At least 3 million doses of Oxford/AstraZeneca’s COVID-19 vaccine have been sitting in American warehouses for at least a month. There are outbreaks of COVID-19 in Peru and Jordan, where AstraZeneca’s vaccine is authorized for use. AstraZeneca has not yet applied for US authorization, and any authorization likely will not come for several weeks. While these valuable doses sit, the United States is now vaccinating about 2.7 million people per day and the numbers steadily grow.
This is a moral tragedy. It is also a health problem for Americans and people around the world and a huge diplomatic blunder.
Many vulnerable people worldwide remain entirely unprotected from COVID-19, while America sits on doses it is not using. The US government has a responsibility to protect Americans, but sitting on stockpiles does nothing to provide that protection — and may increase the risks for Americans by allowing highly transmissible, virulent, and/or vaccine-evading variants to develop.
Addressing this problem need not wait for a final answer to seemingly contentious and intractable questions of how much priority countries can give to their own citizens, or how much profit pharmaceutical companies can seek. There are four steps that the United States can take now to help get the world back to normal.
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▪ The United States should share vaccine doses that we will not use. COVID-19 vaccines are not like fine wine. We are making more and more of them every day, and they do not get better the longer they sit in refrigerators and freezers. Indeed, by May the United States is likely to have authorized four or five vaccines and be producing 5 million doses per day. By that time, about 50 percent of Americans will be vaccinated with the first dose. Certainly, by mid-June when 70 percent of Americans are expected to be vaccinated, COVID-19 vaccine supply will outstrip demand in the United States. The federal government should prepare now to ship excess vaccines to other countries when there is no reasonable probability that vaccines will be used within 10 days. Part of that preparation is working with hard-hit countries to ensure they can receive, distribute, and effectively administer the vaccines.
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▪ Even if the United States exported all its production beginning in the summer, that would only vaccinate about 1.5 billion people by the summer of 2022 — not enough to end the pandemic. Thus, the United States needs to enable COVID-19 vaccine production globally.
Some people argue patents related to COVID-19 should be permanently voided. But this would both be insufficient to end the pandemic and, because it is vigorously opposed by the pharmaceutical companies, prompt time-consuming litigation. Moreover, holding manufacturers to a harsh bargain for COVID-19 vaccines, while offering them free rein to produce and sell less urgently needed interventions, will stymie the production of sufficient vaccines for this pandemic and future ones.
Moderna has already pioneered a more tenable approach: suspending the enforcement of its COVID-19 vaccine patents during the pandemic emergency. The federal government should work to ensure that any patent barriers to the production of all vaccine designs are similarly relaxed. However, removing patent barriers will not be enough. Just as it brokered a deal between Merck and Johnson & Johnson to collaborate on vaccine production, the federal government should push pharmaceutical companies to share technical know-how and even personnel to ramp up production worldwide. The government should also ensure production and access to essential reagents for vaccines and fill finish capacity —that is sterily filling glass vials with the vaccine and preparing them for shipping — are available to other countries Then, over months, production can be scaled up in multiple countries such as South Africa, Brazil, and Bangladesh.
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▪ The United States should work to ensure that vaccine prices are tiered to countries’ ability to pay. Paradoxically, some low- and middle-income countries are actually paying more than the United States for COVID-19 vaccine. This is unjust and counterproductive. Neither countries nor vaccine producers benefit if countries too poor to purchase a scarce vaccine go unvaccinated. For tiered pricing to work, though, both pharmaceutical firms and wealthy countries must commit to fair play. Wealthy countries cannot circumvent tiered pricing by repurchasing doses sold cheaply to poorer ones or demanding a single worldwide price. And pharmaceutical firms cannot impose extortionate terms on countries — especially middle-income countries — that drive them to resort to repurchasing.
▪ America must show leadership in building and funding global vaccine supply and distribution. The United States has gone from struggling mightily at the start of the vaccine rollout to vaccinating our population more rapidly than almost anywhere else. Rather than focusing only on sharing physical doses, the federal government should work to ensure that an effective distribution chain allows anyone in the world who wants a vaccine to get one.
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Nationalists might reject these ideas, insisting that the United States must do nothing to solve the COVID-19 pandemic elsewhere until every American has been protected. This position is unethical. Just as important, it is foolish and short-sighted. If the pandemic continues in other countries, Americans will be put at risk directly by COVID-19 variants and continued spread. Without worldwide vaccination it will be impossible for international trade, travel, student exchanges — normal life — to return. Isolationism is no more practical when facing a viral enemy than when facing a human one.
Nearly 20 years ago the United States launched the President’s Emergency Plan for AIDS Relief. Even while Americans faced HIV/AIDS at home, the United States supplied anti-retroviral drugs and many other interventions to poor countries suffering severely from AIDS. The program began under the George W. Bush administration and was reauthorized by both Democratic and Republican presidents. By leading instead of only looking out for ourselves, we reaped substantial goodwill that has had long-term payoffs in Africa and Asia. Distributing COVID-19 vaccines to other countries now can help the United States regain leadership in global ethics, in promoting America and the world’s health, and in diplomacy.
Dr. Ezekiel J. Emanuel is vice provost for Global Initiatives and codirector of the Healthcare Transformation Institute Perelman School of Medicine and the Wharton School at the University of Pennsylvania. Govind Persad is a professor at the University of Denver Sturm College of Law.
