The United States is well on its way to protecting Americans from the coronavirus. It’s time to help the rest of the world. By marshaling this nation’s vast resources to produce and distribute enough vaccines to meet global demand, the United States would act in keeping with the nation’s best traditions and highest aspirations while advancing its geopolitical and economic interests. It is a moment of both obligation and opportunity.
Unfortunately, instead of a bold, comprehensive strategy to vaccinate the world as quickly as possible, the Biden administration has thus far made a string of tactical decisions: donating millions of doses to countries in need, signaling its support for patent waivers that might expedite vaccine production efforts and nudging two companies — Merck and Johnson & Johnson — to collaborate on increasing supply. These are good steps, but they are not nearly sufficient to meet the moment. The United States and the rest of the world’s wealthiest nations are facing a great moral challenge.
Covax, the World Health Organization’s initiative to pool vaccine resources, remains profoundly underfunded and has failed to meet even its modest target of vaccinating one-fifth of the population in the Global South. Without a major course correction, the rest of the world will have to wait until 2023 or later for large-scale vaccination initiatives like the one underway in the United States. The consequences of this disparity are expected to be severe. Hundreds of thousands more people will get sick and die from a disease that is now preventable with a vaccine. The global economy will contract by trillions of dollars, according to the International Chamber of Commerce, and tens of millions of people will plummet into extreme poverty as the virus continues to fester and evolve in the world’s more vulnerable reaches.
As global hunger rises and global life expectancy falls, instability will prevail. Already, Colombia is mired in deadly protests over the pandemic’s economic fallout. India is facing its gravest humanitarian catastrophe in a generation. As the United Nations has warned, a similar crisis in Syria would be catastrophic.
President Biden can start by announcing that the United States intends to help and by appointing a vaccine czar to oversee the expansion of vaccine production. The federal government has ample legal power to compel the participation of the pharmaceutical companies, including the sharing of critical information and technologies. Congress has appropriated $16 billion to scale up production, most of which remains unspent.
Increasing manufacturing capacity has proved tricky. The global demand for vaccines may be high now, but once the coronavirus pandemic recedes, it will plummet back to normal levels. Increased public ownership, for its part, would ensure that vaccine-production capacity is ready for future pandemics, which are inevitable — potentially including new coronavirus variants for which routine boosters may be required.
To this end, the administration should consider taking a page from the Department of Energy playbook: Create publicly owned manufacturing facilities and contract with private companies to run them. (Several of the D.O.E.’s federally owned laboratories are run by private companies like General Electric and Bechtel.)
The H.I.V. advocacy group PrEP4All estimates that for $4 billion — less than the country is spending per day on coronavirus response efforts — the federal government could build enough manufacturing capacity to vaccinate the entire planet against the coronavirus. It will cost much more to actually make the needed doses, of course. The nonprofit advocacy group Public Citizen estimates that a $25 billion governmentwide initiative would produce around eight billion doses of mRNA vaccine, or enough to vaccinate half the planet. That’s far less than the trillions that could be lost if the economy contracts further as the pandemic persists.
Mr. Biden could task his Biomedical Advanced Research and Development Authority, or BARDA, with setting the parameters of any final program. But it would also make sense for the United States to start by focusing its global efforts on the mRNA vaccine created by Moderna and the National Institutes of Health: mRNA shots are both cheaper and easier to manufacture in massive quantities and should be much easier to modify as new variants emerge and regular boosters become a necessity. What’s more, the federal government has already invested heavily in the Moderna shot, which does not require deep-freeze storage, as Pfizer’s mRNA vaccine does.
Efforts to dramatically increase domestic production should be paired with efforts to do the same elsewhere. The coronavirus is here to stay for the foreseeable future. If new variants require different boosters and localized outbreaks require rapid response, it will be far easier to manage those eventualities with regionally concentrated supplies. That kind of distributed capacity will also leave the world much better prepared for future pandemics.
Low- and middle-income countries have been clamoring for the chance to manufacture their own doses — many of them have infrastructure that could be repurposed, and expertise making other complicated pharmaceuticals that could be built upon. If wealthier nations are concerned about those countries’ ability to manage this challenge safely or quickly, they should step in to help. This worked before. The 2004 BARDA initiative to increase flu vaccine production in low-income countries achieved a fivefold increase since the program began. While the work was hard, the strategy was simple: Invest in companies in low-income countries, help them build facilities and support them as they cultivate expertise.
Likewise, PEPFAR, the President’s Emergency Plan for AIDS Relief, offers a road map for how to manage vaccine rollout in lower-income countries. Since its start in 2003, the initiative has saved an estimated 20 million lives and brought that epidemic under control in several countries, thanks to sustained investment and rigorous on-the-ground support.
The upcoming Group of 7 meeting offers a perfect opportunity for Mr. Biden to push other high-income nations to also step up their contributions to global vaccination efforts. A global vaccine summit — where world leaders and vaccine makers could work out a concrete plan for sharing technology and scaling up manufacturing efforts to meet global needs — would also be useful.
Vaccinating the globe will require leadership and a level of international cooperation that many people may consider impossible. But if the United States provides that leadership and demands that cooperation, millions of lives will be saved, and the world will have a new template for solving some of the many challenges that transcend our borders.
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May 15, 2021 at 02:00AM
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