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COVID-19 shot scarcity weighs on hopes for global push

By James Paton and John Lauerman
Bloomberg News/TNS

With a new president in the White House, the U.S. is re-engaging with the rest of the world to combat COVID-19. But for now, the Biden administration may hold back the one thing poorer countries desperately need: vaccines.

One day after Joe Biden’s inauguration last week, his chief medical adviser, Anthony Fauci, pledged support for the World Health Organization, including participation in the Covax program to deploy vaccines globally. Even with the U.S. playing an active role, tough challenges remain in the effort to aid low- and middle-income nations.

The U.S. has long been the WHO’s leading partner in battling diseases, including smallpox, polio and Ebola. And the superpower could still have a big impact in the bid to slow COVID-19 and tackle other threats after former President Donald Trump’s pullback. Lawrence Gostin, a global health law professor at Georgetown University, said he believes it’s imperative for wealthy countries to start sharing vaccines before it’s too late. But doing so, he said, presents a challenge as the virus continues to spread in the U.S.

“When the U.S. is in an emergency, we start looking inward,” Gostin said in an interview. “Even if the rest of the world is on fire, we start looking inward.”

The administration plans to fulfill U.S. financial obligations to the WHO and looks forward to working with Covax and its partners to maximize the program’s efforts, according to a White House official who spoke on condition of anonymity. U.S. support may “not necessarily” include vaccines, Fauci told reporters Thursday at the White House.

Helping others isn’t just a moral imperative. Containing the spread of the virus in other countries could help limit mutations that might make vaccines less effective. Meanwhile, U.S. rivals for global influence, China and Russia, are busy offering their own vaccines in the developing world, winning friends and influence with traditional American allies.

As the pandemic extends into a second year and more contagious variants of the virus emerge, governments worldwide - though mainly wealthy ones - are rolling out vaccines to protect their populations. That’s triggered concern that by prioritizing their own interests, they’re ignoring the needs of less-fortunate countries while allowing the pathogen to advance.

Vaccine advocates have urged wealthy nations to share some of the supplies they’ve snapped up in recent months and to follow the lead of Norway, which pledged to donate extra doses through Covax.

While that may be a tough call, major economies could move in that direction when vaccines begin to curb severe illnesses and deaths at home, said David Heymann, a professor at the London School of Hygiene & Tropical Medicine and former WHO official.

“It’s going to be very difficult for all countries with money and pre-purchased supplies to provide that to Covax and to countries that need it at this time,” Heymann said. “Once the political leaders who have made these promises to their countries do see an impact from the vaccines, they may be able to reconsider national allocations and contribute more to Covax.”

As of Jan. 18, vaccines had been administered in at least 49 higher-income countries, compared with just one of the world’s lowest-income countries, according to Tedros Adhanom Ghebreyesus, the WHO director general.

But as Western countries have corralled supplies to protect their own populations, others are seeking to fill the void. Russia, for instance, has signed deals with a number of low- and middle-income countries for the Sputnik V vaccine that was approved last year. China too has extended vaccine financing and supplies to a number of countries.

Meanwhile, the U.S. spent billions of dollars to develop and secure for its own use more than 1 billion doses from manufacturers, including Moderna Inc., AstraZeneca Plc, and the Pfizer Inc.-BioNTech SE partnership. Yet only 20 million doses have been administered, according to Bloomberg’s tracker, covering about 6% of the population.

That leaves a huge part of the U.S. still vulnerable to COVID-19, and increases the chance that the next three months of the pandemic, and the start of Biden’s term, could be the worst, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

Even so, he said, the U.S. should also be more involved in the global program for both diplomatic and public-health reasons.

“We want to reduce the burden on the entire world because it will help ourselves,” said Osterholm, who has been advising Biden on COVID-19. “Assisting the world is a diplomatic activity and a strategic activity.”

The question is how. Biden is already restoring channels of funding and personnel that the previous administration withdrew, or threatened to withdraw. At the same time, the U.S. has earmarked more than $4 billion in additional funding for Gavi, the Vaccine Alliance, a Covax partner that distributes immunizations to children in low-income nations.

Many countries are now counting on Covax.

The program, led by the WHO, Gavi and the Coalition for Epidemic Preparedness Innovations, said it is on track to deliver at least 2 billion doses - about two-thirds of which will go to lower-income economies - and to vaccinate at least a fifth of each participating country’s population by year’s end.

Yet several leaders have questioned whether the program will get the vaccines it needs as governments prioritize their own supply deals through direct talks with manufacturers, the head of the WHO said last week. This is driving up prices and may lead to hoarding, chaos and social and economic disruption, he warned.

Even if the U.S. can’t donate doses immediately, it could help ensure that Covax is fully funded, Gostin said. To achieve that goal, Covax estimates it needs to raise an added $2.8 billion this year.

Perhaps one of the most important contributions the U.S. could make would be in the form of high-level diplomacy, said Stephen Morrison, director of the Center for Strategic and International Studies’ Global Health Policy Center. The country was absent from a virtual global fund-raising event supported by the European Union in May that secured pledges of about $8 billion.

The U.S., which will soon hold the presidency of the United Nations Security Council, could facilitate a meeting of global leaders to coordinate efforts against a threat to the entire world, Morrison said. Key issues to discuss could include more financing of vaccine purchases, use of vaccine surpluses, debt relief and emergency humanitarian relief.

“I think it’s inevitable that there will be some kind of summitry dedicated to these issues,” he said. “U.S. leadership has been the missing element and now it’s essential.”

The Biden administration could be a help roll out immunizations worldwide by pushing manufacturers to provide vaccines at affordable costs, said Robert Yates, executive director of the Centre for Universal Health at Chatham House, a London-based think tank. Just days after Biden took office, Pfizer and BioNTech agreed to provide as many as 40 million vaccine doses to Covax after months of talks.

Whatever form U.S. involvement takes, its re-emergence as partners and its highly regarded Centers for Disease Control and Prevention will strengthen the global effort and is a “good sign” for everyone, according to Heymann, a former CDC staffer.

“It’s what America really wants,” Heymann said. “It’s been a terrible time to see the U.S. ignore the CDC and, in general, the global health community.

World Health Organization Director-General Tedros Adhanom Ghebreyesus attends a news conference on July 3, 2020, at the WHO headquarters in Geneva.