Social distancing, contact tracing, and effective treatments can contain and minimize the impact of the COVID-19 pandemic, but only a vaccine can truly end it.

Dozens of labs around the world are currently working to develop an effective vaccine, and major health organizations — including the World Health Organization, CEPI, the Global Fund, and Gavi, the Vaccine Alliance — have formed the Access to COVID-19 Tools (ACT) Accelerator to oversee and facilitate this process. 

The ACT Accelerator is committed to ensuring that a  vaccine, when it becomes available, is equitably distributed both as a means of social justice and public safety. 

“We know that as long as anyone is at risk from this virus, the entire world is at risk — every single person on the planet needs to be protected from this disease,” according to an ACT statement.

“We agree that alongside evidence-based public health measures, innovative COVID-19 diagnostics, therapeutics and vaccines are needed — in record time and at record scale and access — to save millions of lives and countless trillions of dollars, and to return the world to a sense of ‘normalcy,’” it continued.

The ACT Accelerator is providing expertise, funding, and resources to labs working on a vaccine. But developing, scaling, manufacturing, storing, and distributing an effective vaccine will be difficult and many challenges, both known and unknown, remain in the way.

Distribution — getting the vaccine to more than 7 billion people — could be the most challenging aspect of all.

“We have never attempted to roll out a vaccine at the scale and the speed that we are looking to do with COVID-19 vaccines,” James Fulker, a Gavi spokesperson, told Global Citizen. “This is a vaccine that will be needed in every region of every country, for every age group.” 

“It will take an unprecedented manufacturing effort to produce the billions of doses we will need, careful work needs to be done on allocation to ensure the most vulnerable, such as health workers, are prioritized,” he said. “And for global distribution, which Gavi is leading on, we are already planning out a multitude of scenarios to ensure the cold chain is ready to handle what will amount to one of the biggest logistical challenges in history.”

Gavi was formed 20 years ago to improve the system of vaccine production and distribution to address some of the world’s deadliest diseases. 

Today, Gavi has become the leading coordinator of vaccine distribution around the world, helping to vaccinate nearly half of the world’s children, and preventing an estimated 13 million deaths as a result. 

Over this period, the organization has learned insights and developed strategies that have helped to inform the ACT Accelerator. 

Take the “cold chain,” for instance.

“The cold chain presents one of the biggest logistical barriers to getting vaccines where they’re needed,” Fulker said. “Many vaccines need to be kept at a constant temperature of between 2 to 8 degrees Centigrade — just a few hours outside of a fridge can render a vaccine ineffective.”

As the COVID-19 vaccine reaches the market, on-the-ground distribution could depend on cold-chain technology, making it particularly difficult to reach remote, rural populations. 

“In hot countries with unreliable power supplies this can present huge problems,” Fulker added. “Gavi provides support to health systems to ensure warehouses, vehicles, and health facilities have the right equipment to keep vaccines at the right temperature, including through our Cold Chain Equipment Optimization Platform, which is supporting the rollout of new solar-powered fridges.”

Other measures will have to be learned and developed as we go. Manufacturing billions of vaccines has never been attempted before on such a short time scale, according to the World Economic Forum (WEF). 

Making sure there are enough vaccines for every country will require manufacturers to begin producing vaccine doses even before vaccines trials reach the clinical phase. 

It’s hard to know right now which vaccine candidate will be successful, so billions of doses of a number of failed vaccines may have to be thrown out once the trial results come back. This sunk cost might seem like a waste, but it’s necessary to ensure that the final vaccine is ready to go at a moment’s notice.  

Since COVID-19 presents a unique and universal threat, countries are collaborating in ways they never have before — sharing data, resources, and expertise — the WEF notes. The ACT Accelerator, meanwhile, is strengthening the links between every component in the vaccine chain. 

“The collaboration is unprecedented,” Paul Stoffels, vice chairman of the executive committee and chief scientific officer at Johnson & Johnson, told the WEF. “If I look at how we work today with the regulators in the world, where normally we have paper processes which take weeks and months to get feedback, today we talk about getting feedback from regulators within the day.”

Because of this collaboration, no countries will receive priority treatment — vaccines will be fairly and equitably distributed to communities worldwide. 

Successful vaccine delivery also depends on the integrity of health care systems around the world.

The COVID-19 pandemic has already weakened health care globally. Health care workers have faced greater suspicion and discrimination, hospitals have run out of supplies, and economies have been unable to fund public health.

Ensuring that everyone in the world gets access to a COVID-19 vaccine will require millions of community health workers worldwide to be trained to administer vaccines and perform community outreach. These workers will need the personal protective gear (PPE), tracking technology, medical gear, funds, and support networks to do their jobs effectively. 

During the current pandemic, vaccination campaigns for other diseases have been derailed, causing outbreaks of other infections, too. This development could potentially erode long-standing health care infrastructure and protocols. That’s why wealthy countries need to be investing in health systems in developing countries to ensure these networks recover.

Past vaccination campaigns for diseases such as Polio, pneumococcus bacterium, and Ebola have helped to lay the groundwork for future vaccination campaigns and this infrastructure will help to streamline the COVID-19 campaign, according to Fulker.

Gavi is also working to improve mapping, tracking, and delivery of vaccines through a variety of cutting-edge technologies. The organization is deploying drones to carry vaccines to remote areas, working with private contractors such as the United Parcel Services to leverage their expertise, and using artificial intelligence to plan the delivery strategy. 

“In many countries delivering this vaccine to their populations at speed would have been near-impossible even 10 years ago,” continued Fulker. “However [Gavi] the Vaccine Alliance has spent years helping the world’s most vulnerable countries to build up their health systems.”

He added: “While work still needs to be done, much of the infrastructure we’ll need to roll out this vaccine is already in place and ready to meet this challenge.”

Join the Global Goal: Unite for Our Future campaign by taking action here to help mitigate the impact of COVID-19 on the world's most vulnerable people. You can find out more about COVID-19, what's needed to tackle it, and how it's impacting the lives of people around the world, through our COVID-19 coverage here.