Without cash, the chance to ensure fair access to COVID-19 treatments for all is disappearing fast. $4 billion needs to arrive in the next two months.

COVID-19 testing in Madagascar. Credit: World Bank / Henitsoa Rafalia.

As many countries around the world are now experiencing the predicted second wave of COVID-19, their populations could be forgiven for experiencing a sense of déjà-vu. But there is one clear difference this time. As we approach the end of 2020, we know so much more about the medicines, diagnostic tests and vaccines that will help us bring an end to this pandemic.

For example, we’ve seen that repurposed drugs such as dexamethasone can save the lives of ventilated patients. And just last month, we saw the game-changing launch of new Rapid Diagnostic Tests that give results in just fifteen minutes. Clinical trials of innovations such as monoclonal antibodies are showing promising results.

At this moment in time, wealthier nations are making deals to reserve drugs, vaccines and tests that they hope will allow their populations to get back to normality and reduce the death toll from COVID-19.

This response is understandable. But the current trajectory risks leaving countries with limited purchasing power crowded out at the back of a growing queue.

The Access to COVID Tools Accelerator (ACT-A) is a global, collaborative effort which was set up to ensure that the solutions to ending this pandemic reach every corner of the world, with the key principle that “no one is safe until everyone is”. Investment in equitable access to COVID-19 tools should not be seen by wealthy nations as a charitable donation, but rather an essential investment to ensure that their populations – as well as others – are protected.

To provide treatments around the world we need $7.2 billion. So far, only $300 million has been pledged – with vaccines already having received around six times more funding than treatments.

It is imperative to recognise that a vaccine, if and when it comes, will not be a panacea. It will take months and maybe years to roll out across the globe and the initial programme may not be completely effective. This means that people will continue to fall ill and will continue to need rapid diagnosis and appropriate treatment.

We cannot put all our eggs into this one vaccine basket. We need a three-pronged end-to-end strategy that works to: identify cases through rapid testing; treat COVID-19 more effectively with ever-evolving medicines; and vaccinate populations against future infections.

By the end of the year, we will have a clear idea of which treatments work, and how and where they can be used. But the simple fact is that we are running out of time.

Our fear is that when a ground-breaking new medicine or test emerges, we will simply not have the funds to make sure that everyone has access. Wealthy nations have already placed their orders with manufacturers across the world. We need to do the same on behalf of low-and-middle countries now – if we wait even until the start of 2021, it will be too late.

Last month, G20 Health and Finance Ministers gave their strong support to ACT-A. They emphasised the need for a global response and the important role the partnership plays in “accelerating research, development, manufacturing and distribution of COVID-19 diagnostics, therapeutics and vaccines”. They encouraged countries to make voluntary contributions to the ACT-A facility – and some have already done so.

European Commission President Ursula von der Leyen recently referenced in her State of the Union address the €16 billion ($18.7 billion) raised through an EU-led mobilisation effort earlier this year. But despite the impressive pledges made at this event, the funds have simply not been forthcoming. Plenty of warm words have been expressed by leaders from all corners of the globe. But these need to now turn into concrete action and money – and soon.

As leaders of the ACT-A Therapeutics partnership, we are very concerned about the significant shortfall that is emerging, particularly for COVID treatments. $4 billion of the required $7.2 billion total needs to arrive in the next two months.

Without cash on the table, the chance to ensure fair access for all is disappearing fast. The economic outlook is bleak for all nations, but leaders cannot afford to put off financing these vital measures. To do so would result in catastrophic consequences for whole populations, prolonging the pandemic and the economic havoc it has wreaked.

This crisis needs a moment of historic political and financial leadership. No leader can tell their populations that they are protected while other nations are left exposed.

The time for warm words is over. The time for action is now.