needs, and on the stark inequities that exist today, than any other approach to increasing the global supply of high-quality vaccines.Manufacturing of the high-quality vaccines that are available in G7 countries has continued to ramp up, with further increases possible if G7 countries act together. We estimate a 2021 supply of over 7 billion doses of vaccines produced by manufacturers based in G7 member states1. These vaccines are currently authorized or reasonably expected to be authorized this year by a Stringent Regulatory Authority (SRA), and represent enough supply to fully vaccinate over 4 billion people. In 2022, with effective G7 support for production ramp-up, we project potential production of over 14 billion doses of vaccines with current or likely SRA authorization, enough to enable most of the world to be vaccinated. These vaccines should be provided to low- and middle-income countries through donations or at non-profit pricing.
We call on the G7 and EU to share a minimum of 1 billion vaccine doses, and aim to share 2 billion doses, in 2021. The G7 should also develop and implement a process to coordinate enough vaccine supply to enable vaccination of at least 60%, and ideally 70%, of every country’s population as soon as possible in 2022, which would require approximately 9.2 to 11 billion total doses. Overall production could be higher and faster, depending on the success of manufacturing capacity expansion and on evolving national needs. (See Appendix for more detail.)
3. Implement a coordinated G7 strategy to immediately increase production of high-quality, well-regulated vaccines, with the goal of further increasing access to these vaccines across the rest of the world.
The G7 should ease or remove export restrictions and other barriers, such as the US removal of Defense Production Act priority ratings for Novavax and AstraZeneca vaccines, in a coordinated and orderly manner to assure efficient global supply chains. G7 countries must also reduce or accelerate current time-consuming agreements that donor countries and manufacturers now require to donate vaccines to other countries. Immediate, coordinated investments by G7 nations and aligned institutions to address shortages in raw materials, equipment, and supplies, using the regulatory, contracting, and supply chain expertise that have brought high-quality vaccines to the G7 countries, will also help address global needs over the next 6 months, a critical period for avoiding supply frictions and shortages. By leveraging successful planning for manufacturing support in the US and other G7 countries, which has enabled significant expansions in vaccine manufacturing, the G7 can coordinate efforts to further expand short-term production. To achieve this, the G7 countries, in the coming weeks to months, should prioritize addressing critical bottlenecks in supply chains and manufacturing capacity to maximize the number of vaccine doses produced globally. With limited supplies, it is essential that available resources continue to go to high-quality, well-regulated, and efficient manufacturing. These efforts should be coordinated with CEPI in its role leading short-term supply chain optimization for the COVAX Manufacturing Task Force.
4. Accelerate development of high-quality globally distributed manufacturing capacity by bringing together public and private sector stakeholders and using voluntary licensing agreements
The inequities worsened by the pandemic have highlighted the risks of the consolidated nature of the vaccine manufacturing market. This divergence in access has been further exacerbated by the disruption of supply from India because of increased domestic needs in that country.
While establishing new, high-quality vaccine manufacturing capacity in Africa, Asia outside of India, and Latin America will take time, the G7 is uniquely positioned to work with leading manufacturers and local and regional authorities to create it. G7 members have already brought together public and private sector partners to enable sharing of IP, technology, and capabilities, such as with the Quad Vaccine Partnership, the US-Republic of Korea Vaccine Partnership, and the investment by the U.S. International Development Finance Corporation (USDFC) and partners in Aspen in South Africa to produce the J&J vaccine. Team Europe has also committed to invest 1 billion Euros to support manufacturing capacity in Africa.
A systematic G7 plan to implement such cooperative agreements should be accompanied by access to financing through public and private sources, including USDFC, IFC/World Bank and local private funding. The G7 should set a target of finalizing at least 5 public-private agreements by the end of 2021, each leading to the establishment of substantial regional vaccine manufacturing capacity in 2022. To ensure long-term sustainability, attention is also needed to organize the policy framework and demand for future upfront purchasing from new manufacturers.
In collaboration with regulatory guidance and support, this approach can enable faster availability of highly effective vaccines – for this pandemic and the next – and build local expertise through shared know-how to assure global access to high-quality, safe vaccines everywhere.
5. Increase bilateral and multilateral technical and financial support to low- and middle-income countries to enhance their vaccine distribution and delivery capabilities, and address vaccine hesitancy, with three specific goals: achieve demonstrated national vaccination preparedness in each country by the end of 2021; strive for at least 60%, and ideally 70%, vaccination in every country in 2022; and avoid significant excess vaccine stockpiles ahead of pandemic control in all nations.
To increase vaccine distribution and delivery capacity, the G7 should bring together bilateral capabilities, in coordination with WHO, Gavi, UNICEF, COVAX, ACT-A, The Global Fund, IMF, World Bank, IFC, and other relevant organizations and programs to assure financing and integral support to country governments, civil society and private firms. This concerted effort can help strengthen global coordination and leverage all available resources in support of effective local vaccine distribution and delivery. The G7 can also use its initial experience with allocation of donated doses to help identify, in collaboration with COVAX partners, areas where improvements in national and sub-national capacity are most needed.As vaccine supply ramps up, most parts of the world will quickly reach an inflection point where high-quality vaccine supply exceeds the global capacity to use it. The combination of inability to effectively distribute, store, and deliver vaccines alongside vaccine hesitancy will become critical constraints to vaccination in most nations. If vaccine production keeps pace with current projections, we expect this inflection to occur in late 2021 for most low- and middle-income countries.
In-country vaccine distribution and delivery capabilities are largely focused on routine immunizations for children. They will face intense pressure over the coming months to enable rapid mass-vaccination campaigns that ensure equitable access for adult populations on a national level, a challenge that many countries have not faced before. Reliable data on distribution and storage capabilities for many countries is not available. We have already seen several unfortunate examples where suboptimal readiness for vaccination efforts led to wastage of valuable vaccine doses. Coupled to financing and dose-sharing, the G7 should support monitoring and improvements in country readiness for vaccinations.
These efforts should be guided by clear goals for effective vaccinations across low- and middle-income countries, including aiming for every country to achieve vaccination preparedness by the end of 2021. In addition, the G7 should set the goal of striving for at least 60%, and ideally 70%, vaccination coverage in every country in 2022. As experienced in several high-income countries already, this coverage target will likely be more constrained by delivery and demand factors than supply. G7 leadership and coordination should ensure that some countries or regions do not establish excess vaccine stockpiles while other regions or countries still lack adequate supply.
Providing appropriate support for vaccine distribution and delivery efforts will come with significant costs. The IMF has estimated that an additional $50 billion will be needed, including $35 billion in grants, to finance vaccine roll-out and related public health interventions by 2022. However, there are substantial unused resources right now that could achieve major short-term improvements. This includes the potential to mobilize a range of existing global public health funding sources, such as commitments from multilateral development banks (MDBs) that are not yet disbursed, as well as financial and in-kind resources and technical expertise from G7 countries themselves.
The coming weeks and months are critical to address the human catastrophe facing low- and middle-income countries, to preempt further explosive growth of the virus, and to prevent the spawning of new variants that threaten to undermine vaccine immunity everywhere, including in the US and other G7 economies. To meet this unprecedented historical moment, we have described an approach for G7 leadership to assure the fastest possible path to access billions of doses of high-quality vaccines and ensure local capacity to deliver them. We call on the G7 leaders to take the immediate actions described above in order to lead to more equitable global access to vaccines, and to commit to tracking and sharing regular updates about progress toward shared goals and targets.
The G7 Leaders’ Summit on June 11-13 represents a consequential opportunity for meaningful, urgent action. The G7, as a platform to address the world’s most critical challenges, should seize this opportunity to once again demonstrate unrivaled global leadership, harnessing its collective capabilities and partnerships to save millions of lives and bring this pandemic to an end.
Amanda Glassman, Executive Vice President, Center for Global Development; CEO of CGD Europe; and Senior Fellow
Rachel Silverman, Policy Fellow, Center for Global Development
Prashant Yadav, Senior Fellow, Center for Global Development
J. Stephen Morrison, Senior Vice President and Director, Global Health Policy Center, Center for Strategic and International Studies
Katherine Bliss, Senior Fellow, Global Health Policy Center, Center for Strategic and International Studies
Anna McCaffrey, Fellow, Global Health Policy Center, Center for Strategic and International Studies
Gary Edson, President, COVID Collaborative
John Bridgeland, CEO, COVID Collaborative
Anjali Balakrishna, Program Director, COVID Collaborative
Mark McClellan, Director, Duke-Margolis Center for Health Policy, Duke University
Krishna Udayakumar, Director, Duke Global Health Innovation Center, Duke University
Michael Merson, Wolfgang Joklik Professor of Global Health, Duke Global Health Institute, Duke University
Thomas Bollyky, Senior Fellow, Council on Foreign Relations
Helene Gayle, President and Chief Executive Officer, The Chicago Community Trust
William H. Frist, Former U.S. Senate Majority Leader
Scott Gottlieb, Resident Fellow, American Enterprise Institute, and former Commissioner of the US Food and Drug Administration
Margaret (Peggy) Hamburg, Former Commissioner of the US Food and Drug Administration, and former Foreign Secretary of the National Academy of Medicine
Amb [ret] Jimmy Kolker, Former Assistant Secretary, Global Affairs, Department Health and Human Services
Jack Leslie, Chairman, Weber Shandwick
Jennifer Nuzzo, Associate Professor, Johns Hopkins Bloomberg School of Public Health
Carolyn Reynolds, Co-Founder, Pandemic Action Network, and Senior Associate, Global Health Policy Center, CSIS
Appendix: Projecting Vaccine Supply and Coverage
Based on analysis of publicly available information, we have attempted to project 2021 and 2022 overall vaccine supply and vaccine purchases by G7/EU countries, in order to identify the potential scale of doses available for sharing.
Our analysis focused on six vaccines – those by Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, Johnson & Johnson, Novavax, and CureVac – that are currently or likely to be approved this year by a Stringent Regulatory Authority (SRA) and whose manufacturers are based in G7 member states.
We project 2021 production of 7.1 billion doses across these vaccines, enough to fully vaccinate 4 billion people; and 2022 production of 14.3 billion doses, enough to fully vaccinate 8.4 billion people. Details are provided below in Table 1. For vaccines from AZ/Oxford, J&J, and Novavax, we have discounted publicly-stated production targets based on manufacturing and supply chain challenges those vaccines have experienced.
For analysis of G7 purchases, data for EU purchases and population were included as almost all vaccine purchases for Germany, Italy, and France are at the level of the EU. The G7/EU, with a total population of 1 billion, have purchased over 3.7 billion vaccine doses from the six manufacturers listed above (excluding an additional 900 million doses of Pfizer/BioNTech vaccine purchased by EU for delivery in 2022), enough to fully vaccinate 2 billion people.
If the vaccine purchases documented in Table 2 are delivered in 2021, which is feasible given projected 2021 supply for these vaccines, there would be excess doses available in 2021 across the G7/EU of anywhere from 1 billion doses to 2 billion doses. These calculations are shown in Table 3.To achieve ~70% population coverage across G7/EU countries would require ~1.4-1.6 billion doses, making accommodations for wastage, expiration, one vs. two-dose vaccines, and other relevant variables. Many countries are actively evaluating the need for additional boosters toward the end of 2021, based on waning immunity and/or emergence of new variants. A scenario with 70% of G7/EU populations receiving a one-dose booster in 2021 would account for an additional ~0.7-0.8 billion doses, with a cumulative demand of ~2.1-2.4 billion doses for 2021. Further accounting for 10% contingency supply for emergencies has also been included in our calculations.
1 Supply projections include vaccines produced by Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, Johnson & Johnson, Novavax, and CureVac. In addition, incremental supply of these six vaccines for 2021 beyond the G7/EU purchase commitments would be ~3.4 billion doses. Much of this supply has been purchased through direct procurements by other governments as well as by Gavi on behalf of COVAX.