Beyond ample supply, hurdles abound in the race to vaccinate the globe

President Biden promised to send 80 million doses of COVID-19 vaccines to 50 countries by the end of June, but only half have been distributed so far due to what the White House calls “herculean” logistical challenges, ranging from regulatory hurdles to ensuring that countries are ready to deliver doses into arms before they spoil. In the race between vaccines and variants, these distribution and delivery challenges will be the determining factors in whether new and even more dangerous variants emerge that could pierce our hard-won vaccine immunity.  

Biden’s meeting with G7 leaders in Europe last month took steps to head off this crisis, setting the goal of vaccinating the world by 2022. To get there, they pledged to unconditionally donate to the poorest countries 870 million doses (including 500 million from the U.S.) of the high-quality vaccines that have substantially reduced cases and deaths in the U.S. and Europe, with at least half to be delivered before the end of 2021. This was a significant advance in U.S. and allied vaccine diplomacy as compared with Russia and particularly China, which has donated 25 million doses of vaccines that appear less effective in preventing outbreaks caused by COVID variants.  

The U.S. and allies, collaborating with multilateral institutions, are also taking steps to drive increased manufacturing capacity and financing for high-quality vaccines around the world. Examples include the Quad Vaccine Partnership, the U.S.-Republic of Korea Global Vaccine Partnership, the World Health Organization/COVAX led consortium to establish an mRNA vaccine technology transfer hub in South Africa, and the World Bank partnership with the African Union to purchase and deploy vaccines. 

As a result of these and similar activities, projections show that there will likely be over seven billion doses of high-quality vaccines available this year, and over 14 billion in 2022 — more than enough to supply the world. That is why we continue to urge the U.S. and other willing allies to share 1-2 billion doses in 2021, and vaccinate at least 60 percent of the population of all countries by mid-2022. 

However, increasing vaccine donations and production is not enough to contain the pandemic globally. In the coming months, as vaccine availability rises, vaccine delivery capabilities and vaccine hesitancy, not supply, will become the critical bottlenecks to vaccinations in most countries. 

Conducting rapid mass-vaccination campaigns that ensure equitable access for adult populations on a national level is a challenge that most countries have not faced in recent times. Several unfortunate examples of suboptimal readiness have already led to wastage and inequitable use of COVID-19 vaccine doses, worsened by a lack of reliable information on country readiness. Vaccine hesitancy also continues to be a major and persistent barrier in many countries. Unless vaccine administration capabilities markedly improve, we are headed for a global supply glut, even as the vast majority of people remain unvaccinated. 

To prevent a global catastrophe, the U.S. and allies must take urgent action to translate doses into vaccinations, with the aim of every country achieving adequate vaccination readiness by the end of 2021, as measured by the World Bank/World Health Organization readiness assessment tool or similar instrument. Every country should demonstrate the ability to use distributed doses equitably and efficiently. This will require a substantial U.S.-led effort tied to on-the-ground implementation plans, with local ownership and shared accountability for results. 

The President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved millions of lives, provides a platform and a model for a U.S. initiative to build vaccination capacity. Such an initiative should prioritize the countries with the highest burden of disease, the lowest vaccination rates and the greatest distribution challenges in Latin America, Africa, and South and Southeast Asia. Working with host governments, civil society and private entities, USAID, Centers for Disease Control and Prevention and other agencies can facilitate country-operating plans and mobilize assistance to train vaccinators, increase storage and distribution capabilities and address vaccine hesitancy. These activities will increase capacity to respond to the present crisis and prepare and strengthen health systems for future needs.

To ensure that this U.S. Emergency Plan for COVID Relief drives similar efforts by G7 members, other allies and multilateral institutions, the U.S. should call for a high-level conference on vaccine distribution and delivery in the run up to the U.N. general assembly meeting in September. Such a conference — the first on the pandemic since it began — would galvanize action, mobilize resources and coordinate in-country activities to maximize results and minimize duplication of effort.    

Biden announced in Europe that “America is back.” The best way to demonstrate America’s global leadership would be to rally allies to translate vaccine pledges into timely and effective vaccinations around the world — heading off further catastrophic outbreaks now raging in many countries and ending the pandemic’s devastating impact everywhere. 

Mark McClellan directs the Duke-Margolis Center for Health Policy, is a former FDA commissioner and CMS administrator, and is an independent member of the Board of Directors of Johnson & Johnson. Krishna Udayakumar is director of the Duke Global Health Innovation Center. Michael Merson is a Duke University professor and former director of the World Health Organization Global Program on AIDS. Gary Edson is president of the COVID Collaborative and co-led the development of PEPFAR as a deputy national security advisor.