As of Wednesday, the Centers for Disease Control and Prevention (CDC) reports that a third of all Americans, and 42% of American adults, have now received at least one COVID-19 vaccine. It’s quite a milestone, and with the constantly accelerating rate of vaccination in the United States, it seems extremely likely that the nation will exceed the goal of 200 million shots by the end of April—which would mark the end of Biden’s first 100 days. In fact, since 171 million doses have been administered already, it should be a relative cakewalk, even if there are additional delays in vaccine delivery.
Before the end of May, the United States could see 75% of the population with at least one shot of vaccine. That is, unless Republican vaccine rejection stops the nation short of that goal.
After that goal is achieved, the nation will turn almost immediately to beginning to vaccinate younger citizens in time for the return to school in the fall. Pfizer’s recent results are just one indication that the current generation of vaccines are safe for children as young as 12, and it’s hard to get better than the preliminary value of 100% efficacy. Pfizer and BioNTech are now involved in a study that takes the vaccine all the way down to infants as young as six months.
But even when all those children are added in, the United States is going to soon be in an enviable position—we’re going to have more vaccine than we need. Hundreds of millions of doses more. The best thing to do with those vaccines, for both the world and the United States, would be to give them to other nations. But thanks to maddening limitations set in the contracts, that may not be possible.
As the Associated Press reports, medical agencies and volunteer groups around the world are going to extraordinary lengths to distribute COVID-19 vaccine to every area of the globe. It’s reaching remote islands, getting to small Alaskan villages across the ice, and being freighted up Amazon waterways. UNICEF says the vaccine has been delivered by “drones, motorcycles, elephants, horses and camels.”
But the rate of vaccination around the world has been anything but even. According to Our World In Data, Israel has now exceeded 60% of its population vaccinated. That rapid rate of vaccination, and a mask mandate that is still in effect, has brought cases there down from nearly 10,000 a day in January to less than 300 a day in March. Israel seems set to be the first nation to actually achieve something like herd immunity on the basis of vaccination, even though their rate of vaccination has dropped in the last two weeks and issues of unequal access remain.
The U.K. is now getting close to having 50% of its population vaccinated, but the rate of vaccination there is also dropping off, in part because they also have a problem with “vaccine hesitancy.” That issue has been exacerbated by suspicions about the AstraZeneca vaccine (which do not appear to have a basis in fact). Despite this slowing, the U.K. has also seen a tremendous drop in the rate of new cases from a peak of 59,000 cases a day in January to 3,000 a day in March.
And then there’s Chile. The right-leaning authoritarian government in Chile has earned praised for breaking with other Latin American countries and moving rapidly to both secure vaccine and begin a rapid program of public vaccination. With 37% of the population vaccinated, Chile is actually ahead of the United States. But just as in the United States, that level of vaccination is not yet enough to make a serious dent in virus transmission.
Despite the vaccination, Chile is actually seeing a huge increase in COVID-19 cases. Cases have almost doubled since January, even as they’ve fallen in many other countries. The reason isn’t just because of new, more contagious variants—the U.K. certainly has that issue—but because of two other decisions. One is that the government has greatly relaxed social distancing rules even before the vaccination program rolled out (and in fact, never had very strict rules to begin with). The second is the type of vaccine being used, which is the SinoVac vaccine developed in China.
As the Financial Times reports, tests outside China have demonstrated that the efficacy of SinoVac is well below that of Pfizer, Moderna, Johnson & Johnson, and AstraZeneca. When two doses are delivered, the efficacy is 50.4%—a barely acceptable value. That reduced efficacy means that more people need to be fully vaccinated to have a similar effect. In fact, about 60% of Chileans would need to be fully vaccinated with SinoVac to match the reduction achieved by vaccinating 33% of Americans with a mixture of the more efficacious Pfizer, Moderna, and Johnson & Johnson.
Worse still, while Pfizer and Moderna’s two-shot vaccines provide good immunity just a couple of weeks past the first dose (so much so that some nations have delayed second doses in order to get more people vaccinated quickly), that’s not the case with SinoVac. With a single dose, its efficacy is negligible—just 3% in trials. Most of those vaccinated in Chile have received only a single dose, so they’re “vaccinated,” except they’re not safe at all.
So why did Chile buy SinoVac if it’s so relatively ineffective? That’s what is available. Wealthy nations, and in particular the United States, snapped up vaccines in huge orders well before they were available.
Under Trump, the United States had theoretically secured 700 million doses of vaccine. However, 400 of that was for the AstraZeneca and Novavax vaccines still not available in the United States and 100 was for the Sanofi vaccine, which now appears to be a bust after failing to reach desired levels of immune response. Factor that out, and the U.S. still controls:
- 300 million Pfizer
- 300 million Moderna
- 300 million AstraZeneca
- 200 million Johnson & Johnson
- 100 million Novovax
That’s 1.2 billion doses of vaccine. Some of them take two doses per person, but it should still be enough for 750 million people—more than twice the whole population of the United States. Children included.
Making these big purchases up front, and adding millions more doses even when there were theoretically “enough” made sense because the goal was to get as much vaccine coming as quickly as possible. But there’s no doubt that when all the smoke clears, the United States will have a big vaccine surplus.
The obvious thing to do with all that extra vaccine is to give it away. As we’re already seeing with the Indian variant, and U.K. variant, and South African variant, and Brazilian variant, the more countries that have an ongoing COVID-19 epidemic, the more likely it is for more contagious, more vaccine-evasive versions to pop up. Without an effort to vaccinate the world, COVID-19 will likely become an endemic disease in many nations, and an ongoing problem for everyone.
But, as Vanity Fair reports, there’s an issue.
The Biden administration definitely understands both the health and political benefits that could come from “vaccine diplomacy.” Not only would handing out big packages of vaccine help to protect the U.S. from a resurgent pandemic, it could go a long way to mending relationships torn apart under Trump.
Only, well, this …
The contracts the Trump administration signed with the vaccine manufacturers prohibit the U.S. from sharing its surplus doses with the rest of the world.
The original agreements with Pfizer, Moderna, AstraZeneca, and Johnson & Johnson (Janssen) all contain the same language: “The Government may not use, or authorize the use of, any products or materials provided under this Project Agreement, unless such use occurs in the United States.”
Because this is an agreement between two parties, the United States can’t just break it and begin shipping out vaccine regardless. This raises the possibility of a diplomatic and humanitarian disaster, one where people around the world are dying as the U.S. sits on an (expiring) vaccine hoard.
There’s an obvious solution to this: Sit down with manufacturers and draft an addendum to the agreement that authorizes the U.S. to distribute surplus vaccine. There’s also an obvious problem: Why should vaccine manufacturers agree? After all, if the U.S. is forced to simply sit on a dying stock of vaccine, that’s more doses that manufacturers can sell elsewhere. Allowing the U.S. to give away vaccine at this point would require the manufacturers to more or less compete with themselves.
The situation is frustrating because President Joe Biden would like to do more than just give away the existing vaccine surplus. He would like to contract with manufacturers to distribute discounted vaccine around the world, as well as making a $4 billion contribution to vaccine administration. But unless the language left behind by Trump—which goes beyond “American first” to “America only”—can be eliminated, doing the right thing is going to be a lot more difficult.
And the world is going to be able to say, rightly, that the U.S. is hoarding unneeded vaccine.