Biden under pressure to help boost global vaccine supply

The Biden administration’s plans to distribute surplus vaccines to countries in need are being met with skepticism from public health and human rights activists who argue the U.S. must do more to boost the global vaccine supply.

Health officials said Thursday’s announcement of a plan for the first 25 million doses was a down payment of at least 80 million doses by the end of the month, with the promise of more to come later this summer.

Pressure has been growing on the White House to develop a plan to donate its excess vaccines to countries that have been hit hard by the virus without the same access to vaccines as wealthier nations.

But the 80 million doses are enough to reach only 1 percent of the world’s population, and advocacy groups argue that more needs to be done, including helping developing countries expand manufacturing networks and working with vaccine manufacturers to boost global capacity.

Experts fear the limited number of doses being immediately distributed will exacerbate COVID-19’s damage abroad. One concern is that without vaccinations, new variants of the virus may arise in other countries that could threaten the rest of the world.

“I have no complaints about hearing the details on a previously planned donation. But here’s the reality. We are seeing the catastrophe of this around the world, and time is of the essence,” said Tom Hart, acting chief executive of the One Campaign, a global anti-poverty group.

“The United States and … wealthy countries that have surplus doses need to urgently release those and plan early to get them in the arms of people who need them,” Hart added.

Under the White House plan, 19 million doses would be sent to COVAX, the World Health Organization-backed initiative that aims to provide every participating country with enough doses to cover 20 percent of its population this year.

The doses would be divided among different regions, with 6 million doses going to Latin America and the Caribbean, 7 million to Asia, and 5 million to Africa. Biden officials and advocates said COVAX has the necessary logistics already in place to get doses out quickly.

The U.S. announcement comes as more than 60 countries across the world have yet to receive a single vaccine through COVAX, which has been struggling with supply constraints, especially after India’s largest vaccine maker suspended exports.

“It’s a great first start, but why we’re calling it a drop in the bucket is America procured 1.2 billion doses, but we know we don’t have 1.2 billion people here,” said Carrie Teicher, director of programs at Doctors Without Borders.

“Even if all 330 million people in the U.S. — even pediatrics — were vaccinated and they all got a two-dose vaccine and no one had vaccine hesitancy, we would still have half a billion doses of prepared vaccine that America is the owner of that are surplus,” she added.

But there are additional questions about why the White House chose certain countries and how officials ultimately decided on the number of doses sent to each one.

“I don’t fully understand … what criteria were used to decide which countries would receive what doses, whether they were sort of using the existing COVAX rules of the game or whether they were suggesting that there was going to be a different allocation based on some assessment of risk or need in different countries,” said Amanda Glassman, executive vice president of the Center for Global Development.

While other nations have been less prescriptive about where donated vaccines wind up, national security adviser Jake Sullivan said the U.S. has the authority to dictate allocations, though it will be done “in very close consultation and partnership with COVAX.”

Outside of COVAX, the White House is donating the remaining 6 million doses directly to Haiti, Gaza and the West Bank as well as to countries Sullivan said are America’s “closest neighbors … and friends.” 

Sullivan and other administration officials made it a point to try to distinguish the U.S. efforts from the “vaccine diplomacy” that Russia and China are engaging in, by leveraging doses for friendlier diplomatic relations.

“The United States is not asking anything of any country to whom we’re giving doses. We’re not seeking to extract concessions. We’re not extorting. We’re not imposing conditions, the way that other countries who are providing doses are doing,” Sullivan told reporters Thursday.

But at the same time, Sullivan noted there is value in helping friends and neighbors.

He specifically mentioned the 1 million doses of Johnson & Johnson vaccine allocated for South Korea, which is meant to protect American troops and “the Korean troops who are standing shoulder to shoulder with us in that country.”

Gayle Smith, the State Department coordinator for global COVID-19 response, said countries will know the assistance came from the U.S. Vaccine shipments may be branded with American flags, and diplomats will be on hand when the vaccines arrive.

“I think on the branding side, there’s a real difference between trying to curry political favor and letting countries know that assistance we may be providing is from the American people,” Smith told reporters Friday. “Yes, these come from the United States. That’s an important fact that many people will be well aware of.”

The choice of initial countries to prioritize surprised some experts who noted that some doses are going to comparatively wealthier allies with greater power to secure their own vaccine supply.

“Sharing doses with Canada is like vaccinating our 12- to 15-year-olds,” said Teicher of Doctors Without Borders. “It’s not bad public health practice, but it might not be the global priority for equitable vax distribution at this moment in time.”

But there’s more than just vaccine donation. Ahead of the Group of Seven summit later this week, experts and advocates want to know how the U.S. and its allies will help boost global vaccine manufacturing.

Without increased capacity and greater access to raw materials, the global vaccine supply will continue to be limited.

The Biden administration supports waiving intellectual property protections for vaccines as a way to overcome those issues, but experts say other immediate steps are needed.

Rohit Malpani, a public health consultant and board member for Unitaid, which works on disease prevention and treatment in developing countries, said manufacturers that “received very large sums of money from the public sector” should be forced to assist outside facilities in replicating their work.

“If we had pushed them to share the knowledge, share the know-how, share the manufacturing, we wouldn’t be in the situation we are now where we are basically relying on charity to distribute these vaccines in low-income countries,” he said.

Malpani said donations are “necessary” right now, but they didn’t have to be.

“Donation is … a failure because [wealthy nations] are telling governments they are not in control of their destiny, there is not enough in production, and they’re going to need to continue to rely on the charity of rich countries to provide the vaccine on this basis that could be yanked away at any moment,” he added.