Editor’s Note: Reshma Ramachandran is a family medicine physician and fellow at the National Clinician Scholars Program at Yale University. She sits on the board of the non-profit organization Universities Allied for Essential Medicines North America, and is a member of the People’s Vaccine Alliance and co-host of the Free The Vaccine campaign. Asia Russell is the Executive Director of the non-profit Health GAP, a member of the People’s Vaccine Alliance and partner organization of the Free The Vaccine campaign. The views expressed in this commentary are their own. View more opinion on CNN.
Have we been duped? Just a few months ago, our organizations, Universities Allied for Essential Medicines and Health Global Access Project, celebrated President Joe Biden’s support to temporarily waive intellectual property (IP) for Covid-19 vaccines. For a moment, we had hoped that this commitment to global solidarity would be the beginning of the end of this pandemic for everyone, everywhere. Now, with little effort spent to build support for this IP waiver, refusal to commit to the World Health Organization (WHO) Director-General’s plea for a moratorium on booster vaccinations until at least 10% of every country has been vaccinated, and a global response plan with little more than platitudes, Biden’s statements of support have proved to be empty words.
The President has, in fact, stalled in taking meaningful action to stop the continued devastation of Covid-19 and congratulated himself for crossing the modest benchmark of donating roughly 110 million doses to other countries in early August – a fraction of the billions of doses needed. His policies continue to put America first and have largely benefitted the ever-expanding profit margin of the pharmaceutical industry, and as such, President Biden’s global Covid-19 response has so far failed.
Biden has now announced that he will host a global Covid-19 summit with country leaders and other stakeholders focused on ending the pandemic during the upcoming United Nations General Assembly next month. This summit could be the opportunity for Biden to demonstrate leadership and set an example for other world leaders through real action – but only if he chooses to do so. Without such a hard reset, Biden will just continue the same mistakes that have led to two very different worlds – one where the devastation from this disease is preventable and another where it is inevitable.
So what exactly should Biden commit to at the summit?
First, he must stop catering to the misaligned interests of the pharmaceutical industry over people’s lives. Recently, the White House diverted $1.5 billion from the US Agency for International Development (USAID) meant for urgently-needed assistance for low- and middle-income countries including personal protective equipment, Covid-19 treatments, and aid in distributing vaccines, even as they face record-high surges due to variants, to instead pay Pfizer for 500 million doses. These doses, celebrated by President Biden and Pfizer CEO Albert Bourla in a joint press conference, are meant to be given to these same countries in dire need, but will not be fully delivered until mid-2022.
By redistributing these critical funds that USAID needs now to instead pay Pfizer for doses slowly being delivered over the next year, the White House has created an unnecessary tradeoff for these countries that could cost them people’s lives. Biden must correct this mistake that has left USAID asking Congress for additional funds to cover this unexpected shortfall. He must apportion sufficient funds to the agency so they can provide countries initially budgeted aid to address the ongoing devastation.
Biden must also immediately heed the advice of local health department officials and countless others by shipping unused vaccine doses set to expire soon to countries in need and using his power to ensure equitable global redistribution of doses already procured under vaccine nationalism. As efforts continue to combat vaccine hesitancy and misinformation here in the US, willingness to take a Covid-19 vaccine in low- and middle-income countries remains considerably higher despite limited access, according to research published in Nature in July.
Moreover, Biden must stop hoarding vaccine doses from the limited global supply. Although only roughly 1.4% of people in low-income countries have been vaccinated, Pfizer and BioNTech announced that the Biden administration has purchased another 200 million vaccine doses for Americans. This is despite the US having procured more than enough Pfizer and Moderna doses as of February 2021 to fully vaccinate all currently eligible populations including those who are immunocompromised. Over half of these newly purchased doses will be delivered by the end of this year and the rest of the order completed by April 2022. By contrast, production of 100 million doses for the African Union through Pfizer’s recent agreement with the Biovac Institute in South Africa will only begin “towards the second half of 2022”– after the additional order from the US has been fulfilled.
Moreover, rather than sharing the technology needed to establish independent regional manufacturing capacity, Pfizer will only allow Biovac to complete the last “fill and finish” stage relying on vaccine substances shipped to them from Europe. Biovac will not be able to operate independently to produce doses as the vaccine recipe (technology transfer) will not be shared with them.
Reallocating excess doses and relying on pharmaceutical companies looking to profit off the prolongation of the pandemic that has driven demand for additional booster doses will not be enough to end this crisis. Despite his promise to support an IP waiver for Covid-19 vaccines, Biden has done seemingly little to encourage his counterparts in other wealthy nations including the European Union and United Kingdom to do the same; instead, these nations have continued to obstruct the waiver at the World Trade Organization (WTO). Going beyond a single statement of support, President Biden should champion this proposal and leverage his strong personal connections with allies to ensure its prompt passage and enactment at the WTO.
In parallel, Biden should use the authority bestowed upon him under the Defense Production Act to require Covid-19 vaccine manufacturers to transfer their technology to, and share their manufacturing knowledge with other companies abroad to quickly ramp up global production of vaccines in exchange for a reasonable royalty. A recent analysis from Public Citizen of the US government’s contract with Moderna, which jointly developed its mRNA vaccine with the National Institutes of Health (NIH) almost entirely through public funding, shows a potentially even more direct path towards scaling global vaccine manufacturing for Biden to pursue. This agreement shows that not only does the US government have the vaccine recipe, but also the ability to share this with other manufacturers to produce more doses to help vaccinate the world.
Through the Nullifying Opportunities for Variants to Infect and Decimate (NOVID) Act, Democratic legislators in the House and Senate have called for funds to scale up global manufacturing of Covid-19 vaccines and their delivery. As legislators consider this bill, Biden should begin allocating whatever funds are available to increase global Covid-19 vaccine manufacturing capacity and supply in addition to calling on Congress to appropriate the rest of the estimated $25 billion needed to meet global demand.
Such efforts to engage more local manufacturers to produce additional doses will not only benefit other countries in need, but also the US in their vaccine procurement efforts. Under this newly announced agreement with Pfizer and BioNTech to supply 200 million more doses, the US is paying nearly 25% more per dose than last year. If only a few manufacturers retain control of the vaccine supply and price, additional price hikes in the US and abroad are all but guaranteed.
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The head of global Covid-19 response at the US Department of State recently told reporters that she wanted US vaccine manufacturers to share technology with other firms abroad to produce more doses at a lower price. But without immediate action, this will be just more lip service from this administration, supporting a proposal that others around the world have been urgently seeking for over a year.
President Biden can change this course by stepping in as a leader in this global fight against Covid-19, replacing Pfizer, Moderna, and other companies that have led us down a path serving their bottom line, not people. By finally moving beyond just words to real action, President Biden can pull us out of this age of vaccine apartheid to a future of global vaccine equity where the pandemic can truly come to an end for everyone, everywhere.