Biden Pushes Global Plan to Battle Covid-19 as National Gaps Widen

The U.N.-backed vaccine program is so far behind schedule that not even 10 percent of the population in poor countries is fully vaccinated, experts say.

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WASHINGTON — Already grappling with divisions in his own country over vaccine mandates and questions about the ethics and efficacy of booster shots, President Biden is facing another front of discord: a split among world leaders over how to eradicate the coronavirus globally, as the highly infectious Delta variant leaves a trail of death in its wake.

At a virtual summit on Wednesday, while the annual United Nations General Assembly meeting is underway, Mr. Biden will try to persuade other vaccine-producing countries to balance their domestic needs with a renewed focus on manufacturing and distributing doses to poor nations in desperate need of them.

Covax, the United Nations-backed vaccine program, is so far behind schedule that not even 10 percent of the population in poor nations is fully vaccinated, experts said.

The push, which White House officials say seeks to inject urgency into vaccine diplomacy, will test Mr. Biden’s doctrine of furthering American interests by building global coalitions. Coming on the heels of the United States’ calamitous withdrawal from Afghanistan last month that drew condemnation from allies and adversaries alike, the effort to rally world leaders will be closely watched by public health experts and advocates who say Mr. Biden is not living up to his pledges to make the United States the “arsenal of vaccines” for the world.

“This is one of the most moral questions of our time,” Representative Rosa DeLauro, Democrat of Connecticut, said last week. “We cannot let the moment pass. And the United States can recapture its leadership role by taking on what is one of the greatest humanitarian causes ever — and we need to bring this pandemic to an end.”

The landscape is even more challenging now than when Covax was created in April 2020. Some nations in Asia have imposed tariffs and other trade restrictions on Covid-19 vaccines, slowing their delivery. India, home to the world’s largest vaccine maker, banned coronavirus vaccine exports. And an F.D.A. panel on Friday recommended Pfizer booster shots for those over 65 or at high risk of severe Covid, meaning that vaccine doses that could have gone to low and lower-middle income countries would remain in the United States.

“If somebody had told us that 20 months into this pandemic we would still be seeing rates of infection and loss of life of the magnitude we are, I think we would have been absolutely horrified,” said Peter Sands, executive director of the Global Fund, a founding partner in the global collaboration that created Covax.

“That should underscore a real sense of urgency, that when you’re fighting a pandemic, it doesn’t make sense to fight it slowly,” Mr. Sands said.

Officials said Wednesday’s summit would be the largest gathering of heads of state to address the coronavirus crisis. It aims to encourage pharmaceutical makers, philanthropists and nongovernmental organizations to work together toward vaccinating 70 percent of the world’s population by the time the U.N. General Assembly meets in September 2022, according to a draft document the White House sent to the summit participants.

“We also know this virus transcends borders,” Mr. Biden said on Sept. 9. “That’s why, even as we execute this plan at home, we need to continue fighting the virus overseas, continue to be the arsenal of vaccines.”

“That’s American leadership on a global stage,” he said.

Experts estimate that 11 billion doses are necessary to achieve widespread global immunity. The United States has pledged to donate more than 600 million — more than any other nation — and the Biden administration has taken steps to expand vaccine manufacturing in the United States, India and South Africa. The 27-nation European Union aims to export 700 million doses by the end of the year.

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The distribution of Covax vaccines is so far behind schedule that not even 10 percent of the population in poor nations is fully vaccinated.Credit…Brian Inganga/Associated Press

But as recently as July, only 37 percent of people in South America and 26 percent in Asia had received at least one vaccine shot, according to Rajiv J. Shah, the head of the U.S. Agency for International Development during the Obama administration. The figure stood at just 3 percent in Africa, Mr. Shah wrote in an essay published last month in Foreign Affairs.

An estimate by the ONE Campaign, which fights extreme poverty and preventable disease, showed that the leading seven developed nations would together be sitting on a surplus of more than 600 million vaccine doses by the end of 2021.

That is enough to fully vaccinate every adult in Africa, said Jenny Ottenhoff, ONE’s senior director for health policy.

Most doses that have been committed, however, will not be delivered to the needier nations, nor injected into arms, until next year. Given the sluggish distribution, said Dr. Kate O’Brien, the World Health Organization’s top vaccines expert, “we can see clearly from the data that’s coming out that we are very far” from vaccinating 70 percent of the world’s population by the middle of next year, as initially projected.

The president is also under intense pressure from global health advocates who say donating doses is not enough and want him to scale up manufacturing capacity overseas.

On Monday, the advocacy group Health Gap will stage a demonstration near the U.N. headquarters in New York calling on Mr. Biden to “end vaccine apartheid.” A coalition of nearly 60 human rights and other advocacy groups will also send Mr. Biden a letter urging him to back a $25 billion investment that would produce 8 billion doses within a year — and to ask Congress to include a specific line item for it in the $3.5 trillion “Build Back Better” budget legislation that lawmakers are now considering.

“We cannot ‘donate’ our way to safety,” they wrote.

That growing gap between the vaccine haves and the vaccine have-nots has led to a rift between wealthy countries and most of the rest of the world, one that has only deepened with the rampant spread of the Delta variant and potentially thousands of others that are on the rise. Several of the most virulent strains were first identified in lower-income countries, including South Africa and India — both of which have fully vaccinated only 13 percent of their populations.

More than 100 low-income countries are banking on Mr. Biden to lean on the European Union and Group of 7 states at the summit on Wednesday to agree to waive intellectual property rights to vaccine production so that they can be shared with manufacturers in other, developing nations. Some of the leading coronavirus vaccines are produced in Europe — including Pfizer-BioNTech in Germany and AstraZeneca in England — and officials there have been accused of putting potential profits ahead of beating back the pandemic.

The European Union again objected to a plan to waive the vaccine property rights at a closed-door World Trade Organization meeting last week in Geneva, according to a senior European diplomat familiar with the discussion.

The Biden administration has supported a waiver, although not as forcefully as its advocates want.

“The action by the U.S. is particularly important to shift things forward, and make people come around the table and discuss these issues,” said Zane Dangor, a special adviser to South Africa’s foreign minister. He said European Union officials “would like to kick this discussion further down the road.”

Understand Vaccine and Mask Mandates in the U.S.

Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots. Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

“The more we delay in ensuring equitable access, the longer we wait, the longer the pandemic becomes,” Mr. Dangor said last week.

Wealthy nations have argued that the waiver alone will not produce vaccines, given that most developing countries lack technologies or other capabilities to manufacture them.

“Too much energy is being spent on an initiative that won’t provide immediate relief,” Gary Locke, the Commerce Department secretary and ambassador to China during the Obama administration, wrote on Sept. 8.

He said the issue had become politicized: “But it won’t get shots into arms when people really need it — which is right now.”

Health experts have blamed the ban on vaccine exports from India, imposed in March, for stunting the global supply. Two months later, the Serum Institute of India, the world’s largest vaccine maker, announced that it would divert its AstraZeneca vaccine production to domestic needs after a second wave of infections devastated India, reneging on hundreds of millions of doses that were designated for poor countries.

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Egypt started manufacturing China’s Sinovac vaccine with the aim of making one billion doses per year.Credit…Khaled Desouki/Agence France-Presse — Getty Images

The Biden administration has been pressuring Prime Minister Narendra Modi of India to drop the ban. Mr. Modi and the leaders of Japan and Australia will visit the White House for a gathering of the so-called Quad countries on Sept. 24, two days after the president’s vaccine summit.

Senior American and E.U. officials will meet in Washington on Monday, to discuss what several officials described as continued efforts to boost vaccine manufacturing.

That will be all the more necessary as the United States and other countries begin recommending booster shots for elderly and other vulnerable domestic populations. The World Health Organization had asked wealthy countries to hold off on administering booster shots to healthy patients, until at least the end of the year, as a way of enabling other nations to vaccinate at least 40 percent of their populations.

Without naming the United States, Dr. O’Brien noted that some countries are “moving forward with booster programs for which we do not see evidence that would support a need” in the general population.

“And at the same time, others haven’t even started vaccinating health workers or high risk groups sufficiently,” she said.

Dr. Anthony S. Fauci, the president’s top medical adviser for the coronavirus, said in an interview that the Biden administration was working on a far-reaching global response plan, but he would not offer specifics. Building additional vaccine manufacturing plants may be a reasonable step to prepare for the next pandemic, he said, but that cannot happen quickly enough to end this one.

“We’re trying to figure out what is the best way to get a really fully impactful program going,” Dr. Fauci said. “We want to do more, but we’re trying to figure out what the proper and best approach is.”

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