US needs to ensure developing countries access to COVID-19 vaccine

The United States needs to lead in global efforts to supply COVID-19 vaccines to the developing world. Helping developing countries to tackle the coronavirus pandemic is a moral imperative — and is in the U.S.’s own best interest: Until enough people are vaccinated around the world, across dozens of countries, modern life as we have come to know it will not return.

What’s more, efforts to stamp out the virus early on will avoid future deadlier strains or mutations that are more difficult to treat.

Solving the vaccine problem for developing countries will garner large geo-strategic and economic benefits for the United States. Are we really willing to allow Russia and China to seek to and possibly succeed in providing vaccines to the developing world, projecting their leadership and influence? Just standing on the sidelines and criticizing China providing vaccines (as we did when China provided ventilators, personal protective equipment and face coverings and masks) won’t cut it. 

Getting “credit” for solving other countries’ COVID-19 problem isn’t just about restarting international commerce, vacations, and study abroad. This is about ensuring the U.S. remains the world power and not China.

If China is seen as “solving” the world’s COVID-19 problem, this will be a geo-strategic catastrophe for U.S. influence and prestige far beyond global health.

Solving big problems like COVID-19 gives the U.S. a “social license to operate” as the world’s hegemon. Demonstrating solidarity with the other countries in the rules-based system is also important for the United States. Failure to solve the world’s COVID-19 problem means we seriously risk ceding moral leadership to China and missing a chance to cement cooperation efforts with strategic partners like the United Kingdom and Germany.

A proven effective vaccine is not yet available. Over 150 vaccines are in various stages of development, and 11 main candidates are in the phase of large-scale efficacy tests. Six Russian and Chinese vaccines have been accelerated and approved for early and limited use, but the safety and effectiveness of these vaccines is still unclear. The development of a vaccine is challenging, but so is its production and distribution. Many of the COVID-19 vaccines will require very complex and potentially expensive “cold chains,” where vaccines need to be specially handled and kept in continuous dry and cold storage throughout the entirety of the distribution process. This will require a well-structured and optimized logistics management system and sufficient infrastructure to execute.

Convincing people to get vaccinated is yet another hurdle.

Safe and effective vaccines will most likely not be readily available for the whole U.S. population until mid-2021 at the earliest, with the entire global timeline presumably extending beyond that. For developing countries, this production and distribution challenge may signify an even longer wait as they will need to depend on richer countries and global access efforts to ensure they are not just waiting at the back of the line. Vaccine distribution to the developing world will likely take 2 years or potentially longer, and will require more attention to supply chains and immunization infrastructure to ensure proper distribution.

The attention in the United States has been primarily focused on how quickly the government and the healthcare system can get access to, and distribute, effective vaccines domestically to places like Indiana, Minnesota, and Georgia. But there is pressure from the international community to help provide vaccines to countries such as Indonesia, Mali, and Guatemala. The U.S. Congress has passed spending legislation that included significant global COVID-19 response funding, but those funds are largely committed and will not cover the significant cost of global vaccine supply and access. Congress must act for this to happen.

Asserting global leadership for vaccine access is beyond the reasonable scope of any current program. Instead of reinventing the wheel bilaterally, the obvious solution is to work in cooperation with other countries through Gavi, the Vaccine Alliance, an international partnership that has successfully shaped markets and delivered new vaccines to poor countries for two decades. Gavi’s model involves governments, vaccine industry leaders, and national immunization programs — bringing assets to bear all within the global rules-based system. It is an undisputed success story, and its partnership model is an enormous asset for the U.S. to tap.

There is no real estimate of what it will cost to immunize a large portion of the world’s 7 billion people — or who pays for it. The global immunization efforts for polio cost the world about $20 billion over 30 years, with the U.S. footing less than half of the total. The cost for immunizing a large portion of the world’s population against COVID-19 will likely be multiples of that, but no one has so far been willing to venture a guess.

Gavi is currently one of the leaders of a larger global effort to develop, produce and provide equitable access to coronavirus tests, treatments, and vaccines. Within that larger effort, most important for global vaccines access is COVAX, co-led with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO), focusing on providing vaccines to the least developed countries. COVAX aims to have 2 billion doses ready for distribution by the end of 2021, targeting high-risk persons and frontline workers. Vaccines will only be offered if they have been proven to be safe and effective through regulated clinical trials. COVAX hopes to raise $2 billion by the end of 2020 to help with initial funding.

The United States complicated its leadership pathway by withdrawing from the WHO.

With 183 countries worldwide either participating or receiving aid from the COVAX initiative (pending formalized agreements), the United States remains outside this global coalition, along with four other countries: Russia, Belarus, Kazakhstan, and Malaysia. China, after missing the initial deadline to join, has recently signed on to COVAX. It intends to contribute its vaccines to the collaborative effort and has announced that it will purchase vaccines for at least 1 percent of its population through the alliance.

In some respects, being a part of COVAX is not essential, but it would be smart if we joined. In reality, direct support of Gavi as part of a robust global vaccine access strategy achieves much of the same effect, but it will require deliberate and focused diplomatic engagement to translate that support into “credit” for the U.S., explaining why the U.S. has chosen a different route than all the other vaccine-producing countries — as well as the countries we are seeking to help.

The time to help provide foreign aid for vaccine distribution in the developing world is right now, not next year.

Foreign aid has borne the brunt of budget balancing in the Trump administration’s budgets. It is in the best interest of the United States to be a part of — and lead — international partnerships to deliver vaccines.

China may not have the same capacity to provide assistance as the United States, but will nonetheless win a huge public relations triumph — perhaps the biggest public diplomacy triumph of the 21st Century — if they provide the vaccines to developing countries while the U.S. dithers.

There have been well sourced rumors that China has signaled that it will provide vaccines to African countries in return for support in multilateral fora on issues such as Hong Kong and Taiwan. 

The U.S. should look to help tackle COVID-19 in the developing world, not only from a national security and strategic perspective, but also from an enlightened self-interest public health standpoint — because if there are COVID-19 cases anywhere in the world, the U.S. is not going to be safe from a future outbreak. The U.S. has a moral imperative to lead, being the most generous nation in terms of foreign aid spending directed to the developing world.

If China was the source of the problem, the United States can — and should — be seen as the source of the solution.

Originally posted on on November 6, 2020.

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