President Biden: It’s time for an urgent and effective plan to vaccinate the world

In a recent open letter to President Biden, signed by over 50 global health leaders and more than a dozen eminent public health organizations, we called on the president to vaccinate the world. 

He’s already donated or pledged a total of more than 1 billion COVID-19 vaccine doses and provided funding to support COVAX (a global partnership to accelerate equitable access to COVID-19 vaccines). While laudable, President Biden’s charitable donations and piecemeal approach fall far short of the leadership the world urgently needs. 

At a side session of the United Nations General Assembly, Biden set a target of vaccinating 70 percent of the world by next September. But he’s never presented a plan that meets the moment. The world needs President Biden’s plan and needs him to act on it now. Here’s a bold plan Biden should adopt.

But first, the public might ask, why is it our responsibility to help vaccinate the world? The answer is that the U.S. and other wealthy countries caused global inequalities by signing pre-purchase agreements with vaccine manufacturers, paying premium prices to snatch up the lion’s share of the vaccine supplies. We used domestic laws to restrict the export of doses and a vaccine supply chain, so even highly capable manufacturers in middle-income countries could not produce vaccines to scale. Now many rich countries are giving third dose “boosters,” sometimes available to large swaths of the — or even the entire — population, while more than 97 percent of people in lower-income countries have not received even a single dose. All the while, COVAX has been sidelined.

And it’s very much in our national interests to boost global vaccine coverage to prevent more dangerous variants from coming back to haunt us, even with our more than ample vaccine supplies. After all, the “variants of concern” — those Greek letters that endanger us, including the Delta variant that stole our summer solace — all originated elsewhere, in places where transmission will go unchecked in the absence of vaccines.

President Biden’s donations are only part of the remedy, though perhaps the fastest way to get some doses where they are most urgently needed. But donations are a bandage, not a cure. They won’t enable the world to contain SARS-CoV-2 — or to save millions of lives and energize the global economy. 

Joined by leading figures in global health, we have laid out six elements that should be central to the administration’s response.

First, given how urgent the need is for more doses in lower-income countries, Biden should donate the hundreds of millions of surplus doses the United States is likely to have by year’s end to countries where they are most needed. And the president should accelerate the timeline for donating the billion Pfizer doses he has pledged. 

Second, and with the same aim, the U.S. should permit COVAX and low- and middle-income countries (LMICs) to move ahead of the U.S. in COVID-19 vaccine manufacturers’ queues.

Third, COVAX also needs more funding. Biden should provide the lion’s share of COVAX’s 2022 budget, working with Congress if additional appropriations are required.

Fourth, fundamentally, the world needs far more vaccine doses. The mRNA vaccines can and should be quickly scaled up to produce at least 8 billion doses annually, along with scaling up other safe and highly effective vaccines. An increased COVID-19 vaccine production capacity will not only speed vaccination but will also create enough supply for booster shots as the evidence warrants for people everywhere. Even more critically, it will enable rapid, equitable, global vaccination if current vaccines need to be modified to protect us from new SARS-CoV-2 variants able to evade current vaccines.

While we should increase U.S. production, the only sustainable global solution is to empower vaccine production globally. This will require extensive technology transfer, technical assistance, and funding to help establish robust mRNA and other COVID-19 vaccine production hubs in all regions, including support for the WHO-backed mRNA hub in South Africa. The long era of people in poorer countries left to the whims of wealthier countries for life-saving medical technologies must end forever; regional COVID-19 vaccine production at scale would be a critical start.

President Biden should require Pfizer and Moderna to scale up their production and transfer their know-how to vaccine producers in low- and middle-income countries. While U.S. government contracts can provide significant leverage, the president should not hesitate to use emergency powers under the Defense Production Act. Legislation introduced in Congress, the NOVID Act, which has broad Democratic support, would authorize $25 billion to scale up vaccine production and technology transfer. Much as the United States established the groundbreaking global AIDS program, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) to enable people in even the poorest countries to access AIDS antiretroviral medication, Biden should lead a similar initiative — only on a vastly accelerated timeline — for COVID-19 vaccines.

Fifth, sufficient vaccine supply alone is insufficient to achieve high levels of coverage. Vaccine delivery and administration infrastructure in low- and middle-income countries require billions of dollars in support to enable countries to strengthen cold chains for vaccine storage and transport, train vaccinators, develop the necessary data systems, identify high-risk populations and develop extensive education campaigns to combat vaccine hesitancy. The NOVID Act would authorize $8.5 billion for these purposes. The president should call for, and Congress appropriate — through emergency supplemental legislation if necessary — the NOVID Act’s entire $34 billion authorization.

And sixth, the shared global targets resulting from last month’s Global COVID-19 Summit that president Biden hosted are a good start but mean little without a shared global plan to achieve those targets and save the most lives. The president should now spearhead that plan, collaborating with WHO and other partners. For starters, it should aim to achieve at least 80 percent global vaccination, including across even low-income countries. The 70 percent target is too low given the risk of further highly transmissible variants. The plan should include clear actions, commitments, metrics and milestones to ensure that further vaccine supplies are distributed equitably and go first where they are most urgently needed and that all countries have needed vaccine delivery and administration support. 

Failing to finally move towards vaccine justice will delay the end of this pandemic and mean more dangerous variants, imperiling us all. Justice and U.S. self-interest overlap. President Biden must act now for the sake of all of us.

Eric A. Friedman is a Global Health Justice scholar at the O’Neill Institute for National and Global Health Law, Georgetown University Law Center. Wafaa El-Sadr is a professor of Epidemiology and Medicine, Columbia University. Michelle A. Williams is dean of the Faculty, Harvard T.H. Chan School of Public Health. Lawrence O. Gostin is Faculty director of the O’Neill Institute for National and Global Health Law and professor of Global Health Law, Georgetown University Law Center.