Several experimental vaccines for Covid-19 are in final-stage clinical trials and early results from two of them have established safety levels and immune response. With vaccines expected to be ready by early 2021, the World Health Organization (WHO) recently launched the COVAX Facility as a mechanism to guarantee rapid, fair, and equitable access to countries to a broad portfolio of vaccines and manufacturers to a demand-secure market. Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, spoke to Sanchita Sharma about the facility and how it aims to deliver two billion doses by 2021-end to prioritised population groups. Edited excerpts:

When is the earliest the world can expect a Covid-19 vaccine to be ready?

There are promising results from the clinical trials for some vaccine candidates, which is very encouraging. However, we need to wait for the completion of the trials and their outcomes to be in a better position to understand by when the vaccines will be ready. It is important the potential vaccines meet the recommended mandatory standards of efficacy and safety before they are used for mass vaccination.

WHO is working globally with partners to accelerate research and development of a safe and effective vaccine and ensure equitable access for the billions of people who will need it. But even with an accelerated process, the development and production of a vaccine will take time. We must continue to accelerate vaccine research while doing more with the tools we have.

How will WHO ensure equitable access to vaccines, especially in low- and middle-income countries?

WHO is committed to and will continue to advocate countries to ensure that as medicines and vaccines are developed, they are shared equitably with all countries and people. In April 2020, a global collaboration of governments, global health organisations, civil society groups, businesses, and philanthropies came together to form the Access to Covid-19 Tools Accelerator, or the ACT-Accelerator. The idea is to form a plan for an equitable response to the Covid-19 pandemic. There are four pillars under the ACT-Accelerator, of which vaccines are one.

COVAX Facility has been established recently under the vaccine pillar of the ACT-Accelerator to manage the large, diverse portfolio of Covid-19 vaccines that are under development to ensure a global sharing of risks, associated with the development of Covid-19 vaccines and equitable access based on a fair allocation of the available vaccines. The facility is a mechanism designed to guarantee rapid, fair, and equitable access to Covid-19 vaccines worldwide. By connecting a pool of demand to a pool of supply, it will allow countries access to a broad portfolio of Covid-19 vaccines and provide manufacturers access to a demand-secure market.

All countries have been invited to participate, and those that will are expected to receive access to vaccines procured by the facility at the negotiated price. The facility aims to deliver two billion doses by the end of 2021 to prioritised population groups in all participating countries.

What will be India’s role in vaccine development?

India is among the largest vaccine manufacturers and is rightly called the world’s pharmacy. It is also home to many research institutes and experts. Undoubtedly, they would play an important role in making the Covid-19 vaccines available globally.

WHO convened a meeting of vaccine manufacturers from South-East Asia Region on April 29 to get a landscape of the development and manufacture of potential Covid-19 vaccines. Twelve vaccine manufacturers from India, Indonesia, and Thailand participated in the meeting and shared their collaborations with vaccine developers, platforms likely to be used by them to develop the vaccines, potential timelines, and capacities for vaccine production.

Once available, how should vaccines be deployed?

WHO is working with member states, partners, and stakeholders to develop an allocation framework, which is expected to help countries prioritise populations at risk so that the available vaccines are provided to these priority populations first and then expanded to other populations in all countries. The aim is to ensure an equitable and fair allocation of the available vaccines across all countries. This addresses the issue of who would have priority in accessing the vaccine first, such as health care workers, essential workers, and other vulnerable populations, and how groups could be progressively prioritised as more doses become available.

What does early data show on the quality of protection? Are people likely to need a booster dose?

There are 23 vaccines in clinical trials. We expect more to follow as there are at least 160 candidate vaccines. We are engaging with vaccine developers and others to ensure that we have standard endpoints and data collection mechanisms to regularly monitor both the efficacy and safety of the candidates. These trials, once completed, will help to understand better the extent and duration of protection.

Different vaccines are being developed using different technologies and platforms and are likely to have different efficacies, product profiles, and characteristics. This robust vaccine pipeline gives us hope, even if there many unpredictable factors that will determine their success.

Should everyone be vaccinated, including children?

Equitable distribution of a safe and efficacious vaccine is one of WHO’s priorities. We will continue to advocate with member countries and work with them, providing guidelines and updated information on the population at risk and those who should be vaccinated on a priority.