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Vaccines Q & A

Q&A: As Its Cases Ebb, U.S. Can Shift To Global Aid

The Biden Administration is asserting a new global posture in the fight against COVID-19 by sending aid to India and by backing a waiver of intellectual property protections that allows developing nations to access pharmaceutical companies’ vaccine formulas. While cases continue to decline in the United States amid its successful mass vaccination efforts, many nations are struggling with new surges. India has experienced one of the worst resurgences, a wave of new infections that has overwhelmed the nation’s health care system. William Moss, executive director of the International Vaccine Access Center, says the United States should take a more active role in the global battle.

William Moss, Executive Director
May 6, 2021

Should the United States have been more proactive in global vaccination efforts?

It’s understandable and justifiable for the United States to have focused on its own population first. We suffered a terrible pandemic, with the most reported cases and deaths in the world for a long time. In addition, the U.S. government invested heavily in the development of the vaccines that have been very effective at helping us to combat the pandemic. But this is a global concern and needs to be a global fight.

Now that the U.S. vaccination effort has been so successful that we’re worrying about supplies exceeding demand, the United States needs to be a real leader in that global fight. First of all, it’s the right thing to do for humanitarian reasons to assist less fortunate countries. But it also serves the interests of the United States.

We are at an inflection point in the United States and in other high-income nations where we need to turn our attention to the world. We can’t drop the ball in the United States, but we need to turn our attention more globally. The Biden administration has given doses to Canada and Mexico, which reflects our self-interest since those nations border us.

The big challenge right now is the vaccine supply, having enough doses. There are steps countries can take to try to address vaccine inequities and improve global vaccine access. There are increasing discussions with vaccine manufacturers to try to increase that global supply.

Temporary waivers on intellectual property barriers can help scale up vaccine manufacturing in a number of countries.

‘The United States needs to be a real leader in the global fight now.’

How much of a risk is India’s situation to the United States?

The situation in India is a huge risk to the United States when you have transmission of the virus at such high levels as you do in India. It’s a national security risk.

If a variant emerges that can break through or go around our vaccines then we jeopardize all of our efforts to get to where we are today in the United States and elsewhere.

The amount of transmission in India provides the virus opportunities to mutate. What we don’t want to see are mutations that allow variants to evolve in ways to thwart the immunity our vaccines provide.

What is most concerning about the situation in India?

It is striking to see these high levels in India. I’m beginning to wonder if people who were already infected before are getting infected again. It raises the question of whether reinfection is happening in India.

The sad irony is that India has long been one of the largest vaccine manufacturers in the world, particularly for the AstraZeneca vaccine. India has exported more than 60 million COVID-19 vaccine doses to the rest of the world and now they need those doses for their own country.

How do wealthier nations get vaccines and supplies to lower income countries?

First, it’s crucial that the United States is engaging again with the World Health Organization after the Trump Administration had halted cooperation.

The COVAX Facility is the primary global mechanism for getting vaccines to low and middle-income nations. It is part of the Access to COVID-19 Tools (ACT) Accelerator, a global collaboration set up about a year ago with the goal of getting 2 billion doses of vaccines to low-income countries by the end of this year. So far COVAX has shipped over 53 million COVID-19 vaccines to 121 countries. But that’s far below what is needed. They’re targeting health care workers and older adults and the most vulnerable citizens.

The United States has pledged $4 billion to COVAX.

‘Temporary waivers on intellectual property barriers can boost worldwide vaccine manufacturing.’

Are vaccines being distributed equitably around the world?

It’s very clear from our map on the Johns Hopkins Coronavirus Resource Center website that there are gross disparities in vaccination access. Just recently the World Health Organization’s director, Tedros Adhanom Ghebreyesus, commented that of the nearly 900 million vaccine doses as of May 1 that have been administered globally, 81% have gone to high or middle-income countries while low-and-middle-income countries have received just 0.3%.

That is a huge inequity in vaccination access. The United States has been sitting on millions of AstraZeneca doses and has promised to share them with the world since they are not yet authorized for use and we no longer require them to vaccinated U.S. citizens.

The United States and other nations with excess vaccines should donate them to the COVAX Facility or directly to other nations.

What ethical dilemmas do nations face with the current global situation?

One ethical dilemma that I don’t know the answer to is rather interesting. As the United States lowers the age of eligibility for vaccines to younger and younger children, the nation will be faced with the ethical dilemma of vaccinating younger people who are less susceptible to the worst effects of COVID-19 in a nation where a large percentage of adults are vaccinated rather than diverting those vaccines to other countries where health care workers are in desperate need of that protection.

The calculus around that dilemma gets more difficult going forward. It was easy to justify the early singular focus on the U.S. population, but it does get trickier ethically if we start vaccinating children as young as 5 years old while the most vulnerable in other nations are left without vaccines.

‘We also have to continue to support global vaccinations for measles, yellow fever, and polio.’

Have COVID-19 vaccination efforts affected distribution of other crucial vaccines?

The pandemic has impacted other routine childhood vaccinations. There have been disruptions around the world to routine immunization services and to mass vaccination campaigns for measles and yellow fever and polio. The WHO estimates that the pandemic has put at risk over 200 million people, mostly children, for these highly contagious diseases.

As we increase attention on improving access to COVID-19 vaccines for all people of the world we can’t take our eye off the fact that we need to also assure that all of our other vaccines remain available and are delivered to children and people of the world.

William Moss, Executive Director

William Moss, MD, MPH, is Executive Director of the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health.