| | | | |  | | By Carmen Paun and Daniel Payne | | | | |  The world's first malaria vaccine, shown here being given in a 2009 trial, has a difficult road to rollout. | Karel Prinsloo/AP Photo | GATES FOUNDATION MOVES ON FROM FIRST MALARIA VACCINE — The development of the world's first malaria vaccine was a historic milestone, making worldwide headlines last fall. Despite its 30 percent efficacy against hospitalization with severe malaria in young children — dispelling hope that it would be a silver bullet — there was widespread enthusiasm that the vaccine could help prevent the deaths of 400 children for every 100,000 fully immunized kids. Since 2001, the Bill and Melinda Gates Foundation has donated more than $200 million to be used for testing the RTS,S vaccine. Global health organizations then piloted it in Ghana, Malawi and Kenya. Mass rollout was always going to be challenging. But less than a year later, the foundation has decided to pull its support, citing the vaccine's low efficacy, short-term immunity, high price and limited supply. This could spell trouble: Funding will likely fall short of what's needed to deploy the vaccine. "Although we had spent a lot of money on RTS,S directly, when we ran through our analyses and said: 'What saves the most lives today and what is the best use of R&D and product development money and product launch money for the rest of this decade, we ended up moving in a different direction," Philip Welkhoff, director for malaria at the Gates Foundation, told Global Pulse. He called the decision challenging. Accelerating the development of second-generation bed nets to improve protection from malaria-transmitting mosquitoes and supporting the deployment of other tools, such as drugs and insecticides, needed to fight the disease will save more lives with the available resources in the short term than the vaccine, he said. What happens now: Gavi, which funds vaccine procurement for developing countries, has allocated some $155 million to support the vaccine's rollout over three years. The first application window for interested countries is expected to open next week, and the World Health Organization will lay out fair-vaccine-allocation advice in the next few days. What the Gates Foundation is eyeing next: The development of the RTS,S vaccine yielded knowledge, Welkoff said, that could lead to a more powerful tool to fight malaria: monoclonal antibodies. The drug therapy is under development and could become available toward the end of the decade, he said. The aim is to protect children most at risk from malaria with one injection ahead of the rainy season when malaria transmission is highest. Instead of the three-dose RTS,S vaccine, "you could just come in every year, ahead of the season, have a single encounter with the child and protect the child for at least four months and as much as five or six [months]," he said. Until then, countries in sub-Saharan Africa will have to rely on Gavi and their own resources to access the world's first malaria vaccine.
| | | WELCOME BACK TO GLOBAL PULSE, where we would love to know how chomp champs maintain their health after chowing down 63 and 40 hot dogs, respectively, in a Fourth of July contest. Send your guesses — and tips — to cpaun@politico.com and dpayne@politico.com. Global Pulse is a team effort. Thanks to editors Eli Reyes and Barbara Van Tine. Follow us on Twitter: @_daniel_payne and @carmenpaun.
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| | | | PANDEMIC RESPONSE ADJUSTING TO NEW NORMAL — The alliance of global health institutions, governments and foundations cobbled together to respond to the coronavirus pandemic two years ago is transitioning to a new form, yet to be defined. The so-called Access to Covid-19 Tools Accelerator (ACT-A) will stop work in its current form in late September, POLITICO's Erin Banco and Ashleigh Furlongreported Tuesday. "We're … moving into a different phase of the pandemic, one in which it's not over … but many countries are adjusting to what we're calling a new normal; we need to adjust our process to work with them," said Bruce Aylward, the WHO's lead on ACT-A, at a virtual meeting of the partnership Wednesday. The WHO and other organizations involved are working on a transition plan, with a first draft expected by July 15. The transition will start in October and end in March 2023, according to Aylward. "This is the transition from acute emergency to longer-term Covid with waves and surges of disease and how we get on a footing to manage in the longer term," he said. Aylward stressed that support to countries relying on ACT-A will continue beyond September, but global health activists are worried that this transition will harm the poorest nations. "The ACT-A was never intended to be a long-term solution, but it does not make sense for it to wind down until the whole world is ready to transition to a longer-term sustainable response to the virus," Jenny Ottenhoff, senior policy director of global health at the ONE Campaign, told Erin and Ashleigh. Not the end: In a call with reporters, Aylward stressed that this transition is an adjustment "rather than sunsetting or shutting down." The plan is for the collaboration to continue but in a way that allows the organizations involved, such as Gavi and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to also focus on their core business, he said.
| | THE STATE OF THE PANDEMIC | | | 
Paxlovid, which has long been available in many wealthier countries, is still not available in several lower-income countries. | Maya Alleruzzo/AP Photo | WAITING FOR ANTIVIRALS — Low- and middle-income countries are still trying to work out deals with Pfizer to obtain its promising Covid-19 antiviral, leading the WHO to call for Pfizer to speed up the agreements. "This is delaying access, and some countries may choose to wait for a generic version of the antiviral, probably available in early 2023 — and this will cost lives," Tedros Adhanom Ghebreyesus, the WHO's director general, told reporters Wednesday. "I call on Pfizer to work closely with health agencies and countries to ensure its new oral antiviral is available quickly and effectively." But Pfizer has been ready to ship the drug for months , a spokesperson for the company told Global Pulse in a statement. "We have been ready since the beginning of April to ship treatment courses of our anti-viral under the current agreement with UNICEF," the spokesperson wrote. "However, implementation has been delayed due to UNICEF's request to renegotiate certain terms of the agreement." Another antiviral , molnupiravir, is already being distributed to countries in need. But the 43 countries interested in an affordable supply of Pfizer's drug are still waiting, Tedros said. Pfizer signaled an openness to work with countries outside of organizations like the WHO or UNICEF. "Our strategy is to make the product available through both government and supranational channels," Pfizer's spokesperson said. "If a country expresses need for supply of PAXLOVID, we will make supply available, working through whichever supply channel is quickest and most efficient to reach patients in need."
| | | | INTRODUCING POWER SWITCH: The energy landscape is profoundly transforming. Power Switch is a daily newsletter that unlocks the most important stories driving the energy sector and the political forces shaping critical decisions about your energy future, from production to storage, distribution to consumption. Don't miss out on Power Switch, your guide to the politics of energy transformation in America and around the world. SUBSCRIBE TODAY. | | | | | | | | | | $250 BILLION The amount of money needed to end tuberculosis as a global health threat by 2030, according to a new estimate by the Stop TB Partnership. | | | | | | 
Atul Gawande, left, visits a USAID-built clinic in Shelinvoya, Ghana. | USAID/Ghana | 'A MISTAKE OF EPIC PROPORTIONS' — That's how Atul Gawande, who leads global health at the U.S. Agency for International Development, described wealthy countries' decisions to slash global Covid-19 budgets. In an interview with POLITICO 's Erin Banco, Gawande discussed global health's future at USAID, including how it plans to deliver services and supplies to the most people around the world. "Public health lives in a boom-bust cycle where, when the disease is at its worst, is when people are willing to make an investment. And then when the tide has gone out, people … decide, 'Now I don't have to worry about it.' But the tide is coming back," Gawande said. "We have left a health system that is battered at home and abroad. It is not the time to abandon support at this point." As the pandemic drags on, Gawande and other global health leaders face a key challenge: tackling the pandemic while building sustainable systems — all with less resources than before. Read more from the interview here.
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