Remarks from Interim CSO Representatives to the Facilitation Council of the ACT-A

Delivered at the 2nd Facilitation Council Meeting on November 3rd 2020

Remarks from Fifa Rahman – CSO Representative (Diagnostics Pillar) – Board Member, NGO Delegation, Unitaid & Carolyn Gomes – CSO Representative (Diagnostics Pillar) Alternate Board Member, Developing Country NGO Board Delegation to the Global Fund

Carolyn Gomes ~ Prepared remarks:

The impacts of this crisis have been and continue to be, devastating economically everywhere but perhaps most acutely in small island economies mostly or wholly dependent on Tourism for their economic growth and development as has been previously mentioned. We fully appreciate that without the tools to control the pandemic the people that we serve and the countries that we live in will slide deeper and deeper into an economic hole that we cannot climb out of, a debt trap that we cannot escape and a human disaster that will bring instability and almost insurmountable challenges for recovery.

Without resources, we won’t be able to achieve the objectives laid out by the ACT-A partnership. Civil Society are willing to engage in efforts to change this prospect, but these efforts have to be conducted in a proactive and engaging way, in the spirit of reciprocity and with a full understanding that we are all in this together, that the pandemic uncontrolled anywhere is the pandemic uncontrolled everywhere.

This is the fundamental driver of civil society engagement with the ACT-A.

At the moment there are two key funding problems – the first is not having enough for the ACT-A as a whole and the second is the imbalance of funding split between the Covax pillar and the other pillars – so much so that, the diagnostic pillar does not have all the funds it needs to pay for the deal it recently brokered Diagnostics combined with effective contact tracing measures have the potential to limit the demand for Therapeutics and give space for vaccination activities and should be seen as critical to the immediate needs and prioritized. Moving forward full transparency in the available and required funds to meet the goals and planned steps in mobilizing resources is needed.

Unfortunately, it has become increasingly clear over the last couple of months that the projected demand for COVID-19 innovations will not be met by expected ACT-A supply.

Behind this supply gap lie a number of unknowns including the Mid to long term health, social and economic consequences of COVID-19 on its survivors/sufferers. Early studies suggest as much as 40% of those who get COVID suffer debilitating recurrent effects for weeks to months after they have had the illness. Countries should be encouraged to fund ACT-A not only to help reduce deaths, but also to decrease morbidity and in the long run to safeguard their citizens and economies.

CSOs are intellectual partners and not only drivers of financing. However, the full involvement and power of civil society advocacy can only be relied upon with certain provisions – namely respect of the role of CS in the health response and inclusion in decision-making and governance. This means them being at the table where decisions are being made and their voices being heard so that they are part of any decision being reached.

Unfortunately, CSOs have had to fight to get representatives in some of the pillars of ACT-A and only last week were representatives finalised for the ACT-Accelerator. This has not helped CS buy-in to the ACT-A. And while we welcome positive news on the advanced market commitments for Covax pillar as highlighted by Andrew Witty earlier – a lack of inclusion of CSOs mean that we have been unable to provide the scrutiny these deals need.

Side-lining Civil Society ignores the strength they have at National, Regional and international levels in all areas of health to impact on awareness raising, decision-making, service delivery and governance. Civil society is already playing an important role conducting advocacy with country governments to get them to commit more resources and engage fully in developing use cases for diagnostics and therapeutics and understand demand. We are not, however, funded to do any of this work on the ACT-Accelerator.

Institutional or multilateral funding to CS to support these activities is needed to support the sustainability and scale of advocacy and engagement activities.

It will be very important, if we are to succeed together in this critical and visionary and economically sensible mission of ACT-A that we see strategic resource mobilisation plans and would urge co-convenors to make plans clear.

In addition a concrete communications strategy and action plan, with measurable objectives and ways to evaluate impact will be needed for effective engagement of all stakeholders at the National, regional and international levels.

We urge the Co-Chairs and all members of this ACT-A Facilitation Council to ensure that our search for solutions involves not only those in this virtual room but the world writ large and that all voices, hearts and minds are brought into the work to ensure accelerated progress, equity and access. Our children’s future, indeed the future of Dr Tedros’ granddaughter, the world’s recovery demands no less of us.

Fifa Rahman ~ Prepared Remarks:

Thank you Chair. I have a couple of additional points to what my colleague Carolyn has said; we as NGOs fear that the focus on funding means that we are ignoring key policy challenges. While it is true that we have a shortfall of funding on the ACT-Accelerator, we have to acknowledge that there is a massive manufacturing and supply gap to LMICs. For diagnostics, for example, 120 million antigen rapid diagnostic tests are only a part of actual need and manufacturing capacity of the two companies providing antigen RDTs.

It was a privilege to hear the words of Sabin Nsanzimana from Rwanda about how critically important diagnostics have been in the response there – and the fact that they have managed to limit deaths. And yet we continue to see constrained funding towards the Diagnostics pillar of the ACT-A.


For these products to be globally scalable, we need to maximise all the tools available to us – we need to share technology and enable technology transfer to manufacturers in the Global South. The C-TAP or COVID technology access pool seems paralysed by a lack of political support from research institutions and pharmaceutical companies. If resources remain severely constrained, we will need to shift priorities. The volume guarantee approach will not work long term if resources are not drastically increased – and in such a situation, suppliers and innovators should openly licence to qualified producers. Tech transfer to LMICs is the only way to scale up production to the levels needed and to beat this pandemic.

We call upon Member States to insist that deals under the ACT-Accelerator include tech transfer provisions and increase scrutiny on manufacturing capacity and actual need of treatments, diagnostics, and vaccines in their countries.


We express disappointment that a number of countries have expressed opposition to the COVID patent waiver proposed by India and South Africa. In the past, those who have opposed overriding patents often use the excuse that TRIPS flexibilities should only be used in emergencies. The question is – what is the excuse now? What larger emergency is there than this global COVID-19 pandemic, which in turn is causing a global economic emergency? A patent waiver benefits us all – even high income countries that are opposing this.

We think it’s important to remind Member States that the alternative to the patent waiver is approaching each COVID technology with a compulsory or voluntary licensing approach – this is a time-consuming approach that is at odds with the need for us to prevent mortality and reopen economies in this pandemic. This approach ignores the financial and power disparities that exist between countries in access to health technologies – and if we don’t waive these patents, at least temporarily, we will continue to see reduced access for LMICs compared to wealthier nations.

Political leaders at the start of this pandemic spoke at length about these technologies being ‘global public goods’ and underlining that the ACT-Accelerator was about solidarity. True solidarity within this Accelerator cannot occur without eliminating these important policy and political barriers.

Thank you.