Why America’s Next Covid Push Should Be Outside America

By Gary Edson | April 28, 2021

The unprecedented wave of COVID-19 now engulfing India and the staggeringly high death toll in Brazil pose a challenge to our conscience, and fittingly the Biden administration has already loosened some restrictions on assistance. But to get the scale of our global coronavirus response right, we need to consider it more ambitiously — as both a humanitarian issue and a threat to our national security.

The key issue right now is vaccination. Today, the U.S., EU, China and India account for 70 percent of all COVID-19 vaccine doses administered, and the world’s wealthiest nations have locked up the majority of near-term supply. At the current pace, this means the world won’t reach broad immunity for years.

Instead, the virus will continue to circulate widely and new variants will emerge, as in India, threatening to pierce vaccine immunity in the United States and putting lives and economic recovery at risk. It will also be impossible to normalize travel and trade as long as the rest of the world remains a largely unvaccinated reservoir for the virus.

Top White House officials are split over how much help we can give abroad before the U.S. population is fully vaccinated. But what happens outside our borders now will shape our lives at home for years to come. And only American leadership can address the growing vaccine inequity taking shape across the globe.

The U.S. has already taken some steps, including providing lead funding and support for COVAX, the global COVID-19 vaccine collaboration. The U.S. also recently announced its intent to share up to 60 million doses of the AstraZeneca vaccine, as well as to release some supplies set aside for further vaccine production. But it’s not enough. These efforts should be the start of a three-pronged comprehensive strategy to contain the virus.

First, the U.S. should continue to drive support for COVAX. But even if COVAX closes its $1.5 billion-plus funding gap this year, it would still vaccinate only a quarter of the population of the world’s 92 poorest countries — assuming it can get access to adequate vaccine supply. COVAX is essential but insufficient.

Second, the U.S. should lead the development of a multilateral initiative for high-income countries to share excess vaccine doses, ahead of the G7 Summit in June. This is possible while maintaining adequate supply to keep their own citizens protected, including if boosters are needed. Including the AstraZeneca vaccines already announced, we estimate that the U.S. could have 300 million excess doses by July. The EU and other countries will be able to add significantly to this total. Timing is critical — doses not needed until later should be shared now, when needs globally are most urgent, with a clear plan to replenish supply in time based on expanding manufacturing capacity.

Third, the U.S. should lead a strategy to further increase reliable vaccine production and distribution capacity globally through public-private partnerships with experienced manufacturers.

This is a different approach than waiving patents and other intellectual property protections for vaccines, as India, South Africa and 100 other countries have proposed. Simply waiving patents won’t close the vaccine gap reliably or quickly.

Getting safe and effective vaccines into arms is a massive end-to-end effort, requiring reliable sourcing of sufficient quantities of high-quality ingredients, like lipid particles; extensive technical knowhow for the complex manufacturing processes; robust regulatory oversight; and indemnification with no-fault compensation for adverse events to ensure experienced manufacturers participate. Without such a comprehensive approach, patent waivers could lead to quality problems that diminish vaccine effectiveness, cause safety issues and exacerbate vaccine hesitancy.

In contrast, strong American leadership can bring the highly effective and reliably manufactured vaccines used in the U.S. to the rest of the world.

Our experience with the President’s Emergency Plan for AIDS Relief (PEPFAR), which used U.S. leadership to globalize safe and effective treatments for the AIDS virus, helps show the way. This strategy would involve voluntary licensing agreements to share knowhow to expand existing production capacity; a cooperative plan to develop adequate supplies of key ingredients; FDA regulatory guidance; liability protections; and vaccine pricing at nonprofit levels.

As part of the effort, the U.S. could spearhead the development of additional vaccine manufacturing capacity in Africa and Asia, working closely with regional groups like the African Union and Africa CDC, alongside private investors. Financing for the needed capital expenditures could be led by the U.S. International Development Finance Corporation, potentially in collaboration with the International Finance Corporation through its Global Health Platform.

The U.S. could help finance initial advance purchase contracts for these manufacturers, and enable the FDA, in collaboration with WHO, to support a tentative approval process for the resulting vaccines, as has been done for drugs under PEPFAR. The U.S. also could support an extension of the PEPFAR infrastructure to facilitate vaccine distribution.

The history of global health crises tells us that strong American commitment is essential for success. A U.S.-led initiative would save lives and serve as a strategic complement to China’s efforts to expand its influence by pushing its own vaccines.

At this moment of global crisis, with hope fading in some parts of the world, we must swiftly meet trauma with mercy and inequity with action. The pandemic will not end here until it ends everywhere. U.S. leadership in fully funding COVAX, sharing excess doses and increasing high-quality manufacturing of proven effective vaccines can do just that.