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Reality Check May 14, 2021

Reality Check #6: The consequences of an ‘America First’ vaccine policy

By Evan Cooper and Mathew Burrows

Key points

  • The Biden administration has been reluctant to distribute surplus COVID-19 vaccine doses to countries in need or to facilitate foreign manufacturing of vaccines. This approach has short-term political advantages, but it is dangerous.
  • The administration’s hesitancy to assist other countries in fighting the pandemic is contributing to two problems: (1) a failure to vaccinate people outside the United States as quickly as possible increases the chances of the domestic vaccination effort being rendered ineffective or obsolete by a mutation and (2) Washington is being seen as selfishly isolationist in a time of immense need.
  • The United States is still the best-suited country to lead a global vaccination effort and could capture a significant diplomatic windfall by doing so.

What’s the issue?

The Biden administration is focused on the response to the COVID-19 pandemic domestically and has only recently shifted its attention to assisting other countries in the international fight against the coronavirus. Vaccines have been quickly distributed in the United States, and the contagion rate is dropping. Meanwhile, infection rates in other countries and regions are soaring. India is now seeing more daily cases than the United States experienced at its peak. While many European countries are getting their outbreaks under control, waves elsewhere have not yet crested. South America is “taking an alarming turn for the worse,” and the risk of a major outbreak on the African continent is growing.

Other countries have begun providing vaccines to struggling states, capturing diplomatic windfalls in the process. China has exported upwards of 166 million doses of its vaccines, offering free doses to sixty-nine countries and commercially exporting vaccines to twenty-eight. Russia has begun shipping its Sputnik vaccine abroad and has signed deals to supply hundreds of millions of doses to over forty countries. The Biden administration’s global efforts have been slow to catch up with those of China and Russia. In March, the administration decided to share a limited amount of the US stockpile of the AstraZeneca vaccine with the United States’ closest neighbors, Canada and Mexico. After weeks of pressure from humanitarian groups, the administration decided on April 26 to provide up to sixty million doses of AstraZeneca to other countries. “Sixty million doses—that’s showing up to a four-alarm fire with an eyedropper full of water,” Asia Russell, the executive director of Health GAP (Global Access Project), told The New York Times. The Food and Drug Administration has yet to certify that the doses meet US standards, ensuring a further delay. Only recently did the administration agree to lift the US export embargo on raw materials needed for India’s vaccine production.

Leading a multilateral response to COVID could advance Biden’s goal of returning the United States to its former role as a trusted global leader. Failing to do so would cost Washington not just diplomatically but economically.

Such stinginess cannot be attributed to expected shortages in the United States. ONE—an anti-poverty nongovernmental organization—estimates that the federal government has secured 550 million more doses than it needs to cover every American.

The domestic political constraints on Biden taking an outwardly internationalist approach to fighting COVID-19 are significant. Most Americans say the United States should not donate any vaccines to other countries until every American has been vaccinated. If Washington starts shipping vaccines around the world, even in modest quantities, it is all but guaranteed that Biden would be attacked by Republicans for putting the lives of foreigners above those of Americans. The Democratic Party is not exerting any pressure to increase vaccine aid globally. Thus, the administration would be punished—more than rewarded—at home for publicly leading an international vaccination effort.

Why does it matter?

Biden’s vaccine policy, which echoes former US President Donald Trump’s “America First” approach in spirit if not in name, has two primary consequences. First, the failure to significantly help countries where the disease is spreading endangers American lives. The more that COVID-19 spreads throughout the world, the greater the chance that a mutation will occur that will render current vaccines less effective or possibly obsolete. Although it is understandable that the Biden administration would prioritize getting the pandemic under control in the United States, a failure to constrain outbreaks globally could make domestic gains futile. The current strategy has short-term political advantages but is dangerous from a national security and health standpoint. 

Second, the harmful perception that the United States is needlessly hoarding vaccines and preventing technology from being shared risks undermining the US image, which otherwise has improved since Biden took over the presidency from Trump. In a time of global catastrophe, the United States is seen as closing its gates. Some foreign leaders say the sequestering of vaccines and their technology is leading to a “vaccine apartheid.” The inequity in vaccine distribution is likely to cause cascading inequalities, with long-term economic and development consequences for the countries that have to repeatedly shut down and suffer a significant number of deaths from COVID.

The administration still has time to respond to other countries’ needs for support. Brazil recently rejected an offer from Russia to provide doses of the Sputnik vaccine, citing an inability to study its efficacy before administering it. Brazil would be an ideal candidate for a robust US response because it has a large population in which the virus has spread quickly and has mutated. India is currently ramping up its vaccine production, which will take months, while suffering the world’s worst outbreak, making it a similarly well-suited candidate for US vaccine aid. Furthermore, China’s ability to manufacture effective vaccines over the long term is in doubt, leaving the United States as the best-positioned country to lead the effort to vaccinate the world.

A high-profile effort from Washington to bilaterally assist countries struggling with COVID-19 and to lead a multilateral response could advance Biden’s goal of returning the United States to its former role as a trusted global leader. Failing to do so would cost Washington not just diplomatically but economically because countries would continue to go in and out of lockdowns, mortality would increase, and trade would be hindered.

What’s the solution?

1 Get caught trying. The United States cannot singlehandedly supply the world’s population with vaccines. Nevertheless, being seen by foreign publics as doing a reasonable amount to help them fight the pandemic could go a long way toward building goodwill. A robust response to disasters has improved foreign publics’ views of the United States in the past, and the amount of praise and coverage that vaccine shipments from China, India, and Russia have received is indicative of the outsized benefit of being seen as helping other countries to fight the pandemic. Sending vaccines to other states is not the only way to be useful, however. Providing the precursors needed to manufacture the vaccines, offering ventilators and oxygen to keep patients alive, and sending doctors abroad could all help build positive perceptions of the United States.

2 Relax IP law and switch to an award system. The United States, which holds the patent on the key technology used to create the Pfizer and Moderna vaccines, could push the companies to make the information available to all. The Biden administration took the first step towards doing so with the announcement that it would support relaxing intellectual property (IP) protections in the World Trade Organization. Although having access to the intellectual property would be useful, technical capacity and access to the materials needed to rapidly increase production are also needed and could be provided by Washington. Over the longer term, the United States should eliminate patent protections for medical breakthroughs and switch to a prize-based model. Innovation would still be rewarded, but large sums would be paid up front to the creators. This would allow a more equitable share of the benefits of health innovations while still incentivizing research.

3 Create a feedback mechanism in the White House. Establishing and implementing a plan to provide global pandemic assistance should be a top-level issue for the administration, but how the response evolves to meet changing realities will be the ultimate measure of its effectiveness. State Department officials should increase their efforts to monitor how foreign publics view US action or the lack thereof, the contributions by competitor states, and the countries where there is the greatest need and opportunity for US support. This is separate from officials consulting global health experts, who can advise on the efficacy of the US response in fighting the pandemic globally. The public diplomacy element should be integrated with the technical response to maximize the soft power returns for Washington.

4 Expand COVID-19 Vaccines Global Access (COVAX) over time. Organized by the World Health Organization, COVAX aims to have 2 billion vaccine doses available by the end of 2021. The Biden administration has already pledged $4 billion to boost vaccine production and its distribution. The group’s mission is to provide doses to vulnerable populations in disadvantaged countries that would otherwise not be able to purchase and distribute the vaccines themselves. So far, however, COVAX has only been able to deliver forty-three million doses. Because its vaccine supplies are mainly manufactured in India, much of its current work will be stymied as long as New Delhi bans vaccine exports while cases surge inside the country. From the beginning, wealthy countries have undermined COVAX by purchasing more than half of available doses and hoarding supplies until their citizens have been vaccinated. The United States and other advanced economies that already have ample vaccine supplies owe it to the struggling developing world to identify and empower alternative manufacturing sites that can boost production while India’s Serum Institute, the largest vaccine manufacturer in the world, is fully absorbed in satisfying Indian needs.     

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