BackCovid-19 anywhere is covid-19 everywhere: Mark Suzman
The CEO of Bill & Melinda Gates Foundation says making sure the covid-19 vaccine reaches everyone is not just an argument for fairness but it’s fundamental to stopping covid-19 in its tracks.
PremiumBill & Melinda Gates Foundation is partnering with various government departments and vaccine manufacturers in India for the country’s covid-19 vaccine development efforts. Mark Suzman, CEO of the Bill & Melinda Gates Foundation, talked about the pandemic situation in India, country’s strengths in tackling covid-19, timelines for a vaccine and its availability in and for Indians. Edited excerpts from an interview:
Tell us about the foundation’s contribution towards covid-19 vaccines? Please give details related to India.
The only way that we will consign covid-19 to the history books is with a vaccine. Our foundation is supporting efforts through the Coalition for Epidemic Preparedness Innovations, or CEPI. Like our foundation, India is a founding partner of CEPI, which was created in 2017 in response to the ebola crisis to dramatically reduce the time it takes to develop vaccines for emerging epidemics, and ensure they are accessible, available, and affordable. The speed with which companies have begun working on vaccines for covid-19 is a result, in part, of CEPI, and there are now nine covid-19 vaccine candidates in CEPI’s portfolio. Success, however, depends on billions of dollars of additional funding to see successful ones through development and manufacturing.
Today, there are 30 potential vaccines in the pipelines of Indian companies, with several of the most promising backed by government funding. Our foundation is partnering with the department of biotechnology, the Indian Council of Medical Research, NITI Aayog, and the office of the principal scientific adviser to provide insights from our global R&D work that might inform India’s vaccine development efforts. We’ve also collaborated with the Serum Institute (of India; SII) to facilitate covid-19 vaccine production—where the foundation will provide $150 million through Gavi, the Vaccine Alliance for SII to manufacture up to 100 million early doses of covid-19 vaccines for India and low- and middle-income countries. Our foundation is also working with Indian pharma companies to look at the potential of transferring production techniques for drugs created by US pharmaceutical companies to Indian plants for manufacturing and global supply.
When do you think the world will have a covid-19 vaccine? How do you think the price of a vaccine, or vaccines, may be reduced so it can be made equitably available for all?
The covid-19 crisis has transformed timelines for scientific innovation. It used to be that vaccine development was measured in years, or more typically decades. Now, we are talking about a covid-19 vaccine potentially being available in 2021. It’s even possible that with a bit of luck, an initial vaccine might come sooner. Even so, it won’t be perfect in terms of its effectiveness against preventing sickness and transmission, and it may not be that long lasting.
Every person on the planet shares this crisis. And we need to share solutions to it too. Making sure vaccines reaches everyone who needs them is not just an argument for fairness, it’s fundamental to stopping covid-19 in its tracks. Modelling shows that if the first two billion doses of vaccine go to rich countries instead of all countries equitably, twice as many people could die.
The first building block to ensure an equitable response came with the launch of the Access to COVID-19 Tools Accelerator (ACT-A) in April. The main partners in ACT-A’s vaccine strategy—CEPI and Gavi—were built to solve problems like the one the world now faces. That is why our foundation supports ACT-A, and why we urge others, including India, to join this collaboration.
Do you think India, being the world’s second most populous country, will be able to provide covid-19 vaccines sufficiently to its people?
Yes. The great genius of India’s scientists, inventors, and engineers; capacity of its drugs and vaccines manufacturers; ability to meet the highest safety standards for medicines; and culture of collaboration put it in a great position to help get the world out of this pandemic.
India is already a significant player in global health research and development. Thanks to vaccines developed by Indian companies, including our partners, Serum Institute, BioE, and Bharat Biotech, fewer children around the world are dying from diseases such as measles, pneumonia and rotavirus.
This expertise gives India’s vaccine industry a significant advantage in developing cost-effective, quality-assured vaccines as it turns its attention to covid-19. And with an ability to not only develop vaccines and medicines but a proven track record to manufacture them to a high standard, in high volumes and at low cost, India is critical to saving millions of lives at home and in the world’s poorest countries.
What are your thoughts about vaccine nationalism?
This is a global crisis that demands a global response, because covid-19 anywhere is covid-19 everywhere. And, quite frankly, the challenges posed by this pandemic are just too immense for any one country to simply think it can go it alone. Any attempts by one country to protect itself while neglecting other countries will fail. The world must come together to end the pandemic and resume progress toward meeting the SDGs.
How do you see the pandemic impacting the health sector in India? How has the pandemic halted progress toward the Sustainable Development Goals (SDGs)?
Put starkly, covid-19 has stopped more than 20 years of progress in its tracks. Already in 2020, the pandemic has pushed almost 40 million people into such grinding poverty that they have to struggle every single day just to stay alive. Child immunization rates, which had reached 84% globally, are now back to 1990s levels—wiping out 25 years of progress in 25 weeks.
The pandemic’s devastating impact is laid bare in the Gates Foundation’s Goalkeepers Report, released this week. Published annually, the Goalkeepers Report tracks 18 indicators included in the SDGs. In recent years, the world has improved on every single one. This year, on the vast majority, it has regressed.
Like every other country, India can’t escape the catastrophic ripple effects of the pandemic. Health systems, economic systems, educational systems, and food systems cannot be rebuilt—let alone improved—until the virus tearing them down is under control. But given that India has shown such encouraging trends in health and development in recent years, I’m confident that the government will do its utmost to make up any ground lost.
How do you think the slowed progress in health and development is going to affect India in the long term? Do you think the pandemic will affect the country’s position in the world in health-based rankings?
The pandemic is the greatest setback in global health and development in 75 years. And its impact is especially severe in low- and middle-income countries, which are less able to weather the storm. India is no exception, of course. There is little hard data right now to assess the full extent of the pandemic on health and development, and the situation is changing rapidly all the time.
What evidence we do have suggests that worldwide there will be increases in the number of mothers, new-borns, and children under the age of five dying because of the indirect effects of the pandemic. There are also estimates that, globally, cases of malaria and tuberculosis are up by about 6%, and HIV by 2-3%.
That said, and while it feels very grim right now, I am convinced from everything I know from working with India over the last 15 years, that it has the vision and the capacity to put itself firmly on the road to recovery.
As India’s expenditure on healthcare is minimal, do you think that the covid-19 pandemic will further hit the economic situation of the country in terms of health budgets? How closely dependent is healthcare on the economic situation for a country like India? How has less funding for health affected the country so far?
As with every country right now, one of the most important post-covid questions for India today is: What will it take to trigger rapid economic growth in the years and decades to come? The answer is complex, of course. But one thing for sure is that economic recovery and resurgence will take significant investments in health and education, or what economists call human capital. Human capital has always been important. And, as India charts its course for the future, the productivity and skill level of its workforce will be even more critical. Healthy, thriving people build healthy, thriving economies, so any investment in better health for every Indian should be seen as an investment in India’s future.
How is covid-19 further widening the long-standing crisis of inequality in India? How has it impacted women, children, and the socially and economically vulnerable population?
As this year’s Goalkeepers Report makes clear, this pandemic has followed the grim predictability of others, by exacerbating all the existing inequalities that already blight our world—whether that’s race, class, wealth, or gender. Indeed, as Melinda Gates has pointed out, although more men are dying of covid-19 itself, the broader impacts of this crisis threaten to disproportionately affect women’s lives and livelihoods.
With basic healthcare services disrupted as doctors and nurses are reassigned to covid-19 cases, and hospitals themselves overburdened, many pregnant women can’t get the care they need before, during, and after childbirth. That puts them in great danger at a time which should be one of great joy. Around the world, women are also nearly twice as likely to lose their jobs in this recession. And in low- and middle-income countries, like India, women work overwhelmingly in the informal sector, which tends to operate in now inaccessible spaces, such as people’s homes and public markets, and provides less access to government support.
India has recently launched the National Digital Health Mission. What strengths and weaknesses do you see in this mission? How do you assess India to be able to make it successful when internet penetration is low, especially in rural areas, and majority of hospitals are devoid of digital technology?
India has made significant efforts promoting an inclusive financial system, and the use of digital technology to deliver social welfare programmes, and other government services that can help people lift themselves out of poverty. With such an impressive track record, there is no reason why the digital health mission can’t do the same for health. Especially in the wake of the covid-19 crisis, healthcare systems will need to be more resilient and more efficient than ever. Providing everyone with a unique health ID, digitizing health records, and creating so-called Digi Doctors is a great step towards making healthcare services more effective in India—and, importantly, opening them up to more citizens, especially the poorest and most marginalized.
How do you see the covid-19 pandemic evolving and how will it change the world in the long term?
I was last in India in November 2019. Back then, my meetings were about subjects like financial services, rural poverty, and philanthropy. No one even mentioned the word “pandemic". Understandably, there is now talk of little else. This experience of how things changed so significantly, so rapidly, and on such a dramatic scale stands as a stark warning. The single biggest lesson from this pandemic is the enormous human, social, and economic cost of being unprepared. The good news is that if we learn this lesson, efforts now directed at stopping covid-19 can—with the on-going investment and support in the right tools, strategies, and institutions—leave us better-placed to respond to future pandemics.
We’ve also learned how closely we are all connected in this pandemic. Our response must be, too. No matter how good any individual place is at testing, contact tracing, and quarantining, a person who has no idea they are contagious can still get on an airplane and be in another place in a few hours. These shocks deepen the economic crisis too. In this century of sophisticated interconnections, no country’s economy can be fully healthy if the global economy is sick. It is impossible to inoculate a national economy against a global economic catastrophe.
We have our work cut out for us in the years to come. We need a strong coalition of businesses, governments, development banks, and philanthropic organizations like ours to come together to mount a global response equal to the global challenge. If we do, then I believe we will see the benefits of global collaboration expanded to fight other challenges around disease, poverty, and inequality for decades to come. Then, we will have created a world where every person has the opportunity to live a healthy, productive life.
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