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Engagement Reframed February 1, 2022

Engagement Reframed #1: Vaccinate the world

By Mathew Burrows and Evan Cooper

Key points

  • With the spread of the Omicron variant appearing to be on the wane, the Biden administration should accelerate its efforts to vaccinate the developing world, where the virus could further mutate and produce yet more contagious variants.
  • Over the long term, the United States and other Western countries should help poor countries develop their own capacity for manufacturing vaccines, so that if another pandemic occurs, they will not be “left behind,” putting the rest of the world at risk.
  • The efficacy of Western-produced mRNA vaccines over Chinese vaccines creates an ideal opportunity for the United States to rebuild its soft power by leading a campaign to inoculate the almost half of the world’s population that remains unvaccinated.

What is the opportunity?

The COVID-19 pandemic continues to rage around the globe, taking millions of lives. A better US-organized campaign to vaccinate the world’s population could drastically lower the risk of even more dangerous variants than Delta and Omicron threatening global health. With its mRNA vaccines proving to be more effective than others, the United States is well positioned to lead an international vaccination effort. Doing so, however, will require an increased commitment. A quick distribution of vaccines throughout the world would not only save millions of lives, including those of Americans, but it would also spur a global economic recovery and create diplomatic windfalls for Washington. 

Vaccines produced in the United States have proven their effectiveness in combating the pandemic. The efficacy of the Pfizer-BioNTech and Moderna vaccines at preventing serious illness, including from the Omicron variant, makes them one of the greatest medical innovations in world history. Nevertheless, all immunity wanes; thus time is of the essence. Getting as many people as possible vaccinated in the next few months will reduce the circulation of the virus as well as the potential for more mutations to occur. 

Each mutation poses the threat of creating a deadlier and more transmissible version of the virus, which could prolong and exacerbate the pandemic. Mutations could also render current vaccines less effective—as has occurred with the Omicron variant—and repeatedly set back vaccination drives. Rapidly vaccinating as wide a swath of a population as possible is crucial for preventing new, harmful variants.

A concerted US effort could be the tipping point for getting the pandemic under control, which would position Washington to play a leading role in global health reform.

In addition to being a moral imperative, reducing vaccine inequality would also give the global economy a much-needed boost. An analysis by the United Nations Development Program found that economic recovery is expected to occur more quickly in countries with high vaccination rates: global GDP is expected to increase by approximately $7.93 billion for every one million people vaccinated. As International Monetary Fund (IMF) Managing Director Kristalina Georgieva said last year, vaccine policy is economic policy. The cost of manufacturing and distributing vaccines—estimated by Organisation for Economic Co-operation and Development Chief Economist Laurence Boone at $50-$70 billion—pales in comparison to the potential economic upside. The cost of not doing so is even more stark. According to the Congressional Budget Office, premature deaths and lost productivity caused by the pandemic will cost the United States alone $7.63 trillion over the next decade. Another analysis projected that the United States will lose $16 trillion from the effects of COVID, with Microsoft developer David Cutler and economist Lawrence Summers calling the pandemic, “the greatest threat to prosperity and well-being the United States has encountered since the Great Depression.”

Studies already support a strong correlation between increased economic activity and higher vaccination rates. A group of IMF economists examined how the administration of vaccines correlated with rates of daily nitrogen dioxide (NO2) emissions—an indicator that is strongly linked to industrial production and that can be used to measure overall economic activity. They found a significant correlation between increased NO2 emissions and higher vaccination rates. For every shot the United States can administer around the world, the global economic outlook—including the outlook for the US economy—improves.

Meanwhile, if the United States seizes the moment and takes a leading role in vaccinating the world’s population, Washington could experience a diplomatic boon. China, Russia, and India have all recognized the goodwill and other benefits associated with donating vaccines to other countries. A concerted US effort, appropriately branded and publicized, could be the tipping point for getting the pandemic under control. In addition to the lives saved and the economic benefits, such an effort would position Washington to play a leading role in global health reform, helping to forge a system that could more quickly and effectively respond to future pandemics. Eric Lander, President Joe Biden’s science advisor and director of the White House Office of Science and Technology Policy, has called for better early warning systems, operational vaccines within 100 days of detection, and more home diagnostic kits in order to avoid another tragedy like the current pandemic. 

Why now?

Now is the opportune time for the United States to take the lead because health experts have increasing doubts about the effectiveness of China’s Sinopharm and Sinovac vaccines against the variants. China is scrambling to develop its own mRNA vaccine owing to widespread lack of trust, even among its own public, in its existing vaccines. Pre-clinical trial tests with two Chinese mRNA vaccines under development—Walvax and Abogen—show a robust antibody response against coronavirus during the animal-testing phase. Analysts disagree about how fast Chinese pharmaceuticals could produce at scale the mRNA vaccines should their human trials prove successful. 

Although COVID-19 Vaccines Global Access (COVAX)—a worldwide initiative aimed at creating equitable access to COVID-19 vaccines—recently distributed its billionth dose, it missed its overall 2021 target of 2 billion doses because of a lack of donated supplies from rich countries. The World Health Organization (WHO) is calling on companies and governments to help reach a vaccination target of 70 percent of each country’s population by the end of 2022. Africa remains the continent lacking the most coverage, with less than 10 percent of its population having been vaccinated. Africa accounts for almost two-thirds of the global total of new HIV infections, which makes the continent particularly vulnerable to the spread of the virus and forces it to combat two public health emergencies at once.       

India’s Serum Institute, which produces most of the vaccines for COVAX, had to stop its exports last April in order to supply the domestic market, which was struck by a large second wave. It resumed exports in October but has had difficulty getting vaccines to countries in need due to a lack of cold storage facilities in many of those receiving countries. In October, more than 160 former world leaders and global figures called on the United Kingdom (UK) and other rich countries to immediately airlift millions of surplus COVID vaccines to less-developed nations. Even if that happens, many poor countries lack the logistics and cold-storage facilities necessary to provide vaccinations to millions of people a day. Recently, the new Novavax vaccine has been shown to be effective against Omicron (with three shots); Novavax could also help alleviate the logistics problem because it can be stored in a conventional refrigerator. COVAX has ordered 1.1 billion doses to be manufactured by the Serum Institute while the UK, the United States, and European countries other than the UK have booked orders for 60 million, 110 million, and up to 200 million doses, respectively.

For some time, the WHO has complained about rich countries ignoring the plight of poor countries that cannot afford the cost of Western vaccines and must instead rely on COVAX or donations from other sources to meet their needs. Owing to the recent decisions by Western countries to order additional booster doses for their whole populations, including in some cases even young children, experts estimate that there will be a three billion–dose shortfall globally in the first quarter of 2022, further delaying the timetable for vaccinating poor members of the global population. As of mid-December, the number of boosters dispensed in the world’s richest countries had grown by 5.5 million each day, and COVID boosters in rich countries outnumbered all the vaccine shots given in poor countries. In the United States, booster shots have been authorized for children twelve years old and up. 

The Biden administration announced last November a plan to invest billions in US companies making mRNA vaccines to be given to poor countries. Early reports indicated Moderna and Pfizer were studying the plan, while critics questioned how fast production could ramp up to produce the extra doses. The administration’s goal is to produce one billion extra doses in 2022, but in the last few weeks, administration officials have reportedly been worried that the growing demand for boosters will squeeze out the capacity for producing extra doses for poor countries. Critics charge that the United States should be able to provide enough doses to meet its own needs and those of other nations, particularly because it is in Washington’s interest to have the bulk of the world’s population vaccinated. Nongovernmental organization advocacy groups have called on the Biden administration to pursue a government-owned, contractor-operated manufacturing model if companies such as Pfizer and Moderna are able to boost their production for developing countries. 

How to make it happen

The United States can immediately take several steps to increase global vaccination rates. An article featured in Harvard Business Review in mid-2021 offered a number of ways to increase global vaccine supply, many of which remain relevant today and are discussed below, along with additional ideas for diversifying supplies and encouraging wider distribution:

1. Improve the flow of raw materials essential for production of vaccines. Late last April, the United States announced that it would ease restrictions on the export of raw materials needed for India’s Serum Institute to produce the Covishield vaccine based on AstraZeneca’s design. A typical vaccine-manufacturing plant uses around 9,000 different materials sourced from some 300 suppliers across approximately thirty different countries, according to an International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) estimate. The absence of just one of these elements can have a crippling impact on production. Indian vaccine makers struggled to access materials before the US export ban was eased even as Pfizer and Moderna, two American pharmaceutical companies, benefited from a key raw material from India for their mRNA COVID-19 vaccines. Recently, vaccine manufacturers have warned that limits on raw materials are constraining their ability to produce new doses. Those constraints would deepen if the manufacturers had to produce a new vaccine to counter a more potent variant. The United States and its allies should push for an international agreement that requires all countries to remove trade barriers that disrupt the global flow of both materials for making vaccines and ancillary supplies. 

2. Expand vaccine-manufacturing capacity. As noted, boosting production is especially important for developing countries which, outside of India, lack the ability to produce vaccines. To be sustainable, such facilities need to achieve “cost economics,” which would involve producing not just COVID vaccines but others for combating current and future diseases. Harmonizing regulatory processes could speed up the production and distribution of vaccines during emergencies. The WHO emergency-use-listing procedure provides a global mechanism to streamline regulatory pathways, but many countries require local clinical trials as well as additional steps before authorizing a vaccine.  

3. Encourage allies and partners to grant the TRIPS waiver. Although many experts believe increasing manufacturing outside existing centers in the United States, Europe, and India should be the priority, it is important for Washington to encourage its allies and partners to support the Agreement on Trade-Related Aspects of Intellectual Property Rights or TRIPS Agreement waiver proposal at the World Trade Organization (WTO). Doing so would temporarily waive intellectual property rights protections for technologies needed to prevent, contain, or treat COVID-19—including vaccines and vaccine-related technologies. The waiver would allow WTO member states to issue licenses to firms other than those that hold a particular patent to produce and market a patented product without the prior approval of the patent-rights holder; this allowance would encourage pharmaceutical firms in the developing world to produce COVID vaccines. More than one hundred low-income countries support the waiver, but most rich countries, including Australia, Canada, EU members, Japan, and the UK are opposed. The United States announced its support last May but has not gone much further than rhetoric.

The success of the mRNA vaccines gives the United States an opportunity to rebuild its soft power. President Biden has talked about the United States becoming the vaccine producer for the world, saying at an international conference on COVID, “I made—and I’m keeping—the promise that America will become the arsenal of vaccines as we were the arsenal of democracy during World War II.” Biden and his administration should work with the international community, not just allies and partners, to make sure that the WHO meets its goal of getting 70 percent of every country’s population vaccinated by the end of 2022. Achieving such a goal faces stiff challenges, and there will always be domestic demands, but a combined effort in which the United States takes a lead is possible. After all, at the height of the Cold War, the two opposing antagonists, the United States and the Soviet Union, cooperated to end polio—the scourge of children in both countries and around the world at that time. What was possible then should certainly be doable today.

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