World Health Organization (WHO) Response to the External Evaluation of the Accelerator for the Access to the COVID-19 Disease Tool (ACT-A)

WHO appreciates the wide range of views on the ACT-Accelerator (ACT-A) deployment, operations and results that were captured in the external evaluation commissioned by the ACT-A Implementation Council. Of particular value in this report are the perspectives expressed by the many countries in Africa, South America and Asia that have used ACT-A processes and services during the pandemic, but whose voices have not always been heard in such reviews.

While acknowledging the limitations noted by the authors and other commentators, this report provides important perspectives that contribute to the growing body of evaluations, reports, reviews, and recommendations that aim to inform the establishment of a stronger countermeasures platform. Together, this work will help shape efforts to build on the experience of ACT-A and other instruments and initiatives (eg, the Pandemic Influenza Preparedness Framework (PIP), the ‘100-Day Mission’) so that the world can rely on a more robust platform for accelerating development and equitable distribution and delivery of countermeasures in future pandemics.

Of particular note in this report is the strong, majority view of survey respondents that the innovative and collaborative ACT-A arrangement is the right approach to accelerate access to countermeasures for COVID-19 at a time when the global community needed to act quickly and decisively to combat the poorly understood threats. The report also documents important results achieved through ACT-A’s approach, including the unprecedented speed of its key agencies in delivering vaccines and diagnostics to the lowest-income countries, compared to previous pandemics, and in launching key market interventions that have significantly reduced prices and improved access diagnostics, oxygen and antiviral drugs at a critical moment. The counterfactual is that in the absence of ACT-A, equality in access to countermeasures would be much worse.

WHO agrees with the challenges identified in the areas of Health Systems Connector (versus HSRC) and quality assurance of rapid diagnostics. As for the former, this lesson was learned and corrected during ACT-A, with the Connector being significantly reworked and relaunched in 2021 (a point not fully covered in the report). Addressing gaps in WHO’s capacity to assess the very high volume of diagnostic submissions during a pandemic was inherently more challenging and signals a vital need for additional funding and staffing for this area, adaptations of assessment processes for emergency situations, and greater support from partner agencies.

The report also reinforces previously identified deficiencies in ACT-A’s operating model that were largely the result of the urgency and speed with which ACT-A had to be established.

These findings support the existing consensus on the vital need to ensure that the future countermeasures platform is more inclusive, has greater transparency in its work and establishes strong mechanisms for collective accountability. In particular, the report highlights the need to fully review and rework key processes with low- and lower-middle-income countries to ensure their full and meaningful engagement. An important omission in this evaluation is an assessment of the role and influence of industry in ACT-A through its participation in the Facilitation Council, the Principals Group and some pillars, and the extent to which this facilitated or did not facilitate the coalition’s main goal of ensuring equal access to vaccines, tests and treatments in real time.

However, in formulating other recommendations on the way forward, the report appears to have based some important conclusions on incomplete information or a misunderstanding of key aspects of ACT-A cooperation. This appears to be the case in areas such as the way product volume targets were set, the original ambition for the COVAX drive, the nature of the COVID-19 Vaccine Delivery Platform (CoVDP) and how it works, and the key role of individual ACTs . -Agencies in resource mobilization. Most importantly, and contrary to the data presented, the report may inadvertently lead readers to conclude that creating a more robust countermeasures platform is best achieved by starting from scratch, rather than building on the significant, documented strengths of ACT-A collaboration and its three pillars of products. The framing of the important survey question(s) may have contributed to this perspective. From a pragmatic perspective, it would seem more useful to use and build on the considerable experience that international health agencies and partners have gained through their work in ACT-A, while also addressing the shortcomings of this model.

Notwithstanding these issues, the perspectives contained in this report strongly emphasize the need for an inclusive, robust process involving countries, relevant international health agencies and organizations, civil society and community organizations, donors, industry and other stakeholders, in co-creating a countermeasures platform that is based on the principles of speed and equality. This process will need to build on all such reviews and experiences to optimize upstream operations (eg R&D, market shaping), downstream work (eg procurement, delivery), collective responsibility and funding. WHO will initiate such a process with partners and stakeholders urgently, because, as the evaluation report reiterates, it cannot wait for the next pandemic.

WHO is deeply grateful for the outstanding role that Norway and South Africa have played in co-chairing the ACT-A Assistance Council during these turbulent times, and for commissioning this external evaluation, which is an important contribution to our joint efforts to build a safer, more just world, together.