Biden faces new pressure on vaccine equity as Omicron variant reveals perils of global gap

Moderna, which is based in Cambridge, has been pressured to share its vaccine-making technology with others so doses can be more rapidly produced.Gretchen Ertl/Associated Press

WASHINGTON — When it comes to the Omicron variant, global health experts are making one thing clear: They saw this coming.

For months, they have warned that a failure by rich countries and manufacturers like Moderna to distribute COVID-19 vaccines widely enough throughout the developing world would create opportunities for the spread of new variants that would make their way to American shores. Now, they say the emergence of Omicron, which appears to be spreading locally in Southern Africa and made its first reported appearance in the United States on Wednesday, proves them right.

That’s lending new urgency to their calls, echoed by some congressional Democrats, for the Biden administration to do more, faster, to get American-made vaccines — and the technology to produce more of them — to the rest of the world to stop the next variant before it starts.

“I think we need to ask ourselves,” said Senator Elizabeth Warren, “what are we going to do differently to make sure this doesn’t happen again?”

Global health experts say there is an “unconscionable gap” between the vaccination rates in countries like the United States, which has fully vaccinated more than 70 percent of its population of people 18 or older and administered more than 40 million booster shots, according to data from the Centers for Disease Control and Prevention, and low-to-middle-income countries. An analysis by The New York Times found three quarters of vaccines have been administered in high and upper-middle income countries, while just 0.8 percent have been given out in low-income countries. Botswana, one place where the new variant appears to be spreading, has fully vaccinated only 20 percent of its population.

They say it is on the Biden administration and leaders of other developed, vaccine-producing nations to ramp up their efforts to protect the citizens of the developing world — and thus, their own.

“I think the United States has not lived up to the moment,” said Lawrence Gostin, a professor of global health law at Georgetown and the director of the World Health Organization Collaborating Center on Public Health Law & Human Rights. “It’s almost a gift to the COVID virus, enabling it to mutate at will, and to form a perfect virus and send that virus back to the United States, which is what essentially may be happening with Omicron.”

Global vaccine distribution is deeply complex and has been further knotted by a rising tide of vaccine hesitancy. Some experts are quick to credit the administration for pledging more doses of the vaccine overseas than any other country. Biden, who says he wants the United States to be the “arsenal of vaccines,” has pledged more than 1 billion doses to the rest of the world, and a tracker on the State Department’s website says more than 278 million of those have been delivered. Some countries, including South Africa, have actually turned down US vaccines due to oversupply, the White House said this week.

“The Biden administration is doing a lot of things right. They are focusing on global needs, they are donating where they can,” said Dr. Thomas Frieden, who was director of the CDC for most of the Obama presidency and now runs an initiative aimed at preventing epidemics called Resolve to Save Lives. Nevertheless, he said, there has not been enough progress scaling up the production of mRNA vaccines, which are made by Moderna — the Cambridge-based company that received billions of dollars in government subsidies to develop its highly effective vaccine and has profited handsomely — and a partnership between Pfizer, which is an American company, and BioNTech, which is German.

“They either cannot or will not force Moderna, which is using technology that was created with US taxpayer dollars, to behave more responsibly,” Frieden said.

Moderna has become a major focus among those who want the administration to do more to make vaccines available in poorer nations, having supplied its shots almost exclusively to rich countries and earning billions in profit. The company expects to supply about 800 million doses of its vaccine this year, but some global health experts and members of Congress want the company to share its technology with manufacturers in other countries.

“I’ve been clear that I think the federal government needs to put more pressure on these companies to come to the table and transfer their technology,” Warren said. “I’ve been pushing, pushing hard behind the scenes on this. I’ve talked to several people within the administration, urging them to use every authority at their disposal, and to do it fast.”

Warren and several health advocates called for the administration to review its authority to invoke the Defense Production Act to increase production of the vaccine; but White House officials have said they can’t compel anyone to share intellectual property data and their contracts with Moderna don’t give the government the technical information or ownership rights that would be needed to manufacture the vaccine.

Warren is among a group of senators, led by Senator Tammy Baldwin of Wisconsin, who signed onto a letter urging the Biden administration to push for a waiver of intellectual property rules by the World Trade Organization that would expand access to vaccine technology and, they said, boost production of the vaccine in developing countries. That’s a move the Biden administration announced support for in May, but one that has been snarled in negotiations at the WTO.

“Moderna should do the right thing,” said Senator Ed Markey of Massachusetts, who applauded Biden for his goal of vaccinating 70 percent of the world by September of 2022, but said the United States needed to dramatically intensify its efforts.

“I think right now, we don’t have the concrete plan that is understandable and as a result implementable to achieve that 70 percent vaccination goal.”

Moderna chairman Noubar Afeyan told the Globe this week that the issue of vaccine equity was complicated and that uptake in poor countries had to do with vaccine hesitancy and misinformation as well as supply.

Not every Democrat believes the problem lies with the vaccine supply.

“The prime problem is distribution, not production,” said Representative Jake Auchincloss of Newton, who has pushed for a so-called Marshall Plan for vaccinations and believes the administration has fallen short in getting vaccines distributed. “They’re not moving with the scale or urgency that I want, and I’ve made that clear, and I’ve continued to engage them on this issue.”

A White House official who declined to be named defended the administration’s record and said it was pushing every company to do more. The White House plan to work with manufacturers to produce 1 billion additional vaccine doses next year has won praise from congressional Democrats. The administration has also diverted delivery of some American Moderna doses to the African Union, and arranged to send Johnson and Johnson shots to conflict zones that have struggled to obtain vaccines.

“We are far and away the world’s largest provider of vaccine doses, vaccine know-how, vaccine support … including to Southern Africa, of any country in the world,” press secretary Jen Psaki said this week.

Some experts disagree with those who want to pressure companies to transfer their technology, which would likely affect their bottom lines.

“We want them to remember how fat they got by doing a good job on this one when the next one comes along,” said Richard Goldsby, an emeritus professor of biology at Amherst College.

Many experts said the United States had already fallen short by keeping so many doses for itself earlier this year while other countries tried to get by with so little.

“Everyone was looking out to get the vaccine into the hands of their own people,” said Simon Mutembo, an epidemiologist with the International Vaccine Access Center at Johns Hopkins who used to work for the Zambian Health Ministry. That country, he said, lost a chance to get more people vaccinated during its third wave of COVID this year, because it lacked supplies at the time. Now, less than 10 percent of people in that country are vaccinated and officials are trying to combat vaccine hesitancy.

“During that wave, people became willing and started accepting the vaccine,” he said. “With time, the wave subsided and everyone just went to sleep… It was in those periods we lost opportunities.”

Jonathan Saltzman and Neya Thanikachalam of the Globe staff contributed to this report.