2022-10-27-世界卫生组织-Addendum_to_the_ACT-Accelerator_Transition_Plan_1_Oct_2022_to_31_Mar_2023_14页_604kb

ACT-A Transition Plan Addendum (Oct 2022 – Mar 2023): Key Learnings for Strengthening Global Health Architecture

Overview

This document provides perspectives from ACT-A Pillars (Vaccines, Diagnostics, Therapeutics), the ACT-A CSO Platform, and Industry Partners to inform discussions on improving global health architecture for pandemic preparedness and response.

Key Insights from ACT-A Pillars

Vaccines (COVAX)

• Equitable Access: Requires end-to-end solutions centered on public health needs, with risk-sharing mechanisms and pre-pandemic preparedness.
• Challenges: Hoarding, export restrictions, and nationalism hampered equitable distribution. Strategies must prioritize lower-income countries proportionally.
• Recommendations:
  • Institute flexible funding models and clarify risk-sharing frameworks.
  • Strengthen COVAX as a central coordinating mechanism for diagnostics, therapeutics, and vaccines.
  • Ensure sufficient volumes and affordability for low/middle-income countries (LMICs).

Diagnostics

• Critical Roles:
  • Test-to-Treat: Essential for effective pandemic response; integrate with clinical care pathways.
  • Local Manufacturing: Expand diagnostic capacity in LMICs to reduce dependency on high-income countries.
  • NGS Capacity: Strengthen sequencing for pathogen identification and surveillance.
• Challenges:
  • Prior pandemics lacked robust diagnostic tools; underinvestment limited responses.
  • Bottlenecks include high-cost tests, regulatory delays, and poor community engagement.
• Recommendations:
  • Co-develop diagnostics with LMIC stakeholders.
  • Invest in community-based systems and workforce training.
  • Support digital tools and multi-pathogen testing.

Therapeutics

• Equitable Access: Treat therapeutics as global public goods; overcome supply chain and pricing barriers.
• Key Actions:
  • Leverage advance market commitments (AMCs) and voluntary licensing.
  • Develop repurposing of existing drugs to address urgent needs.
• Challenges:
  • Uneven focus on vaccines over diagnostics/therapeutics during early pandemic phases.
  • Insufficient commitment to test-to-treat strategies.
• Recommendations:
  • Prioritize early industry coordination platforms (e.g., C-TAP).
  • Ensure continuity in R&D and production for LMICs.

Health Systems & Response

• Strengthen primary healthcare systems, community engagement, and workforce capacity.
• Avoid verticalization; integrate medical countermeasures into routine health systems.

CSO Platform Perspectives

• Civil Society Engagement:
  • Civil society representation was limited in early decision-making processes.
  • Recommendation: Institutionalize civil society in governance structures (e.g., country-level coordination teams).
• Health Systems & Equity:
  • Prioritize community-led responses and address systemic inequalities.
  • Advocate for sustained funding for CSO platforms during transitions.

Industry Partner Insights

• Coordination & Transparency:
  • Industry participation in ACT-A was restricted, limiting impact on equitable access.
  • Recommendation: Create a formal industry coordination platform to address challenges like repurposing and supply mapping.
• Capacity Building:
  • Generic/affordable medicines viable but require harmonizing regulatory pathways.
  • Support developing-country vaccine manufacturing networks (e.g., DCVMN).
• Funding:
  • Advance purchase commitments and innovative financing mechanisms are critical for equitable distribution.

Conclusion

To improve global pandemic preparedness, policymakers must:

1. Prioritize equity: Ensure tools reach all countries through end-to-end public health solutions.
2. Strengthen systems: Invest in diagnostics, therapeutics, and health infrastructure in LMICs.
3. Enhance coordination: Foster collaboration between governments, civil society, industry, and health systems actors.
4. Maintain agility: Build adaptive frameworks for real-time response and financing.

ACT-A should be transitioned strategically, with mechanisms for rapid reactivation during future emergencies.