How a New Gates Commitment Aims to Ensure Affordable COVID-19 Vaccines Worldwide

One of these days, and hopefully soon, one or more of the several COVID-19 vaccines under development will be proven effective and safe. But along with the key medical question surrounding vaccine development—does it prevent sickness?—there’s an important question of equity at play. In other words, if and when a vaccine passes muster, will it be available to all, globally? Or will people in rich countries get it and start pulling their lives and economies back together while billions of people in poorer nations around the globe continue to wait and suffer?

This is not only a question of compassion and equity, but of practicality. To shut down an easily transmitted disease like COVID-19 in a lasting way via vaccine, it has to be stopped everywhere. Ensuring availability of COVID-19 vaccines globally is the goal of an initiative called COVAX, a collaboration of Gavi (a public-private partnership that promotes access to vaccines for people in poorer countries), the World Health Organization and the Coalition for Epidemic Preparedness and Innovation. (Some 80 countries support COVAX. The U.S. is not one of them.)

As we’ve written previously, the Bill & Melinda Gates Foundation has been championing vaccine research and access globally for years before the coronavirus pandemic, focusing on malaria and tuberculosis, as well as funding research to develop new vaccines for syphilis and dengue fever. COVID-19, with its fast global spread, is just the foundation’s latest and perhaps most universal vaccine concern.

Now, with several vaccine hopefuls in the pipeline, the Gates Foundation has committed $150 million to support a partnership between Gavi and the Serum Institute of India, the world's largest vaccine manufacturer. Their goal is to manufacture and deliver up to 100 million doses of COVID-19 vaccines for use in India and other low- and middle-income countries. The money is coming out of the Gates Foundation’s Strategic Investment Fund, which makes grants to stimulate private-sector-driven innovation, encourage market-driven efficiencies, and attract external capital to priority initiatives.

The money will enable Serum Institute of India to ramp up capacity in anticipation of successful testing and regulatory approval of a vaccine or vaccines. Their goal is to produce doses for large-scale distribution as early as the first half of 2021; the partnership will fund candidate vaccines under development by AstraZeneca and Novavax at no more than $3 per dose. In fact, the company is set to begin testing the AstraZeneca vaccine in human trials.

The Gates Foundation reacted early and deliberately to the coronavirus threat, and this funding for the vaccine partnership is the latest in a string of COVID-19 grants. Prior to the newly announced investment in Gavi and Serum Institute of India, the foundation had committed more than $350 million, including $100 million for vaccines in lower-income countries in Africa and elsewhere. Also, early money included $250 million for detection, isolation and treatment in Africa and South Asia, as well as the development of drugs and vaccines.

Gates, of course, is funding several other vaccine efforts and working on many fronts. In 2017, the organization co-founded the Coalition for Epidemic Preparedness Innovation, along with the Wellcome Trust and the governments of Norway and India. Even before that, in 2015, it invested $40 million backing German biotech CureVac. That company recently received approval from the nations of Germany and Belgium to begin clinical trials of one of its potential COVID-19 vaccines.

More recently, the foundation granted $3.4 million to Dynavax Technologies Corporation, a California-based biopharma company, to ramp up capacity for the company’s CpG 1018 advanced adjuvant. Adjuvants are added to vaccines to produce more antibodies and longer-lasting immunity. This also minimizes the dose required, enabling the production of more doses of the vaccine.

The ability to manufacture billions of vaccine doses might be even more critical than you think. Not all vaccines are one-and-done, and Gates has said in news reports that none of the vaccines currently in focus look like they’ll do the trick with a single dose. If people need multiple shots of a COVID-19 vaccine to develop immune protection, the world may need more than 7 billion vaccines to be administered globally.