Low- and middle-income nations are facing an unconscionable shortage of coronavirus vaccines that threatens to upend progress against the pandemic.
So far, this global shortage has been obscured by pockets of vaccine abundance in wealthier countries like the United States. But if the shortage isn’t addressed soon, the trouble will become all too clear. Hundreds of thousands, if not millions, of people will continue to get sick and die, even as the pandemic recedes in richer nations. The most fragile economies will continue to teeter, and gains made elsewhere will eventually be imperiled: The longer the virus spreads, the greater the chance it mutates into something even more contagious, deadly or vaccine-resistant.
It’s tempting to peg this disparity to recent questions raised about some of the vaccines. Rare but deadly blood clots have been linked to the vaccines made by AstraZeneca and Johnson & Johnson. The former has never been approved for use in the United States, and administration of the latter was paused by American officials while an advisory committee formulated recommendations for how to proceed safely.
It’s true that such precautions are a luxury of wealthy nations that have other options to fall back on, and that they risk tainting the public perception of the few vaccines low-income countries have been able to get. But the underlying problems of both vaccine hesitancy and vaccine shortages run much deeper than any one issue.
Nearly as soon as vaccines entered clinical trials, wealthy countries began hoarding doses, ensuring that instead of the most vulnerable people everywhere being vaccinated, their residents would be first in line.
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Then, as the vaccines came to market, some vaccine makers insisted on sweeping liability protections that further imperiled access for poorer countries. The United States, for example, is prohibited from selling or donating its unused doses, as Vanity Fair has reported, because the strong liability protections that drugmakers enjoy here don’t extend to other countries. (The Biden administration recently circumvented this stricture when it classified the vaccines it gave to Mexico and Canada as “loans,” but that’s a cumbersome workaround that creates further confusion and delay.)
In other countries, Pfizer has reportedly not only sought liability protection against all civil claims — even those that could result from the company’s own negligence — but has asked governments to put up sovereign assets, including their bank reserves, embassy buildings and military bases, as collateral against lawsuits. Some countries have understandably balked at such demands, according to the nonprofit Bureau of Investigative Journalism, and the pace of purchasing agreements has slowed as a result.
As they find themselves shut out of vaccine procurement, those same nations have also found that they cannot make the shots themselves. Companies and countries are hoarding both raw materials and technical expertise, and have prevented poorer nations from suspending patents despite international treaties that allow for such measures in emergencies.
There is no shortage of solutions to these problems, but the countries with leverage, clout and excess supply — like the United States — need to act now, in the following ways:
Stop hoarding doses. The richest nations account for 16 percent of the global population but hold 53 percent of all purchased coronavirus doses, according to the Duke-Margolis Center for Health Policy. The United States is projected to have 300 million extra shots by late July, even after accounting for the supply needed to vaccinate the millions of children who are expected to be eligible by the end of the year.
The Biden administration has already arranged to send four million unused shots to Mexico and Canada. That’s a welcome course correction, but the nation can and should give more. In separate reports, the Duke-Margolis Center and the Center for Strategic and International Studies have laid out a roster of options for doing so without imperiling the nation’s own vaccination efforts. Their suggestions include delaying some orders long enough for other countries to go first; donating more excess doses to Covax, the global cooperative working to pool vaccine resources; and using existing global health networks such as the President’s Emergency Plan for AIDS Relief, known as PEPFAR, to expedite shipments to countries facing the greatest need.
The Biden administration should consider employing all of these measures, and should also renegotiate its contracts with vaccine makers so that such dose transfers no longer have to be masked as loans. The administration has several bargaining chips with which to effect such changes, including a federally held patent on a crucial component of the Pfizer and Moderna mRNA vaccines that the government has not yet demanded full royalties for.
Suspend patents. Nearly 60 nations have petitioned the World Trade Organization to allow countries to temporarily override intellectual property rights for coronavirus-related drugs and vaccines, but so far the measure is languishing. The Biden administration should support this waiver, nudge vaccine makers into voluntary licensing agreements and help build the public-private partnerships needed to bring those agreements to fruition. It should also press companies to offer better deals to the countries trying to secure doses — no more absurd indemnity clauses that protect company profits over human lives.
Share technology and resources. More than eight months ago, the World Health Organization established a technology access pool where companies and countries could share their technology and expertise with governments trying to scale up vaccine manufacturing. The Biden administration signaled its willingness to participate in this effort back in January, but so far, the National Institutes of Health has not joined in, nor have the major vaccine makers. That needs to change quickly.
The administration should also lift any embargoes resulting from its use of the Defense Production Act. President Biden was wise to use this law to bolster domestic vaccine production, but that move has also prevented companies from exporting raw materials. As a result, production lines in India and elsewhere are at risk of shutting down for want of key ingredients available in the United States. The administration could help keep those facilities running by lifting those strictures.
Build more capacity. Experts say that virtually no vaccines are being manufactured in Africa and that very few are being made in Latin America. The reasons for this shortcoming are complex — a longstanding underinvestment in regional capacity combined with an overreliance on multinational corporations. But the solutions to it are clear. Britain has managed to scale up its manufacturing capacity from just two plants at the start of the pandemic to four now, with two more under construction. There’s no reason the same can’t be done in other countries where the need is even greater. Throwing his weight behind such an effort could be one of Mr. Biden’s most enduring legacies.
Another good step would be to support the global pandemic preparedness treaty that the W.H.O. is urging, which, among other things, aims to strengthen manufacturing capacity around the world.
Invest in alternatives. As miraculous as the current coronavirus vaccines are, they come with downsides. The mRNA shots have complicated storage requirements. The ones that rely on adenovirus vector technology — those made by AstraZeneca and Johnson & Johnson — have been linked to rare but potentially deadly side effects. What’s more, there are not enough of any of these, or of all of them combined, to meet the world’s needs. Sub-Saharan Africa and Latin America alone will need nearly four billion shots of any two-dose vaccine. So far, only 1.3 billion coronavirus vaccines, of any kind, have been made at all.
Fortunately, there are other promising alternatives in the offing. One of them is based on the same technology used to make the hepatitis B vaccine that’s been in use for nearly 40 years. This coronavirus vaccine is cheap and easy to make, its early clinical data looks good and its creators — Dr. Peter Hotez and Maria Bottazzi at the Baylor College of Medicine — have no plans to patent it. If the United States put half as much weight behind this simple technology as it put behind the mRNA vaccines, manufacturers could churn out billions of doses of it in fairly short order.
No country has cleared every hurdle to vaccinating its entire population. In the United States as much as anywhere, vaccine hesitancy persists and some especially vulnerable populations, like the homebound and unhoused, remain hard to reach even as supply increases. But the world cannot afford to wait for all of those problems to be solved in one country before it works to make coronavirus vaccines more available to all countries. The global vaccine gap is a matter of life and death, and all nations should be working to close it as quickly as possible.