We are now more than six months into the Biden administration. Six months during which so many of us have been crying out for him to turn his attention to the global Covid-19 pandemic. Six months of absolute dereliction of duty, imperiling millions around the globe and hampering our own efforts to conquer SARS-CoV2 at home.
The figures have been widely circulated. While some states are heading toward 75–80 percent coverage of vaccines and the United States will top 50 percent coverage this summer, in Africa and among many regions of the world fewer than 5 percent of people have received a vaccine against this disease. The sheer denial this displays of human suffering on a monumental scale is a disgrace. Even in the context of self-interest, the inaction by the Biden administration is tremendous folly. Its willingness to let SARS-CoV2 replicate unchallenged around the world has already spawned one variant, Delta, which has taken over among the unvaccinated in this country. Are we really foolish enough to simply wait for the emergence of others—potentially more transmissible, lethal, or resistant to neutralization by our current vaccines? Not to mention the economic and social disruption—or the national security stakes of letting this pandemic rage outside our borders.
The administration will say: Wait, we’ve committed to sending vaccine doses overseas; we support a TRIPS waiver; aren’t we done yet? You haven’t even started. There are three things the Biden administration can do right now to change the course of the pandemic and put the virus on the defensive.
First, we know the mRNA vaccines—those produced by Moderna and Pfizer—have been remarkably effective and safe, even against the current variants. Compared to other types of vaccines, they are also relatively faster to produce. The US government subsidized the development of mRNA vaccines and owns some of the critical intellectual property, including patents on some of the vaccine components. The US government also has $10 billion in the Treasury under the American Rescue Plan Act that it could use to manufacture vaccines under the Defense Production Act (DPA). Groups like the New York City–based PrEP4All have called on the Biden administration to invoke the DPA, harness domestic manufacturing capacity, and start producing mRNA vaccines for export now. While there are complications—the need for raw materials and a shortage of experts who know the field—Washington could work with the companies or with those producing on behalf of them now like Lonza to get this done, under the Bayh-Dole Act.
Second, other groups, such as Resolve to Save Lives and Public Citizen , have mirrored PrEP4All’s calls, extending the idea of new mRNA production to hubs around the world—an idea being worked on now by the World Health Organization, which has announced the first vaccine production hub in South Africa. The United States can do more than one thing at a time. Supporting the rapid scale-up of these hubs is vital while getting vaccine doses made now at home for export. A distributed production network will always be more resilient than a single source for vaccines, and this dual track—immediate scale-up with US (or European) facilities while supporting vaccine production hubs in South Africa and elsewhere in the Global South—is critical to get to full vaccine coverage and to prepare for the next pandemic, or the emergence of new variants of our current nemesis, SARS-CoV2.
Third, as vaccinations slow in the United States, we are sitting on millions of doses that are getting close to their expiration dates. Right now, supply is exceeding demand here at home. Any country sitting on unused doses should make them available immediately to other countries in greater need and where demand is off the charts. This does not require additional manufacture. It simply needs sign-off from the White House beyond current promises made to date.
These three actions would set us on a path to vaccinating the world. But we are facing a crisis of political leadership. Some may think that the manufacturers are working as fast as they can and that by 2022 we’ll have more than we need. This is the line the drug company CEOs are feeding the White House. But by that time many more millions around the world will have been infected and died, while we simply said, “Just wait your turn.” Imagine if we said this to our own people: “We can make more vaccine faster, but we prefer not to—2022 or 2023 is good enough for you.” Meanwhile, some in the United States are talking about booster doses for Americans, which will constrain supplies for export into the future should these come to pass.
President Biden could be the hero here. The rationale for rapid worldwide vaccination is ironclad, on both scientific and humanitarian grounds. What’s stopping him? In medical school, to underscore the importance of the most plausible diagnosis rather than the most exotic, students are taught: “When you hear hoof beats, think horses, not zebras.” Well, this horse is the political power of the pharmaceutical lobby and its iron grip on American politicians—and that’s just getting worse. It’s time to break free. Biden can choose fealty to industry in the midst of a pandemic; that may indeed be the most politically expedient path. But it’s a morally reprehensible choice that will indelibly tarnish his young presidency, leaving a legacy where millions suffered and died while he refused to act.