They're Asking Biden To Vaccinate The World. It's Not Fair. But It's Not Impossible

What if the U.S. decided to vaccinate the rest of the world against COVID-19?

That's what more than 175 health experts proposed to President Biden in an Aug. 10 letter sent to senior White House officials and shared with The Washington Post.

"We urge you to act now," the letter reads. "Announcing within the next 30 days an ambitious global vaccine manufacturing program is the only way to control this pandemic, protect the precious gains made to date and build vaccine infrastructure for the future."

The experts are asking the Biden administration to do three things:

• Scale up production of mRNA vaccines in the U.S. with a goal of manufacturing 8 billion doses a year to distribute globally. MRNA vaccines, say the co-signers, are faster to produce and more effective against variants than other types of vaccines.
• Help set up manufacturing hubs around the world to make even more mRNA vaccines.
• Export 10 million mRNA vaccines a week to COVAX or other global vaccine-sharing programs. According to the letter, the U.S. has over 55 million doses of mRNA vaccines in storage but is only administering 900,000 shots a day.

Only 24% of the world's 7.8 billion people have been fully vaccinated, according to figures compiled by Our World In Data, which gets its information from governments and health ministries. If the letter's proposal is adopted, 4 billion people – more than half the global population – could be fully vaccinated by the end of 2021 with U.S.-manufactured doses.

These are highly ambitious goals. But the signatories say they are necessary to curb rising infection rates as the delta variant surges in Africa, Latin America and Asia – regions where vaccines are least available. These measures can also protect against emerging variants, some of which may be resistant to current vaccines.

To better understand the letter's demands, we spoke with Dr. Paul Farmer, a Harvard Medical School professor and co-founder of the global health organization Partners In Health, who co-signed the letter alongside health academics, civil society leaders and others. This interview has been edited for length and clarity.

Why did you and your colleagues decide to draft and send the letter?

This is a group of global health folks with long experience responding to health crises in this country and in others. But this time, we have some new tools that are revolutionary. In sharp contrast to global plagues in the past, not even a year after identifying the pathogen, we have these highly effective vaccines, particularly mRNA vaccines. [The COVAX goal of] hitting 20% of the populations [of low-income countries] in the coming year is low. So, we thought, is there a way for us to spur into action what we see as a fairly supportive administration in Washington?

Is it fair to single out the U.S. to shoulder the global burden of vaccinating against COVID-19? Why not ask other wealthy countries to chip in?

It's not fair. We're cognizant that we're asking the U.S. to do more than any other country. But we have the vaccines and the technology [to cover the vaccination gap for the whole world]. So, it's a wonderful opportunity for us to say no to vaccine nationalism and yes to establishing a global standard of care for COVID and prevention of COVID.

Also, most of the signatories of the letter are Americans. So, we're begging our own country to do more because we think it can and we think it should.

Is this going to be an impossible challenge?

It's not impossible. Otherwise, we wouldn't have pushed the Biden administration so hard on the specifics. Is it going to be difficult? It sure is. We came to those big numbers by looking at the projected need and also the likelihood, if not certainty, that boosters would be needed. But we think the Biden administration has the resolve and wherewithal to do it.

We learned from the success of PEPFAR [President George W. Bush's HIV/AIDS initiative] that the higher we set our goals, the more people are enrolled in care and the more children protected. We're not drawing on nothing. We're not trying to be unreasonable. We're trying to be optimistic and audacious because that's what the moment calls for.

What first step would you like the Biden administration to take toward meeting the demands in the letter?

I'd like to see us facilitate vaccine production in Africa. They deserve a chance, especially because they have the highest burden of lethal infectious disease. If we are going to be pushing boosters on top of trying to vaccinate the whole continent against COVID, it's hard for us to see any option other than on-continent production.

Is there a place in particular that you think would make a great vaccine production hub?

I'm confident this could be done within months or a year in Rwanda, which has rolled out a very effective health-care delivery system – from community health workers to clinics to district hospitals to referral hospitals – over the last 15 years. And certainly South Africa, which is already a vaccine producer.

COVAX was supposed to ensure that vaccines were distributed equitably around the world. Does the fact that you and your colleagues felt compelled to send this letter mean COVAX has failed?

Looking at history, we've never pulled off a global vaccine rollout as quickly as we're trying to now. It took us almost two centuries to declare smallpox vanquished after a vaccine was developed. Even antiretroviral therapy for HIV took the better part of a decade for its widespread delivery. So, I'm not sure we find ourselves in the midst of some epic failure.

This is the most rapid development of novel vaccines that we have ever seen. Now the task is to see who can help us shorten the time between development and delivery. There's nobody in the world that can do more on this than the Biden administration.

Have you received a response from the Biden administration?

We don't need or expect a letter back. Many of us have friends there, so we have a pretty good idea that some of the best people in the administration don't think this is a bad idea or imprudent or ridiculous. Of course, the buck stops with the boss, and the boss is President Biden. But our experience [as global health experts] with this administration so far has been a positive one.

So do I think we will see some response to this? I think we will.

Joanne Lu is a freelance journalist who covers global poverty and inequity. Her work has appeared in Humanosphere, The Guardian, Global Washington and War is Boring. Follow her on Twitter: @joannelu

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