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United States must do more to vaccinate the world

Donating vaccines to low- and middle-income countries isn’t enough.

Syringes containing a dose of the Pfizer Inc. and BioNTech SE COVID-19 vaccine ready for administration at a vaccination center inside the Camp Nou stadium in Barcelona.Angel Garcia/Bloomberg

As the coronavirus has shown time and again, it does not care about borders. The longer that COVID-19 is able to spread in any part of the globe, the likelier it becomes that more dangerous and easily transmissible variants — potentially even ones that are immune to currently available vaccines — will come about and further prolong the pandemic for the entire world. And so, if the United States and other wealthy nations want to finally be able to move on from the pandemic, they need to work just as hard on vaccinating the vast populations of low- and middle-income countries, who don’t have ready access to health care, as they have been on vaccinating their own.

So far, the progress isn’t good: While over half of the world’s population has received at least one dose of the COVID vaccine, a closer look at that data underscores just how unequal distribution has been. Seventy-four percent of people living in high-income countries have been fully vaccinated. In low-income countries, that number is only 6 percent.


While rich governments have made some efforts to help low- and middle-income countries bolster their vaccination rates, they have fallen far short of what is needed to actually bring an end to this global health crisis.

That’s why the United States should step up and fill in for the drastically short supply of global leadership. While the US government has already done more than many others — it has delivered more vaccine donations, for example, than any other country has even pledged — the Biden administration is still not doing enough to boost global vaccinations. To turn that around, the federal government should quickly address the most urgent bottlenecks in the near term while also laying the groundwork to help low-income regions more efficiently vaccinate their populations in the coming years.


That means looking at the main causes for such low vaccination rates in poor countries, which go far beyond a shortage of vaccine supply. And while the United States should certainly work toward increasing vaccine production and delivery to low- and middle-income countries, it has to do much more than just producing and then shipping vaccine stockpiles overseas. “The journey from airports to arms is going to be the most critical aspect to support over the next year,” said Krishna Udayakumar, the director of Duke University’s Global Health Innovation Center. “That’s going to be the make or break for how quickly and how well we can vaccinate the world.”

First and foremost, that means assisting countries in building the necessary infrastructure to distribute and administer the vaccine. That may sound like a daunting task, but small and manageable steps from major donor states like the United States can make a big difference. “It’s something as simple as employing additional staff,” said Shabir Madhi, a professor of vaccinology at the University of the Witwatersrand in Johannesburg. “In many of these countries, there are health care workers that are unemployed and can’t actually be brought into the health care system because of finance.” That’s why the United States should promptly invest more money and resources to help hire, train, and finance health care personnel.

There’s also the matter of vaccine storage. Both the Pfizer and Moderna vaccines require extremely cold storage temperatures, for example, and many countries have outdated vaccine-refrigerator technology that is also severely hindered by unreliable electricity. Investing in cold chains — the network of cooled trucks, warehouses, and other facilities used for goods that must be kept refrigerated — in low- and middle-income countries would help them store more vaccines and get them to harder-to-reach populations. It would make future vaccination campaigns much more efficient. Building cold chains in low-income countries could also serve a dual purpose, potentially creating long-term economic opportunities for agricultural goods and other perishables.


Second, the United States should lead by example and provide much greater transparency regarding its vaccine stockpile, when it will deliver donations to other countries, and when those vaccines will expire. “There are multiple reported instances where doses are showing up with 24- or 48-hour notice,” Udayakumar said.

Indeed, in a joint statement, the African Vaccine Acquisition Trust, the Africa Centres for Disease Control and Prevention, and COVAX called for more predictability from donor states. “The majority of the donations to-date have been ad hoc, provided with little notice and short shelf lives,” the statement read. “This has made it extremely challenging for countries to plan vaccination campaigns and increase absorptive capacity.” That’s why the Biden administration should give reasonable donation forecasts to recipients so that countries can adequately prepare to administer the vaccines. And donor states, including the United States, should stop sending so many batches of vaccines that are so close to their expiration dates unless donee countries actually have the capacity to distribute them quickly.


Third, the United States should always plan ahead of the next bottleneck. That’s how it can ensure that low- and middle-income countries have successful vaccination campaigns, not just in the immediate future but in the long term as well. One of those oncoming bottlenecks is a shortage of supplies needed to administer vaccines. According to UNICEF projections, for example, there could be as much as a 2.2 billion shortfall in auto-disable syringes next year.

Part of the cause is that India, a major producer of the syringes necessary for COVID vaccines, is limiting its exports of syringes. That’s why President Biden should not only invoke the Defense Production Act to produce syringes for vaccination campaigns at home, as he promised to do when he assumed office, but he should also further ramp up syringe production so that the United States can supply low- and middle-income countries with syringes along with its vaccine donations. Yet, so far, the White House has shown no plan or initiative on that front.

The supply of vaccines globally is also still far short of what’s needed. COVAX, the international program to distribute vaccines to low- and middle-income countries, for example, has yet to deliver even a fifth of its pledged vaccine donations to poor countries. As Joia Mukherjee, the chief medical officer at Partners In Health, put it to the Globe editorial board, the program “has so far been a failure.”


Ultimately, every dollar spent on vaccinating populations outside America’s borders is a dollar well spent. According to UNICEF, investing about $23 billion in vaccinating poor nations today would save the global economy $5.3 trillion in the long run. More importantly, it could prevent up to 5 million additional COVID deaths. When it comes to battling the pandemic, political leaders and public health experts have made clear that vaccinations are the best tool at our disposal. But rich nations have yet to actually do what it takes to put that tool to work globally and get shots in arms around the world.

Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.