Shots Without Borders

Taking care of our own was the right thing to do - but now America needs to shift into high gear to help vaccinate the world against a pandemic that knows no borders

Is the worldwide purchase, manufacture, and distribution of safe and effective COVID-19 vaccines a top foreign policy priority for the United States?

That’s the question the Biden administration will need to answer in the weeks ahead. India’s ongoing COVID-19 calamity forced matters to a head, but the “glut” of vaccine doses predicted to hit the United States at some point near the end of May would have raised the issue in any event. Debate within the administration over how and when the United States will start to send vaccine doses overseas has reportedly been contentious, with the State Department, US Agency for International Development, and public health agencies supporting such a move and officials in the White House and National Security Council weighing in against it.

President Biden appears to have settled the debate, at least for now. Some 60 million unused doses of the AstraZeneca vaccine – ordered by the government but not approved for use within the United States by the Food and Drug Administration – will be shipped abroad to countries like Canada, India, and Mexico.

Overall, the Biden administration’s record on fighting the pandemic overseas has been mixed. It has rightly insisted that the United States take care of itself before helping other nations vaccinate their own populations, while Secretary of State Antony Blinken offered a compelling argument in favor of vaccine internationalism. Moreover, the administration has some important early achievements on the global vaccination front:

  • The Quad Vaccine Partnership. Along with commitments from other members of the “Quad” – Australia, India, and Japan – the United States agreed to help fund the production of at least a billion vaccines in India by the end of 2022.  Once manufactured at facilities in India, the Quad plans to distribute these doses across Southeast Asia.

  • Funding for COVAX. While its predecessor shunned international cooperation on vaccines altogether, the Biden administration joined COVAX and has pledged $4 billion to support its efforts. 

  • Appointment of an international COVID-19 policy coordinator. Earlier this month, Secretary of State Blinken named former USAID head Gayle Smith as the State Department’s international COVID-19 policy coordinator.

At the same time, however, the administration has faced a number of obstacles – some of them self-inflicted, others largely out of its control:

  • A reluctance to export vaccines and raw materials for their manufacture until compelled.  Only after the existence of tens of millions of idle AstraZeneca doses came to light in mid-March did the Biden administration find a way “loan” them to Canada and Mexico. Likewise, it took the disastrous recent COVID-19 surge in India for the United States to approve the limited export of raw materials used to make vaccines along with other gear and equipment like ventilators.

  • Excessively strict adherence to vaccine production contracts. The Biden administration claims that the legal agreements negotiated by its predecessor under Operation Warp Speed prevent the U.S. government from exporting any of the vaccines it’s procured. It has, however, creatively interpreted the terms of these contracts to allow for the “loan” of vaccines to Canada and Mexico.

  • An unduly cautious pause on Johnson and Johnson vaccine shots. With an overabundance of caution, the FDA and Centers for Disease Control briefly paused the administration of the single-shot Johnson and Johnson vaccine in the United States. With COVAX – the international COVID-19 vaccine procurement and distribution consortium – relying on the J&J vaccine along with the AstraZeneca vaccine to supply some 80 percent of the billion doses it’s already ordered, this move could undermine the global immunization campaign before it picks up steam.

Fortunately, though, there’s still time for the Biden administration to build on its early successes and shift America’s international COVID-19 policy into higher gear. There’s little time to lose, and the following measures could help:

  • Make international vaccine production and distribution a top U.S. foreign policy priority. Right now, it’s hard to tell just where international COVID-19 policy stands in America’s long list of foreign policy priorities. While welcome, large financial contributions to international consortia like COVAX effectively outsources the problem of providing the world with safe and effective COVID-19 vaccines and tacitly disavowing our own ability to contribute to the solution. Once America’s own vaccine supply needs are met, the United States ought to assume greater responsibilities when it comes to the manufacture and distribution of COVID-19 vaccines worldwide.

  • Plan to take advantage of an anticipated vaccine glut. By the end of July, the United States will probably have received enough COVID-19 vaccine doses to vaccinate 400 million people – 70 million more than the overall national population. It remains unclear what the Biden administration intends to do with these additional doses, but such a surplus could prove an ideal American contribution to global vaccination efforts. The Biden team will need to cut through legal red tape, not hide behind it – most likely through the creative use of legal legerdemain like “loans” of vaccine doses to other nations.

  • Work with allies and partners to fund and supply COVID-19 vaccines, gear, and equipment. A more active international pandemic policy would also seek to leverage the financial resources and manufacturing capabilities of America’s long-standing allies and security partners. In the Middle East, for instance, countries like Egypt and Jordan face severe problems in treating COVID-19 patients – most notably insufficient supplies of oxygen. America’s wealthy Gulf Arab partners could play an important role in helping their own regional neighbors address their COVID-19 issues, but will likely require encouragement from the United States to do so.

Despite some early missteps, the United States remains in a strong international position when it comes helping the world vaccinate itself. Taking the lead on this vital issue would allow America to present a new face to the world and recoup lost international influence – especially when the vaccines provided by countries like China appear to be far less effective than those made by the United States and its European allies. 

There’s little time left to lose, and much to be gained from moving with dispatch. Like it or not, the provision of COVID-19 vaccines have become an important factor in the global competition for influence between the United States and rivals like Russia and China. More importantly, major developing countries like Brazil and India face public health catastrophes unprecedented in the modern times – including appalling and mounting death tolls. 

In making vaccine internationalism a top U.S. foreign policy priority, the Biden administration has an opportunity to protect Americans at home and improve our standing in the world at the same time. It should seize it without delay.