international analysis and commentary

Biden’s ambitions and the vaccines’ realities

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In his 2020 campaign, Joe Biden made the point that under his presidency the US would step back into the role of global leadership it had relinquished during Donald Trump’s administration. However, he is taking time – too much, according to critics both inside and outside the US – to actively pursue the most important opportunity to build back lost soft power: vaccine diplomacy.

Until June, the US government’s actions to promote global access to vaccines had been timid at best. The administration had donated only about 19 million excess vaccines (with a pledge to deliver about 90 million more) to low-income countries – not enough to make a noticeable difference in a world that needs billions of doses.

Boxes containing the Moderna vaccine are prepared to be shipped at the McKesson distribution center in Olive Branch, Miss. (Source: NBC)

 

China, on the other hand, had been moving swiftly. By April, it had donated its Sinopharm vaccine to 53 countries, and exported it to 27, using the vaccine – as it had done with personal protective equipment early in the pandemic – as a way to strengthen allegiances, especially in countries where it already had strong economic interests.

Eventually, the US increased efforts. In early June, ahead of the G7 summit in Cornwall, it pledged to donate 500 million doses to countries in need. The commitment then served as a model for the rest of the group, which altogether pledged one billion doses to be delivered within a year, the majority by the end of 2021.

The US also put its weight behind a proposal to be discussed at the World Trade Organization that would suspend patent enforcement for COVID-19 therapeutics (including vaccines) until the pandemic is over. The proposal, led by India, South Africa and other low-income countries, is opposed by big pharma, which is concerned about profits and is pushing for countries to share vaccines, rather than know-how. Several European countries are siding with drug makers, which makes the US position all the more unusual, especially considering that the US government has traditionally sided with corporations.

After years of “America First” policies, the change is remarkable. But in such an unprecedented crisis, the US commitment – not to mention, the G7’s – comes short of the transformative impact it would need to have. A billion doses might seem like many, but they barely scratch the surface of the global need for vaccines, which is estimated to be at least six billion.

Despite programs such as Covax, which was supposed to distribute two billion doses to low- and middle-income countries by the end of the year, and the World Health Organization’s (WHO) repeated calls for equitable distribution, vaccine inequality is rampant.

The pandemic – in which some had initially seen a great global equalizer – is moving at two speeds. Rich countries have reached high levels of immunization: in the US, nearly 70% of the population will have received at least one dose by early July, and Europe isn’t too far behind. Mask mandates are being lifted, travel is resuming, the economy is coming back.

Meanwhile, much of the world is still being ravaged by new, aggressive waves of COVID-19. From India, to South Africa and Nepal, families are begging for oxygen and hospital beds. Covax has been hitting delays since its inception, while 99% of people in poor countries remain unvaccinated, and supplies are a slow trickle. The G7 pledge of a billion doses is a step in the right direction and provides more sizeable help than the few millions donated before, but it still perpetuates the reality by which rich countries are accessing immunization first, and poor ones will have to wait for the leftovers.

The vaccine procurement plan in place for the next two years shows this disparity – ”vaccine apartheid” as WHO Director-General Tedros Adhanom Ghebreyesus called it – is likely here to stay. By 2023, the EU has secured enough doses to cover its population 6.6 times around. The US has put in orders that would cover five doses per citizen. Canada has plans to get more than 10 doses per person. The UK will have eight per citizen.

The rationale is simple: Booster shots will likely be needed even after vaccination is complete, and countries want to have their orders in for the necessary doses to protect their populations.

But at the speed things are moving, most poor countries won’t even have completed the first round of vaccination by then, making the Western hoarding strategy rather short-sighted. Since the beginning of the pandemic, the global health community has been pushing back against vaccine nationalism with the warning that “COVID anywhere is COVID everywhere.” Reaching global herd immunity – or at least the base level of immunization of at-risk categories around the world – offers better protection than full vaccination of the population of a few countries.

Recent developments prove their point. In India, where less than 11% of the population is vaccinated, the recent deadly COVID-19 wave led to the emergence of the highly contagious Delta variant, which is spreading rapidly in the UK and US.

This, too, happens at a time when the US is encountering the first significant slowing down of vaccination. Biden had set a goal of vaccinating 70% of the American population by July 4 but missed it: 34 states are lagging behind schedule, and many adults under 30 are deciding to skip the vaccine as they feel less threatened by the virus.

It might seem so in certain parts of the world, but the pandemic is far from over. To leave a true mark, the US has to lead a much bolder strategy that focuses on equal distribution and the sharing of know-how to increase production.

Only a global approach can solve this global problem. It isn’t just a matter of ethics, but safety. Until action is taken to move away from vaccine nationalism, the risk that vaccine-resistant variants might emerge continues to loom, putting in danger lives everywhere – including in countries that have now found, in their easy access to vaccines, some sense of safety.