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IDJ English – Series: “Nautical Map for the Post-Corona Era”

Series: “Nautical Map for the Post-Corona Era”

Cooperation in the spirit of multilateralism supporting the construction of an international framework


Shunsuke Mabuchi
Senior Advisor, Global Delivery Team, Bill & Melinda Gates Foundation

The COVID-19 pandemic has strongly shaken the political and economic structure of the world including in developing countries. What kind of seismic shift will occur in the world in the future? And how should Japan overcome these big waves? As one of the experts of the development sector, Shunsuke Mabuchi of the Bill & Melinda Gates Foundation talks about changes in the trends of  global health and the role that Japan should play.

Crisis in fundamental healthcare services

The spread of COVID-19 has accelerated the need for support in the field of healthcare, especially in developing countries. The donor aid from developed countries and international organizations, as well as the interests of developing countries, are focused on measures against COVID-19. As a result, crises in other healthcare fields, especially basic healthcare services, are gradually becoming serious.

For example, a survey of 63,000 healthcare facilities in developing countries found that the number of children vaccinated against all necessary vaccinations fell by 35 percent in Liberia and 13 percent in Nigeria. In addition, maternal and child healthcare services are becoming difficult to receive in developing countries.

The reasons behind this include “avoiding the use of medical facilities for fear of infection” and “not being able to pay due to the worsening economic situation”, as well as reasons such as “health workers are busy with the COVID-19 countermeasures” and “stagnation in the distribution of medical supplies”.

A deepening crisis in health services could increase the number of deaths of children beyond the number of deaths caused by COVID-19. According to a study by Johns Hopkins University, the pessimistic scenario estimates a 45 percent increase in deaths among children aged 5 and under in the next six months, an increase of 1.2 million in numbers. If this becomes a reality, achieving Goal 3 of the Sustainable Development Goals (SDGs) to “ensure healthy lives and to promote the well-being for all at all ages” will become even more elusive.

Building a co-purchase mechanism

To stop the spread of COVID-19, the Foundation has taken a proactive approach. The first is cooperation with private companies. Medical science experts affiliated with the Foundation have been engaged in vaccine development and drug discovery support for a long time. Among the COVID-19 countermeasures, we are working with pharmaceutical companies to develop and manufacture vaccines and therapeutics. If all goes well, the vaccine is expected to come into practical use soon. It has realized an unprecedented cooperation between pharmaceutical companies, to share production lines to produce larger quantities of vaccines and therapeutics faster.

The second is quick and flexible funding. Vaccines usually move to mass production after tests confirm their effectiveness and safety. However, we have been funding the development of manufacturing capability for promising vaccines, even before the results of the trials have come out. This means, when the effect is confirmed, the vaccine is already ready for production and can be delivered to those who need it without any time lag.

The third is support for the development of an international framework. Presently, the concept of “nationalism” in response to COVID-19 is spreading and the purchase of vaccines is progressing mainly in developed countries. This would prevent the developing countries with most need from accessing vaccines, which could have a significantly negative impact on public health. To end the COVID-19 crisis globally, providing vaccines, therapeutics and test kits equitably to developing countries is an urgent issue.

The Foundation believed that “multilateralism is the way to solve it” and, in collaboration with the World Health Organization (WHO) and other international organizations, we established a partnership called “Access to COVID-19 Tools Accelerator” (ACT-Accelerator). Countries, as well as international and private organizations, are working together to support the rapid development and manufacture of vaccines, therapeutics and new test kits, with the aim of delivering them fairly to people around the world, including developing countries.

As for vaccines, an international mechanism for pooled vaccine procurement “COVAX” has been established within the ACT-Accelerator, and the Foundation has called for participation from both developed and developing countries. Under this mechanism, together with the Foundation, the countries that can purchase vaccines with their own funds and donor countries that support developing countries pool funding and purchase vaccines from pharmaceutical companies. What’s groundbreaking is that you can make purchase agreements with many companies, which is something a single country cannot do on its own.

Because of the large number of contracts, the possibility of buying a vaccine that has been verified for effectiveness and safety is dramatically increased. The vaccines purchased will also be distributed to developing countries participating in COVAX, so they can access the vaccines at the same time as developed country participants.

As of October 1, 2020, 76 middle- and high-income countries have shown interest in COVAX, and the combined number of developing countries is expected to be a partnership of about 170 countries. Under COVAX, the partnership aims to deliver 2 billion doses of vaccines to those in need by the end of 2021, aiming to avoid a catastrophic outcome for these countries.

Significance of a global framework

It is estimated that for every month the COVID-19 pandemic ends earlier, the world could prevent $375 billion in economic losses globally. In addition to preventing further economic losses, it is important to establish a strong and functioning international cooperation mechanism that include developing countries, such as the international partnership described above, and to bring infections to an end, everywhere.

Under the concept of “human security”, Japan has long promoted universal health coverage (UHC), through official development assistance (ODA), as well as international cooperation in the field of global health. I have high expectations for Japan in taking on a strong leadership role in international COVID-19 response, through its participation in ACT-Accelerator and COVAX. On September 15, 2020, Japan was one of the first countries to announce its participation in COVAX and contributed 17.2 billion yen. At the United Nations General Assembly in the same month, Prime Minister Yoshihide Suga indicated Japan’s full support for a framework ensuring equitable distribution of treatments and vaccines.

If we can overcome this crisis well, we will also see a path to address the basic health service crisis described at the beginning. The Foundation will continue working to improve the efficiency of immunization programs and enhance delivery of healthcare services, with the view to improve the quality of such basic services in developing countries. With the spread of COVID-19, infectious diseases have become recognized as one of the most important health, economic and social security issues in the world. Based on the lessons learned from the pandemic, it is necessary to think about “how to rebuild the mechanisms of infectious disease control on a global scale and in each country”.

Japan can also contribute at this juncture. During the spread of the Ebola virus in Western Africa from 2014 to 2016, Japan, together with the Gates Foundation and the UK’s Wellcome Trust Foundation, established the Coalition for Epidemic Preparedness Innovations (CEPI) in January 2017, to support research, development and production of vaccines and therapeutics. I look forward to seeing Japan demonstrating leadership in building and making an impact around the establishment of a global framework again. Now is the time to promote international cooperation in accordance with the spirit of multilateralism.

“International Development Journal”, 2020, November edition

(The data indicated in this article was the latest data available at the time of interview.)


連載 : ポストコロナ時代の航海図
クチンの公正な配分へ ―今こそマルチラテラリズムの精神に則った協力を

グローバルデリバリーチーム シニアアドバイザー
馬渕 俊介氏









そこで当財団は、「マルチラテラリズムこそ解決への道」と考え、世界保健機関(WHO)をはじめとする国際機関と連携して「Access to COVID-19 Tools Accelerator」(ACTアクセレレーター)というパートナーシップを構築した。各国や国際機関、民間団体が協力してワクチン、治療薬、新しい検査キットの迅速な開発・製造を支援し、途上国を含む世界中の人々に公正に届けることを目指している。









『国際開発ジャーナル』 202011月号掲載記事

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