Dr. David Nabarro:

I am here as the WHO envoy. There is a requirement as we go into the evidence process for me to state that, although this is a formal meeting of the committee, my representation of the WHO has to be seen as informal. It cannot be, we respectfully suggest, an alternative to the formal governance process of the WHO through the UN World Health Assembly or other similar mechanisms.

I wish to start by acknowledging the incredible work being done by Dr. Kieran Harkin, Dr. Aisling McMahon and Ms Winnie Byanyima. I may have got the order wrong but that was the order I was given. What the committee has been hearing this morning is really important. I was proud to be able to join and hear Dr. McMahon and Ms Winnie Byanyima talking and explaining their points of view, and I am pleased indeed to be here.

I want to talk about three things. The first is Covid-19 and the pandemic. The second is the way in which efforts are being made to improve access to vaccine through something called COVAX, which the contributors have been describing. The third thing I want to talk about is improving access to technologies through initiatives like the People's Vaccine initiative and C-TAP.

We will start with the pandemic. I imagine everyone in Ireland knows but perhaps I will say it again. This pandemic is nowhere near finished. This is nowhere near the end. Some people say there is light at the end of the tunnel but from my point of view, I am not sure how far away that light is. I have no idea how long it will take to reach the end of the tunnel. I am prepared to say to committee members that I believe there are some really difficult and rocky periods ahead of the world to get through it.

This is a new virus that has appeared and entered into the human ecosystem, just as HIV did some decades ago. The world needs to adapt to a new virus. That adaptation process takes time, especially given that the virus will change. Humanity's response to the virus will change as well. The adaptation will be continuous. Right now, we are in a phase where the incidence of reported new cases of Covid-19 in Europe has gone into a decline.

This is in particular since the beginning of January and is super-welcome news. It has gone into decline because of the extraordinary effort by the people of Europe and, increasingly, the people of North America to take this virus seriously by maintaining physical distancing, wearing face protection, practising incredible hygiene, self-isolating when ill and protecting the most vulnerable. These are the tried-and-tested measures through which people can reduce their risk. That has to be accompanied with well functioning public health systems that can detect people with the disease, enable them to isolate in a decent way, trace their contacts and enable those contacts to isolate and, when necessary, deal rapidly and robustly with outbreaks that occur.

These are big shifts happening in humanity. We are all working out how to come to terms with it. We have had various moments when we have been able to learn: the first acceleration in March and April of last year; the second acceleration at the end of the summer months of last year; and the dramatic third acceleration towards the end of last year and over the new year period. We have been learning such a great deal, perhaps most importantly that the virus is the adversary and people are the solution. There is a requirement to enable people to be strong, connected and empowered to fight the virus despite the fact that this entails massive social and economic dislocation. It hits poor people the worst and it often hits people who have different ethnicity from the dominant ethnicity in western European countries the worst. Dealing with Covid in Ireland and elsewhere in Europe means empowering people to respond and enabling those most affected, particularly the poorest and those with least access to resources, to be strong.

Having said that, there are ways in which it is possible to help people. The ways to help include all those I have mentioned and now we can add vaccines. Who should be receiving vaccines now? In our view, it is clear that it should be the people who are at risk: older people and people with simultaneous illnesses; and those who are most exposed to the virus, namely, people dealing with Covid in their professional work all the time, particularly in healthcare, residential care, dentistry or other professions where one is in contact with the exhalations of people with the virus. If the vaccine is helpful in protecting people, there is one priority for the world, as stated clearly by the Director-General of the WHO and the Secretary-General of the UN. That priority is to make sure everybody in need of the vaccine can access it on the basis of need first, not on the basis of geographical location or nationality. Right now, the people who must be a priority for any vaccine are health workers, older people and people with concomitant illness, wherever they live.

That is why at the request of the different member states of the WHO, the COVAX scheme was set up as part of the access to Covid-19 tools, ACT, accelerator. COVAX is a scheme to enable the pooled purchase of vaccines at a negotiated price, ideally a low price. The vaccines can then be made available to countries to purchase with their own funds or, if their GDP is low, to purchase with aid funds. It is an advance purchase scheme like what we have used for other vaccines around the world to enable everybody to get the lowest possible price. By negotiating with the producers, we are able through COVAX to get the price low. In order for that to work, there has to be vaccine in the system and there is not enough for COVAX to work right now.

Anybody who criticises COVAX needs to be clear about what he or she is criticising. Is it that it does not have enough vaccine coming through or is it because it has design flaws? At the moment, the people who run COVAX tell me they want more vaccine in, which means, first, expediting the regulatory approval of existing vaccines that are currently on the edge of COVAX but not in it because COVAX can distribute only vaccines that have an emergency use licence from the WHO advisory committee on vaccination. Second, we have to get some of the new vaccines properly into the COVAX portfolio, that is, the ones that use messenger RNA. These are very exciting vaccines. At the moment, they have to be kept super cold, which makes them a real challenge to use, but the technology will improve and we have to get them in.

Third, countries that have purchased their own vaccine through bilateral deals and have some to spare should give it to COVAX immediately. It should become a movement everywhere that whenever there is some spare, it is given over. The key question is what is spare. My colleagues and I are asking whether, given the current availability of vaccines, any country should be planning to vaccinate all its adults against Covid or whether they should carry out vaccination of the at-risk groups and then share the rest with COVAX so that it can go to other countries where it is needed. Moreover, COVAX needs to take on new products and new vaccine production needs to come in.

Another key question is what is the hold-up. What could allow there to be more vaccines? I certainly agree that the resolution produced by Costa Rica before last year's World Health Assembly, which led to the C-TAP proposal and the associated medicines patent pool being set up, is very important. It is a mechanism that has worked for voluntary licensing for vaccines and treatments for other products, and it is surely the right way to go in the long term. In the meantime, let us try at least to get existing schemes working as effectively as possible while, at the same time, exploring possibilities for upgrading the C-TAP system. To get vaccines moving now, we need not only more vaccines coming in but also to scale up the potential of different manufacturers working to the full. When that happens, each scale-up has to be individually licensed by the WHO system. That is absolutely essential for quality assurance, safety and efficacy. Let us ensure that all the approval processes happen quickly.

It will not be possible to get vaccines into the arms of people everywhere without an enormous global support programme for vaccine administration throughout the world. Without that, we might end in the embarrassing scenario of vaccines becoming available more and more, particularly during 2021, with the inability to implement them. For polio, we have had to have a global immunisation programme, while for measles and other childhood illnesses, there are strong global programmes. There will need to be the global support of countries so that they can implement the vaccines.

Some of that is available through COVAX but, frankly, I know from experience that the world will have to get behind poorer countries to help them carry out their immunisation programmes. That is where we will need continued commitment from the G7, the G20, the UN Security Council, the UN General Assembly and other global bodies to ensure that the money moves. That is absolutely the key. Colleagues have made that point and I endorse it. COVAX will work if it gets the support it needs from rich countries; it will fail if countries go round the back, do not give it enough money or discredit it. Let us work together to make COVAX a success. In the longer term, let us use the C-TAP system and other medicine patent pools to increase the availability of supplies in poor countries where they are needed.