Opinion | Unprepared for the Big One

Covid-19 may have been the biggest global health crisis in a century, but in so many ways it could have been worse, much worse. Despite the scale and suffering — with the pandemic not yet over and at least 15 million people dead, nearly 600 million people infected (possibly more than Spanish flu) and at a cost to the global economy of at least $11 trillion and counting — we still got lucky. Had the virus been more transmissible, more virulent or more lethal, the state of the world today would likely be even bleaker. Given that the risk of another pandemic occurring with the same kind of impact as Covid-19 is increasing by 2 percent with each year, that threat still hangs over us. So, are we now prepared for the next Big One?

To be blunt: No.

As with every “Public Health Emergency of International Concern” so far except for the Zika virus, the global Covid response has centered around our best defense: vaccines. And with vaccination, the greatest impact during a pandemic lies with first protecting high-risk groups — those most likely to come into contact with a virus and those most vulnerable — and then increasing coverage to slow the spread of the disease. Yet the current blueprint being mapped out by G-20 leaders for how we should prepare for and respond to future pandemics does not lay out how the poorest countries in the world would get access to vaccines in the next health emergency, nor how high-risk groups would be prioritized.

For more than two decades my organization, Gavi, the Vaccine Alliance, has been on a mission to protect the poorest and most vulnerable children in the world, vaccinating more than an additional billion children so far, and every year providing vaccines for more than half the world’s children. This has led to a 70 percent reduction in vaccine preventable disease deaths. We also support the stockpiles for epidemic vaccines. So, when Covid-19 came along we knew that billions of people could miss out on immunization unless immediate action was taken. This is why we helped create COVAX.

During the Covid pandemic, COVAX was the only initiative that had global equitable access for high-risk groups as its primary operational focus; for hundreds of millions of people most at risk in the poorest countries, this has been the only source of Covid vaccines. Despite facing immense barriers every step of the way, COVAX is the main reason why 75 percent of healthcare workers and 63 percent of older people in lower-income countries are now fully protected, as are on average 50 percent of their populations. So, if we are to stand a chance of being prepared for the next pandemic, then it makes sense to have something like COVAX already in place and funded in advance — particularly before the Big One strikes — to ensure that next time the response is faster and more effective. Yet currently there are no plans for this.

It’s true that global governance frameworks and financing are being drawn up to make sure that countries are better prepared for the next pandemic. But there must also be an operational response on standby, particularly when it comes to vaccines.

With infectious disease, no one is safe until everyone is safe, so the role COVAX has played in ensuring that people everywhere have access to vaccines has been undeniably important. Given that it has delivered 1.7 billion doses and is responsible for 76 percent of Covid vaccines received by low-income countries, this begs the question of how people in these countries will get access to vaccines the next time unless something like COVAX is in place to secure and deliver billions of doses of vaccine to them?

This doesn’t mean we need to create a new pandemic organization or institution. In fact, the reality is that no one organization has all the knowledge, resources or infrastructure needed to achieve this end-to-end approach anyway. The only reason COVAX has been so successful is because it is built around a networked approach that was able to draw upon the strengths of global health organizations that already existed. From its core partners, the Coalition for Epidemic Preparedness Innovations, Gavi, the World Health Organization and UNICEF, to civil society organizations, private sector and ministries of health, each partner pivoted when crisis struck to enable COVAX as a whole to respond quickly, adapting and innovating when needed.

All this is necessary because carrying out vaccine rollouts on the scale we’ve seen with Covid — the largest and most complex global deployment ever — involves far more than just delivering vaccines. It also entails accelerating the development of vaccines, scaling-up manufacturing so larger volumes could be produced, securing doses, negotiating lower prices and putting in place all the logistical pieces needed to deliver vaccines, including the supply chain, cold storage, data systems, surveillance networks and trained health care workers, as well as all the important legal indemnity, liability and compensation safety nets too.

As daunting as that may sound, the point is that now we know it’s possible, and we need to ultimately improve it. Because despite all that it achieved, COVAX could have done better. In the face of vaccine hoarding, export restrictions and a lack of transparency from manufacturers, last year COVAX experienced severe supply constraints which led to delays. Had COVAX existed before the pandemic, rather than being created on the fly, and had at-risk contingency funding already been in place rather than having to be raised in the midst of a global crisis, then it could have responded quicker, secured deals with manufacturers earlier and got larger volumes of doses out to people quicker.

We don’t know what form the next pandemic will take, or whether it will be possible to develop vaccines against it. But what we do know at least is that if we don’t put all this in place now, the response will be slower and less effective. And if the next one is another Big One, it could come at a frightening and devastating cost.