The first annual progress report on the American Pandemic Preparedness Plan (AP3), released earlier this month by the White House Office of Science and Technology Policy (OSTP), builds on the initial AP3 published by OSTP in September 2021 and frames global equity as a keystone of research and development for pandemic preparedness. GHTC applauds the report while acknowledging significant funding and political will are critical to achieving its objectives.
The annual report’s emphasis on global equity in product development represents a significant and growing shift in the many plans, frameworks, and strategies issued by the US government to support pandemic preparedness over the past few years. It resonates, for example, with the recently released five-year strategic plan for the Biomedical Advanced Research and Development Authority that includes a greater focus on working with global partners and developing products for diverse populations living in different contexts.
Early in the pandemic, the success of many research efforts was defined by the safety, effectiveness, and speed at which a product could be developed. Fortunately, those efforts led to safe and effective first-generation products that were quickly implemented in places with strong health care systems, such as Washington, DC, and Houston, Texas.
What was missing, however, were safe and effective first-generation products that could easily meet the needs of people living in places where there are fewer resources, both in the United States and in many other countries. For example, in places with poorly funded health care systems, few highly trained health care workers, and limited refrigeration, it can be especially challenging to access, rapidly distribute, and administer millions of intramuscular vaccines that require ultracold storage.
An important part of global health equity is developing products that are designed for and with the communities that will use them. This is true even in pandemic emergencies, and so GHTC advocates for pandemic preparedness research agendas to prioritize the needs of communities in low-resource settings. Safety, effectiveness, and speed are critical—but deliverability, availability, affordability, and ease of administration cannot be afterthoughts saved for the development of second- or third-generation tools.
Some language in the AP3 annual progress report aligns with this vision. While the initial AP3 recognized that “vulnerable communities” face the greatest risk in public health emergencies and that the United States must work to strengthen global research systems and coordinate with global research partners, the new report goes further. Its executive summary states that “scientific and technological advances must be paired with public engagement, trust-building, and recognition and resolution of previous harms and challenges in public health.” The report goes on to recognize that for future responses, medical products need to be developed simultaneously with community engagement processes.
Perhaps the most significant items in the new report are the key goals that weave in global health and the development of products that are designed for low-resource settings.
The goals include:
- Exercising pandemic preparedness by “addressing infectious and global health challenges” such as influenza, antimicrobial resistance, and other infectious disease threats.
- Strengthening clinical trial networks and “warm base” research globally to develop next-generation vaccine technologies, therapeutics, and diagnostics, especially in “geographic regions most likely to see emergence of pathogens of pandemic potential.”
- Supporting diversified manufacturing for vaccines in low- and middle-income countries (LMICs).
- Developing vaccines that are easier to administer, more efficient to produce, and provoke a broader immune response.
- Strengthening national regulatory systems in LMICs to facilitate vaccine production.
- Supporting health care technologies that can be used at home and in remote locations.
- Developing a better understanding of global product manufacturing capacity and global investments to inform investments in essential medical product manufacturing in LMICs.
- Developing multiplex, “pathogen-flexible,” and “pathogen-agnostic” diagnostic tests and minimally invasive, simple-to-use diagnostic tests.
It must be noted again, however, that although the AP3 annual report outlines laudable goals and provides a strong signal of White House priorities, for many of its goals to be achieved, Congress would need to provide additional funding and authorizations, which GHTC would support.
Despite its limitations, the report is a step toward more equitable research agendas for product development and pandemic preparedness. Further US government commitments to such principles would go a long way toward ensuring that in future health crises, those in low-resource settings are not left behind and are able to quickly and equitably benefit from the development of new tools to protect and restore health.
