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Vaccine Reports

Q&A: 80 Million Donated Vaccine Doses: Too Little, Too Late?

By the end of June, the Biden Administration aims to deliver 20 million out of its pledged 80 million donated doses of COVID-19 vaccines to other nations, a commitment that officials said is “five times more than any other country in the world has shared.” But is it enough? The United States has now authorized children as young as 12 years old to be vaccinated while the most vulnerable adults in many other nations still lack vaccine access. It’s a complicated question. William Moss, vaccinology lead for the CRC and executive director of the International Vaccine Access Center, discusses the need for the United States to exert worldwide leadership in fighting the global pandemic.

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William Moss, Executive Director, International Vaccine Access Center, JHU
May 26, 2021

Is the U.S. donation of 80 million doses enough to make a global difference?

No, it’s far from adequate. It’s a small step in the right direction. It’s a good gesture. But the United States needs to play a much bigger role if we’re going to address the global vaccine inequities between high and middle- and low-income countries. The world vaccination map on the Coronavirus Resource Center website provides a stark illustration of how vaccines are being administered in richer nations far faster than anywhere else.

Is there a number that would provide the world with a serious infusion of vaccines?

There isn’t a specific number, but for context here is one way to think about it. There are 8 billion people in the world. Each one would need two shots. That’s 16 billion doses. Say we want to vaccinate 70% of the world population to really try to stop this pandemic – that's more than 11 billion doses. Now you can see how 20 million or 60 million or 80 million doses is really a trivial amount considering the challenge ahead for the world.

My understanding is that there are several hundred million doses available each month in the United States. An 80 million donation is a drop in the bucket.

How can the United States get those doses into the arms of citizens of other nations?

There are three strategies that countries can follow for vaccine donations overseas.

The first is to deliver them through the COVAX Facility, which I think is the best. That’s the primary global mechanism for getting vaccines to low- and middle-income nations. They use equity to determine where to deliver the vaccines, with the number of doses proportional to the population size. COVAX is thus the most equitable. The Biden Administration said it would be supporting the COVAX Facility, so that’s a good thing.

‘A donation of 80 million vaccine doses is a trivial amount considering the challenge ahead for the world.’

A second strategy is to target hotspots and emerging hotspots. For example, some of those doses are going to be targeted to India, which is facing a tragic surge in cases. The idea is to get vaccines to where they are needed most. But it has to be done early. That’s the trick and the challenge with that approach.

And then the third strategy is based on foreign policy decisions. This is my least favorite. For example, the Biden Administration has donated doses to Canada and Mexico, obviously because they are countries on our borders where we have a self-interest in preventing virus importations.

Is there enough time to deliver the vaccines to make a difference?

Well, with India, I must say, it's late. Technically, it’s never really too late but vaccines take time to be administered and to work so they’re not a short-term solution. But right now it’s so far behind the curve. Let’s say all 60 million of the AstraZeneca doses go to India. It’s going to take some time to even get those doses into people. Then you need to give them two doses. And then you’re not fully immunized until two weeks later. That’s really a strategy to help two months down the line not during a terrible surge in cases. Not that it’s wrong to do this, but you have to temper your expectations as to what it is going to do.

You can look at where outbreaks are really emerging like in Nepal or Thailand to target vaccine doses.

What more can the United States do to address the global situation?

The United States needs to do a lot more than donating vaccines. That’s just one part of a portfolio in addressing global vaccine inequities. The United States needs to support the expansion of vaccine manufacturing both domestically and abroad. It needs to help build that capacity, provide training for personnel, and relax export restrictions on supplies, reagents, and chemicals that go into manufacturing vaccines.

This needs to be a global partnership among the wealthy nations to coordinate all of the responses needed.

‘The U.S. needs to do a lot more than donating vaccines to address global vaccine inequities.’

It is in the self-interest of the United States to do this because we are always going to be at risk of importing SARS-CoV-2, and the risk of importing variants for which our current vaccines may be less effective. It’s really enlightened self-interest to try to reduce transmission and to get this pandemic under control everywhere. We need to substantially reduce the burden of disease for humanitarian purposes and reduce transmission of the virus for self-interest to prevent the emergence of variants that could cause outbreaks in the United States.

We are already at a point in the United States where we have a surplus of vaccines. Obviously we expanded eligibility for children 12 to 15 years old, and this will increase our need. But the demand is decreasing among adults in the United States and we’re going to have excess doses.

To date 1.7 billion COVID-19 vaccine doses have been produced. We’re still at a small fraction of what is needed to vaccinate the world and we’re not going to get much of the world vaccinated until 2023. This needs to be an urgent and collaborative global effort.

Can surplus vaccines be used as booster shots later?

I believe that is one of the reasons why there has been some reluctance to donate a large number of doses. It’s still a bit uncertain about the timing and need for booster doses. Many experts believe we will need them. The question is when. The Biden Administration justifiably has been focused on bringing the pandemic under control in the United States. It does not want to put the United States into a shortage, which I think is reasonable. But the United States still need to be a global leader in addressing global vaccine inequities.

The United States will need to maintain a supply of vaccine for potential booster doses. Now if there is a new variant that is driving the need for additional vaccine doses, we could use the current vaccine as a booster, but we may also need a new vaccine created specifically to target a variant.

William Moss, Executive Director, International Vaccine Access Center, JHU

William Moss, MD, MPH, is Executive Director of the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health.