National COVID-19 Coordination Commissioner and CEPI chair Jane Halton AO says global cooperation in the hunt for a COVID-19 vaccine is critical.
Jane Halton AO PSM FAICD was in transit at a US airport when she got a call alerting her to the early threat of the COVID-19 pandemic. “It was a credible authority — they said it was some weird type of pneumonia,” she reflects. “I had that sinking feeling then. You have these moments.”
In her second year as chair of the Coalition for Epidemic Preparedness Innovations (CEPI), Halton was acutely aware of the risks. With a 33-year career in the Australian Public Service, including as secretary of the departments of Health and Finance, and global roles with the World Health Organization and the OECD, an infectious outbreak was something she had feared.
When it comes to epidemics, “this stuff is scarred into my hide”, she says. “We had SARS, H1N1 (swine flu) and MERS when I was secretary of the Department of Health. I’d had all that experience and knew we were well overdue for a pandemic. Bill Gates was saying it for ages, but most of us thought it would be a flu pandemic.”
CEPI was set up at Davos in 2017 by the governments of Norway and India, the Bill & Melinda Gates Foundation, Wellcome Trust and World Economic Forum. A partnership of public, private, philanthropic, and civil society organisations, it aims to advance, finance and coordinate the development of new vaccines to prevent future epidemics.
Pathogens, as is now acutely evident, are no respecters of borders. And with increasing population density, human mobility and ecological change, emerging infectious diseases pose a growing threat to global health and economic security. The need for a different response was recognised after the 2014–16 West African Ebola epidemic, which killed more than 11,000 people and created an economic and social burden of more than US$53b. A vaccine — later shown to be 100 per cent effective — had been under development for more than a decade, but was not deployed until a year into the epidemic. CEPI was established to fill a gap in the vaccine ecosystem, in which development is a long, costly and risky exercise.
Race for a vaccine
CEPI has been trying to identify potential vaccines for COVID-19 since January. China released the genetic sequence on 9 January, which Halton says has been important in enabling efforts around the world. CEPI has sought to raise US$2b to expand the number of vaccine candidates to increase the chances of success, and fund the clinical trials. “This is just the work to do to get to the starting line,” notes Halton, adding CEPI is going as hard as it can to negotiate arrangements to ensure equity of access for personal protective equipment and vaccines.
At the National Press Club in May, Halton warned of the threat of “vaccine nationalism”. Most vaccine candidates — 94 per cent — fail at phase one or two of clinical trials. To date, there are about 130 groups working on vaccines across seven different technologies and Halton says there is a good chance at least one will succeed.
Four CEPI-funded vaccines have so far have gone to clinical trials, including work in Australia, with preliminary results expected in July. It’s estimated between 12 and 15 billion doses worldwide will be required. But finding a vaccine is only half the battle, the other is making it and scaling for mass production, which can take years. Australian biotherapeutics and vaccine developer CSL is in the mix with capacity, science and the people.
Countries need to think carefully about the obligation they have to their people, particularly vulnerable citizens and frontline responders, says Halton. For example, it would not be morally right for Australia to produce 25 million doses for Australians first.
“We are all in this together,” she says. “As soon as there’s a vaccine, I fear that we will maybe not be as all in it together as we have been. We need to understand that if this virus is anywhere in the world and vulnerable people have not been protected, then everyone is vulnerable. It’s a bit like the Clint Eastwood movie [Dirty Harry]. Do you feel lucky? Would you be in a global consensus to allocate vaccines? At the moment we’re in a game of chicken.”
US$2b Minimal cost estimate to develop COVID-19 vaccine within next 12–18 months
US$570b World Bank estimated annual global cost of moderately severe to severe pandemics
US$2.8b Average minimum cost for progressing one vaccine against each of WHO’s 11 priority epidemic infectious diseases
10 million Lives saved by vaccines between 2010–15
WHO Priority diseases
COVID-19, Crimean-Congo haemorrhagic fever, Ebola, Marburg virus disease, Lassa fever, Middle East respiratory syndrome coronavirus (MERS-CoV), Severe Acute Respiratory Syndrome (SARS), Nipah and henipaviral diseases, Rift Valley fever (RVF), Zika virus, Disease X*
Sources: CEPI , WHO, World Bank; *Pathogen currently unknown to cause human disease
Public vs private
The times suit Halton’s capacity and experience and her high-level public policy background is bringing valuable skills to corporate boardrooms. Based in Canberra, Halton comes from a public service tradition. She was born in the UK and her family moved to Australia in 1973 when her father, Charles, was recruited by the Whitlam government to run the Department of Transport.
With an honours degree in psychology from the Australian National University, she joined the Australian Bureau of Statistics, going on to spend three decades in Australia’s public sector. She was appointed Secretary of the then Department of Health and Ageing by PM John Howard in 2002, and later led the development of the Memorandum of Understanding between Medicines Australia and the Australian government, and worked on the policy shift to plain cigarette packaging under Labor health minister Nicola Roxon.
Her experience spans finance, insurance, risk management, technology, human resources, health and ageing and public policy skills — and she has had a long interest in digital technology.
After stepping down as secretary in late 2016, Halton joined the boards of the ANZ Bank, cloud services company Vault Systems (which she now chairs), Crown Resorts, Clayton Utz and the Strategic Policy Institute. ANZ chair David Gonski AC FAICDLife said of Halton in an ANZ interview: “I knew her colossal appetite for digesting the subtleties of a sector and then coming out with a very reasonable way through. She had an immediate impact on our board.”
Halton had a full load, so when she got the call to be part of the NCCC she at first rejected the offer. “This is my sweet spot,” she says, explaining her change of mind. “I’m absolutely at my best when I have a bunch of different balls all in the air, with busy, complicated multiple issues to deal with. I was a CEO for 15 years. I was done being a CEO, but I adore working with the bank and being able to make a contribution on this globally.”
At the time of going to press, according to CEPI there were more than 123 COVID-19 vaccine candidates in development, with 10 in clinical trials — six of those being undertaken in China.
CEPI had provided initial support and funding to develop COVID-19 vaccine candidates through nine partnerships — including the University of Queensland (UQ), Curevac, Clover Biopharmaceuticals Australia, Moderna, Inovio Pharmaceuticals, Novavax, the University of Hong Kong and the University of Oxford.
In June, CEPI and UQ announced a new partnering agreement to accelerate the development, manufacture and distribution of a COVID-19 vaccine candidate pioneered by researchers at UQ. CEPI and CSL will fund the development and manufacture of UQ’s “molecular clamp” enabled vaccine for COVID-19.
CSL and CEPI will fund human trials of the vaccine candidate, which will start this month. Halton says if this vaccine is successful, the partnership model will enable CEPI to provide a significant number of doses to the COVID-19 Vaccine Global Access Facility for those who need them most, while allowing CSL to fulfil its own long-standing biosecurity commitments.
The other important organisation is Gavi, the Vaccine Alliance, a public-private health partnership that works to increase access to vaccines for children in developing countries. In June, Gavi launched a new financing instrument designed to incentivise vaccine manufacturers to produce sufficient quantities of eventual COVID-19 vaccines, and ensure access for developing countries. AstraZeneca will guarantee 300 million doses of the COVID-19 vaccine it is developing in partnership with the University of Oxford, which developed one of the first COVID-19 vaccines to go into human trial.
It is going to require a great deal of creativity and flexibility. The impact is different depending on your geography and sector, and the risks some communities face are much greater in some than others. There’s no one size fits all here.
Leadership and the board
Halton says while directors are hyper-conscious of the board’s role being governance, not management, the roles have evolved in the crisis. It becomes a matter of leadership. “People have been understanding that when there’s a crisis, your engagement goes up quite significantly,” she says. “You aren’t making the day-to-day decisions, but strategic ones. For example, take my CEPI role — I’m talking to them, if not every day, sometimes twice a day. It’s about coaching, judgement and helping them think through the issues as a board. That’s what you do as a board. We are constantly thinking through our strategy and risk management. We have to understand the fear and uncertainty — that people are confronting something not just in their professional life, but in their personal life as well.”
She says “talking to people constantly” has been key, even if simply to acknowledge that times are uncertain and unpredictable. Leadership requires clarity of communication, empathy and a level of support and acknowledging shared experience.
“We practise and we talk about empathetic and collaborative leadership,” says Halton. “There are times in a crisis when you don’t have time to workshop decisions. People don’t want a sense of indecision or that people aren’t stepping up to the plate in terms of undertaking the job. To be able to say to people we are going to make mistakes and the challenge is to fix them, and we absolutely have your best interests at the heart of it. When the chips are down, people expect you to lead.”
From a director perspective, Halton says it’s important organisations think carefully about reopening and how to keep their workforce safe and operating in a way that’s sustainable, but keep public health measures in place. “The trick for all of us is not to revert back to old ways. The challenge is to learn everything we can from this experience. Let’s not make it a net negative experience.”
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