The progress we’re making against the coronavirus is precarious. Even as vaccinations accelerate and hospitals empty, emerging variants of the coronavirus threaten to keep us stuck in a purgatory. Some variants may be nothing to worry about; viruses evolve all the time, after all. But some variants, like B.1.1.7, discovered in the United Kingdom, may have more transmissibility. Others, like B.1.351, found in South Africa, may be better at evading immune responses from available vaccines. We are learning more by the day. In that uncertainty, we need to work to get the pandemic under control not just here, but globally. The United States should start sending some of our vaccine supply abroad—now.
This might seem irrational given that there have been plenty of hiccups and failures at getting vaccines into arms here in the U.S., where our rollout is still very much in progress. (And as I am a physician, I’ve already been vaccinated, so I recognize that I’m in a secure spot compared with most Americans.) But even as we figure out how to vaccinate more people faster, we’ve actually done a very good job of securing doses compared with the rest of the globe. As I write this, the United States is second only to Canada in securing the highest percentage of vaccines relative to its population. This includes both doses that have been produced and are ready to go, as well as doses that the government has preordered from manufacturers. At this point, we have enough Food and Drug Administration–approved doses reserved to cover Americans about twice over. Most countries haven’t secured enough doses to vaccinate their own health care workers. While the Biden administration has indicated it will plan to share some doses eventually, it’s important to also remember that we’re doing pretty well in administering doses right now, too: Globally, in terms of the percentage of the population that has been fully vaccinated, the United States ranks fourth.
Sharing some of our supply immediately would be about more than correcting an imbalance of privilege (though, yes, helping achieve global vaccine equity is morally the right thing to do). It would be a practical move to strengthen our own public health outlook, and by extension our economy. SARS-CoV-2 variants don’t respect international borders, and variants rapidly spreading anywhere, whether here or abroad, threaten us all. Even if cases decline rapidly in the United States after the mass deployment of vaccines, our new normal would only be fragile at best, and unsustainable at worst, if the pandemic rages on globally. We need to reduce as much as possible the opportunity the virus has to spread and mutate. Currently, variants seem like they may diminish the effectiveness of vaccines a little, but not by a hugely worrying amount (though this remains up in the air). Pfizer and Moderna are already considering booster shots for their vaccines to keep pace with the variants out there, in particular B.1.351. Future variants may be more adept at avoiding the immunity offered by current vaccines, making getting ahead with booster shots increasingly difficult. And future variants that are able to evade immunity to some degree would also threaten to spark community outbreaks and spikes in hospitalizations. In the direst of circumstances (though the Centers for Disease Control and Prevention notes that this is unlikely), a variant may carry an “escape mutation” that even renders herd immunity from vaccines ineffective, undoing our progress and leaving us in a situation similar to that we found ourselves in roughly one year ago.
The sooner we get a handle on the virus globally, the less we will have to worry about any of these scenarios, however low-probability some of them are. But the White House is not acting quickly. Last year, the Trump administration failed to join COVAX, a collaborative of wealthier countries to distribute COVID vaccines. The Biden administration has since reversed course, joining the effort and pledging $4 billion in financial support, which are both good and necessary steps. But the current White House has been conspicuously noncommittal when pressed on an actual timeline for sending vaccine supplies abroad, even as our own domestic vaccine campaign picks up steam. Biden has said the government is planning to start sending doses “once there is sufficient supply in the United States.” It’s unclear what “sufficient supply” is, but there should be enough vaccines available for all Americans in May, according to other statements by the president (though we know well at this point that vaccine timelines are fickle). Even waiting until spring, however, to start shipping doses would allow for variants to continue spreading in different corners of the globe—where sequencing may be less frequent or nonexistent, and where vaccines are extremely scarce.
In the immediate term, the commitment to send vaccines abroad wouldn’t need to be substantial. The United States, after all, remains a major COVID hot spot globally. Variants are cropping up here, too. The vast, vast majority of our supply should be dedicated toward Americans. We can, however, start by shipping off a small fraction of our supply, and adjust from there based on the severity of the COVID pandemic here at home—say, dial it back if cases start rising again (a frustratingly real possibility, given that several states are lifting mask mandates). A figure that may be reasonable to start with is 5 percent, the fraction of vaccine supply French President Emmanuel Macron recently suggested high-income countries should quickly donate to their lower- and middle-income counterparts. Donations of our own vaccines could be strategic, sent to areas where new variants are emerging or at risk of emerging based on indicators like weekly cases per capita, test positivity rates, and local hospitalization rates. The recently approved Johnson & Johnson vaccine, which doesn’t need ultracool storage and only requires one dose, would be particularly useful in rapid deployment to resource-poor settings around the world. The U.S. government just purchased another 100 million doses Wednesday; allocating some of those would be an excellent step.
Whatever the U.S. can contribute may help encourage other wealthy countries to increase their vaccine donations as well, snowballing the effort to vaccinate the globe as quickly as possible. Despite the past four years, the United States is still a leader on the global stage. Allies and adversaries take note of our actions. Some countries, like Portugal and Norway, have already started to send doses abroad, and Russia, India, and China are using vaccine donations and sales to gain influence in poorer countries. Vaccine generosity by the United States, however, could truly spur a global effort by high-income countries to walk away from vaccine nationalism—an ideology that has led to banned exports, diplomatic tiffs, and faceoffs between countries and pharmaceutical companies—and band together to address the virus variants.
As an exercise of soft power, sending vaccines abroad would sow badly needed goodwill among allies after the Trump era, while signaling to the world that the United States has reentered the global health arena as a force for good. The COVID-19 pandemic has demonstrated how interconnected and interdependent we are with others around the world. It’s in our best interest—for this crisis and for future ones—to share our resources when we can.
