The Biden administration on Thursday took an important first step to try to finally achieve global vaccine equity, announcing that it will be sending overseas the first of the 80 million doses of Covid-19 vaccines it promised to send in the month of June. Of the 25 million doses that will be sent immediately, 75 percent will go to countries that are part of a global alliance led by the World Health Organization.
Eighty million doses might sound good — but it’s the equivalent of battling a sprawling forest fire with an 8-ounce cup of water.
Deep into the second year of the pandemic, continued Covid-19 infections have caused South Africa, Argentina and Malaysia to reimpose lockdowns. Taiwan, once thought to be a model in preventing surges, has closed schools and nightspots in the face of new waves. India has had more than 3,000 people die each day for the past month — and that is surely an underestimate.
Most Americans have not internalized that this pandemic will not stop until both the U.S. and the rest of the world achieve much higher rates of vaccination. Over half of adults in the United States are fully vaccinated — but only 4 percent of the developing world can say the same. In Kenya, only 1.8 percent of its citizens have received just one dose of vaccine.
There is an obvious humanitarian reason we should care: Infants are dying in Brazil due to lack of ventilators, and children are left orphans in the streets of India due to an incredible variant that is affecting young and old.
Most Americans have not internalized that this pandemic will not stop until both the U.S. and the rest of the world achieve much higher rates of vaccination.
But there are selfish reasons Americans should demand more accountability and actions from the wealthy nations of the world. According to the Open Society Foundation, these countries “representing 16 percent of the global population had hoarded two-thirds of doses from the most promising Covid-19 vaccine developers.” Without rapid access to vaccines, this virus will have the time to further evolve in an effort to survive, thrive and overrun the defenses of its potential hosts, potentially threatening even those who are fully vaccinated in the United States. The variants we’ve already seen develop have proved to be extremely efficient, prompting increased transmissibility and reinfection among some people who’d already recovered.
Even before the vaccines were developed, lower-income countries had been forced to deal with Covid-19 while struggling with a host of prior issues. The difficulties range from the economic to the political to the logistical, including chaotic infrastructure, misinformation and the consequences of poverty and political instability. For example, the entire continent of Africa, with 1.3 billion people but lower per capita cases than many of the worst hit areas of the globe, is working to ensure that basic resources — such as refrigerators to store doses and needles to administer them — are available, when some countries still lack water access and basic sanitary measures.
Meanwhile, resources spent to purchase vaccines also come at the cost of dealing with pressing issues such as famine, forcing some nations such as Ethiopia to choose their battles. Nepal, which last month reported a 45 percent Covid-19 positivity rate, had only around 800 ventilators for the entire country in March 2020.
Peru, on the other hand, is a country of 32 million people with a relatively stable economy — but has had nine different ministers of health and four presidents over the last several years, leading to delays in decision-making as well as delays in purchasing mitigation supplies such as tests, masks and air filters. The result is a catastrophe where most of the globe has no alternative to vaccination despite social distancing, masks, hospital infrastructure and stable leadership all being unavailable options.
So, what else should the United States be doing in the face of these challenges? The Biden administration on Thursday took additional steps to disentangle some vaccine manufacturers from the requirement to complete contractual obligations first with the United States and instead allow them to deal directly with other nations. This was an absolute must and possibly more consequential than 80 million doses. As President Joe Biden heads to the G-7 summit in the United Kingdom later this month, he must also press the other resource-rich countries to do the same as well as continue to use domestic manufacturing capacity to produce vaccines for the rest of the world.
In addition, the United States should ask vaccine manufacturers to focus on affordability, not profit, and provide vaccines free of charge to those nations that have not had enough doses secured through other means. Without rapid access to vaccines, this virus will have the time to further evolve in an effort to survive, thrive and overrun the defenses of its potential hosts, potentially threatening even those who are fully vaccinated in the U.S. At the same time, attention needs to be paid to guiding nations on the allocation and prioritization of scarce resources, including vaccines. Some countries have prioritized older citizens over health care workers, leaving them exposed, infected and dead. A transparent allocation mechanism that is agreed upon by all nations will prevent desperation, violence and confusion. Finally, like many things in this pandemic that have exposed deep disparities and systemic racism, the wealthy nations that form the G-7 recently held a meeting of health leaders, but they should invite other nations to have a seat at the table during debates about access and conversations about research. American exceptionalism has become a common sentiment in our daily lives — the notion that our emergence from the American Revolution was unique and that our values and political system are so unique that we are destined to play a distinct role in the world. This all too often has translated into expectations that food shortages, oil crises and most other man-made or natural disasters only offer minor setbacks — until Covid-19. Never before have our vulnerabilities been as exposed as they have been during this pandemic, hopefully shifting our perspective. While the United States is an incredible nation of possibilities, we are completely dependent on every other nation on Earth to get back to normal.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
