“Taking part in this global effort is in Switzerland's direct interest”

First, a brief summary: the Access to COVID-19 Tools (ACT-A) Accelerator was launched last year by the G20 countries and the European Commission. The aim of this initiative is to develop vaccines, medicines and tests, and to strengthen healthcare systems worldwide. The Federal Council has thrown its support behind ACT-A by earmarking CHF 300 million in assistance for developing countries. What is Switzerland's contribution to this initiative? What are Switzerland's interests? Christian Frutiger shares his thoughts on these questions.

What are the main challenges faced by low- and middle-income countries in managing the COVID pandemic?

According to official data, high-income countries are disproportionately affected by COVID-19. But are we really to believe that there are as many positive cases in Germany – some 3.3 million – as in all of Africa? The explanation is obvious: many countries of the South are simply unable to systematically track case numbers. They have fallen short of the recommended level of testing because their health systems, beset by structural deficiencies, have been overwhelmed by the public health shock.

This observation about SARS-CoV-2 testing also applies to prevention (vaccination) campaigns and treatment (therapeutics). In order to vaccinate people and provide them with medicines, you need a solid infrastructure, sufficient resources and trained, available caregivers with the requisite equipment.

Significant funding is also important in the fight against the pandemic. Coming up with effective medical products requires research and development, and then manufacturing, purchasing and distribution capacity. This is beyond the scope of individual countries – especially low-income countries with limited financial means and methods.

Why did the SDC, Switzerland's international cooperation agency, join the global ACT-A initiative?

First of all, the COVID-19 pandemic is a true global public health crisis and we wanted to take action. The ACT-A initiative is a remarkable and unprecedented collective response to this type of challenge. It was designed with the specific conditions of countries of the South in mind in order to ensure our efforts in combating the pandemic are most effective.

More broadly, the SDC has supported various public and private partners for more than 20 years in the research and development of new diagnostic tools and medicines. Geneva plays host to many leading actors in global health, and Switzerland boasts a network of research institutes and private firms – such as pharmaceutical companies – engaged in medical R&D. Switzerland is sharing this comparative advantage through its international cooperation.

As Dr Tedros Ghebreyesus, Director-General of the WHO, has reminded us regularly since the crisis began: “No one is safe until everyone is safe”. Even if we apply the most advanced monitoring policies in a given country or region and drastically reduce the prevalence of the virus, the virus will find its way back if it continues to spread among neighbouring countries and elsewhere. Taking part in this global effort is therefore in Switzerland's direct interest.

The Federal Council allocated CHF 300 million to ACT-A. What are Switzerland's priorities?

Switzerland's contribution to ACT-A is part of our country's broader international cooperation response. The SDC is taking a holistic – rather than a strictly biomedical – approach to the crisis. We are active in the areas of water, sanitation and hygiene, health security, jobs, migration and education, making humanitarian financial commitments at the bilateral and global levels. Our country is harnessing all of its international cooperation instruments to maximise both leverage and synergies. For example, when we're involved in negotiating and monitoring complex resolutions on equitable access to vaccines in UN forums, we bring our first-hand observations to bear. Conversely, our efforts at global and regional level facilitate the delivery and administration of vaccines in individual countries.

The CHF 300 million approved by the Federal Council will cover Switzerland's entire range of contributions to the work done by ACT-A. These funds are being invested in various partners at the operational level.

Switzerland's priorities are as follows: to ensure equitable access to vaccines, diagnostics and treatments; to encourage knowledge-sharing between North and South; and to push for an expansion in production capacities in countries of the South. ACT-A is working on these issues, and we have our say in its governing bodies.

How is ACT-A organised?

ACT-A's stakeholders – the WHO, FIND, the Global Fund, the IOM, the IFRC and UNICEF – are among the SDC's long-standing partners, and most of them are based in Geneva. The ACT-A initiative is built on four pillars: diagnostics, vaccines, treatments and health system strengthening. By working towards the same goals in these four areas, we can hope to bring the pandemic to an end. One or two leading global health institutions or foundations take the lead on each of these pillars. They all updated their mandates and operational processes in record time in order to meet the challenges raised by the COVID pandemic. When it comes to strengthening health systems, Switzerland endeavours to incorporate issues of global health security and pandemic preparedness and response into its approach through the global political dialogue.

You are the chairman of the donors council for the diagnostics pillar. What does your work consist of? What do you promote in particular?

I was asked to accept this role by the FIND team, which co-leads the diagnostics pillar, and other donors. The donors council meets every three months, bringing together the countries and institutions that contribute to it. The FIND team delivers a progress report on the development of new tests and consults with us on strategy alternatives. My role is to ensure continuity between our partners' interests and our shared objectives. We also work together to identify potential synergies with other actors, and we're involved in global advocacy for rapid tests.

What do you consider the main challenges facing ACT-A?

ACT-A has already scored a major achievement, as it is driving the research and development behind new diagnostics, treatments and vaccines. It's been just over a year, and we now have effective products for combating SARS-CoV-2. For the coming months and years, I see two main challenges. First, we need to ensure the supply of products keeps up with global demand. Vaccine production capacities are clearly lacking at this point. The current surge in cases of COVID-19 in India underscores the need to quickly and drastically ramp up the production of vaccines, diagnostics and therapeutics.  

The second challenge is on the demand side. In a number of countries of the South, we have observed some reluctance among citizens and public health authorities to undergo rapid tests and get vaccinated. A large-scale and transparent awareness campaign is needed to explain the benefits of these products. The aim is to increase the level of trust and win over as many people as possible.

What else can we expect from ACT-A this year?

ACT-A has four priorities in 2021:

1. Quickly expand distribution of at least two billion doses of vaccine to the most high risk and highly exposed people around the world
2. Strengthen its R&D programme, improve product evaluation and streamline regulatory approval for new tests, treatments and vaccines, in part to keep pace with variants of the virus
3. Encourage low-income countries to quickly and effectively adopt and use COVID-19 tests, treatments and protective equipment
4. Ensure low-income countries are supplied with the tests, treatments and protective equipment needed to ensure widespread access for their residents and to safeguard their countries' basic health infrastructure.

These objectives are ambitious but, we believe, attainable if all public and private actors, as well as research centres and institutions around the world, work together.