WASHINGTON – The Biden administration is besieged with requests from foreign leaders for help accessing COVID-19 vaccines.
But while President Joe Biden has vowed the U.S. would be “an arsenal of vaccines” for the world, his advisers have yet to detail how or when the United States would begin sharing the U.S. supply. Instead, Biden has repeatedly said his administration would help the rest of the world only after all Americans have access to the vaccines.
That position is increasingly untenable, particularly in the face of India’s deepening COVID-19 crisis and a growing global chasm in vaccination rates, global health experts and advocates say.
India broke another record this weekend with more than 400,000 daily new cases, while its daily death toll doubled over the course of 10 days (April 19-29). Independent reporting suggests deaths are vastly undercounted.
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“We are not dealing with one COVID pandemic. There are multiple strains involved, multiple pandemics really, in different parts of the country,” said Manoj Gopalakrishna, CEO of the nonprofit group CARE India.
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In Delhi and other cities, the health care system is “completely overwhelmed,” he said, with ill patients parked outside hospitals waiting for beds to become available and frontline workers running out of oxygen and other supplies.
Gopalakrishna noted that India only has 95,000 critical care beds for its population of 1.4 billion people. The country needs everything right now – from emergency supplies to COVID-19 vaccines, he said.
As the crisis in India became more urgent last week, the White House said the U.S. would share as many as 60 million doses of the AstraZeneca COVID-19 vaccine once it receives federal approval in the coming months. And the U.S. Agency for International Development began airlifting emergency supplies to the country, including oxygen cylinders, rapid diagnostic tests and 100,000 N95 masks to help India protect its frontline health workers.
“Our assistance, we hope, will have a catalytic effect on society more broadly here and around the world to come to the aid of the Indian people,” said State Department spokesman Ned Price.
Those are “great, welcome steps, though it has been a little late,” said Gopalakrishna, though he said initial frustration has softened into appreciation.
Gayle Smith, the State Department’s coordinator for global COVID response and health security, said the U.S. intends “to remain fully engaged and do what we can to get through this crisis period … this is going to need urgent and persistent attention for some time.”
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Meanwhile in the United States, infection and death rates are dropping as the Biden administration continues its aggressive vaccination campaign. About 43% of Americans have received at least one COVID-19 shot, compared to less than 9% of India’s population, according to Our World in Data.
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‘It is an apartheid’
Globally, more than 1 billion vaccine doses have been administered – with 82% of shots given in high- and middle-income countries and just 0.3% in low-income countries, according to the World Health Organization.
“It is an apartheid,” Winnie Byanyima, executive director of UNAIDS, said during an April 28 briefing hosted by the ONE Campaign, an anti-poverty and global health nonprofit. “We knew it was coming. We have allowed it to happen.”
The vaccine divide could be further exacerbated by India’s current crisis. India is home to the world’s largest vaccine manufacturer, but the country has restricted COVID vaccine exports amid its domestic surge.
International aid groups and global health advocates are ramping up pressure on the U.S. and other G7 countries to take a range of steps to expand vaccine access – from sharing more of their own doses to waiving pharmaceutical companies’ vaccine patents.
“Look, I get it. Wealthy countries hedged their bets early on” in the pandemic when it was unclear when vaccines would become available, said Tom Hart, acting president of the ONE Campaign.
“But now that vaccines are rolling out, that hedging looks like hoarding,” Hart said.
But the politics – both global and domestic – are fraught for Biden. He has promised to craft a foreign policy that works for America’s middle class, a twist on the Trump administration’s isolationist “America First” doctrine. At the same time, Biden has vowed to restore America’s standing as a leader on the world stage.
Perhaps nowhere are those two pledges more in conflict than with COVID-19, as Biden races to save American lives and reboot the U.S. economy while confronted with desperate pleas for help from key allies, like India, and neighbors, like Canada and Mexico.
“The president’s calculation remains rooted fundamentally in the concern about what’s happening here domestically,” said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, a Washington think tank.
But Morrison and others that approach is both dangerous and wrong.
“It’s going to aggravate our allies, and it’s going to feed the narrative that we’re sailing into radically divergent outcomes in the world,” he said. The U.S. and the United Kingdom, among other countries, are headed toward “a very positive set of outcomes,” Morrison said, “but the vast majority of low- and middle-income countries are going to be looking at no solution until 2023.”
With the U.S. situation improving, he said, “we should be moving immediately to pivot toward significant (vaccine) sharing” and using U.S. influence to create a more coherent global strategy, including rapid expansion of manufacturing capacity and technology transfers.
Smith said officials are still in the process of crafting a U.S. plan.
“There is huge demand for vaccine all over the world,” Smith told reporters during a briefing on Friday. “To be honest, we have not made a decision yet as to the criteria for allocating those vaccines.”
Smith said decisions would be based on “what impact we can have on the spread of the virus (and) where needs are most acute.”
Biden’s advisers say the administration is committed to a global response and note the White House has already pledged $4 billion to COVAX, the global vaccine alliance dedicated to helping poor countries inoculate their populations. The White House has also promised to advance 4 million AstraZeneca vaccine doses to Mexico and Canada.
Smith noted the U.S. is already the largest donor to COVAX.
“This is going to be a steady process for some time,” she said. “It’s a huge operation.”
More: US to share up to 60 million AstraZeneca COVID-19 vaccine doses with other countries
When there’s a ‘five-alarm fire’ at a neighbor’s
Arthur Caplan, a professor of bioethics at the NYU School of Medicine in New York City, said the White House was right to engage in a bit of “vaccine nationalism” when the rollout of shots began. The U.S. then led the world in deaths, he noted, and Biden was justified in focusing on Americans first.
“You don’t wake up in the morning and say, ‘Well, I could feed my kids, or I could feed kids in Africa. I guess I’ll flip a coin’,” he said. There is a moral obligation in a crisis, he said, to help “your friends, your neighbors, and even your country.”
But the dynamics have shifted now, he said, with U.S. infections and deaths on the decline and vaccination rates on the rise. The White House should be debating where to ship vaccines, not whether to ship them, he said.
Although the instinct might be to help poor countries first, that might not be the fastest way to end the pandemic, Caplan added, noting, for example, that India has a limited capacity to vaccinate its population right now – about 3 million shots per day.
“Brazil and India may need equipment – ventilators, protective gear – much more right now than they need vaccines,” Caplan said, while Canada and other wealthy nations may benefit more from an infusion of U.S.-purchased vaccines. The U.S. also needs to help other countries develop manufacturing capacity, he said.
“It’s the long-term answer,” he said, because every country will need COVID booster shots, as well as possible new vaccines to combat variants of the virus. Otherwise, “the world is just going to be doing this again and again.”
There’s no question the U.S. has an adequate vaccine pipeline.
Last year, the Trump administration pre-purchased 300 million doses of the AstraZeneca vaccine, 200 million each from Moderna and Pfizer-BioNTech, and 100 million each from Johnson & Johnson and Novavax, all to be delivered after the vaccines were authorized. The Biden administration, which took office Jan. 20, has purchased another 100 million doses each of the Moderna, J&J and Pfizer-BioNTech vaccines.
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The U.S. will have enough vaccine doses to meet U.S. demand for the vaccine in mid-to-late May, according to an April 20 analysis by the Kaiser Family Foundation. Then the U.S. will hit an “enthusiasm limit” among those who remain hesitant to get inoculated, although more Americans could drop their objections and line up.
“It appears we are quite close to the tipping point,” the Kaiser report says.
The longer the Biden administration puts off sharing its vaccine surplus, the greater the risk that more virulent COVID-19 variants emerge and circle back to hit the U.S. population, Caplan and others warned.
“This is very, very frightening as we look at what’s happening in India – both in and of itself and what it could mean to the next evolution of this pandemic,” said Hart.
He called India a “harbinger” as low-income countries with weak health systems and densely populated cities suffer catastrophic outbreaks.
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Morrison said he understands that Biden “doesn’t want to be diverted in any way from getting control over the pandemic in the United States, and we are not yet there.“ There are fears about the COVID variants causing new spikes in the U.S., along with ongoing efforts to overcome vaccine hesitancy among key populations.
But “we have to walk and chew gum,” he said. “We’ve got to finish what’s a very promising vaccination campaign in the United States, but not delay in addressing these other five-alarm fires that are going on.”
Contributing: Karen Weintraub and Mike Stucka