Why this USAID official is optimistic the U.S. can get the world vaccinated

Just over 61% of the world's population has gotten one shot of a COVID-19 vaccine. That number plummets to about 10% in low-income countries. That disparity has led to criticism of the world vaccination effort as inadequate and not responsive to the needs of lower-resource nations.

Jeremy Konyndyk, executive director of the COVID task force for the U.S. Agency for International Development, has an optimistic perspective. He talks to NPR about his perception of the campaign to bring vaccines to countries that are currently lagging behind.

These numbers suggest that progress isn't where it needs to be. Yet you've [told The Washington Post] this is a "winnable fight." Why?

The supply issue now is mostly resolved. The challenge has been in a lot of low-income countries. They haven't had the resources and the technical support to do something they haven't ever needed to do before: vaccinate their adult populations.

What is USAID doing to address this?

We are attacking the in-country distribution challenge in a few ways. There is a logistical and operational element to this. Do they have the internal transport infrastructure that they need [to get vaccines where they need to go]? We provide support with that.

You also need a different approach to vaccination than these countries are used to taking. Most low-income countries have very developed childhood immunization programs. But they haven't really needed to vaccinate their adult populations in large numbers. That requires different strategies and different approaches. We're helping [these countries] with the planning to reach that population.

And [we are] helping to build confidence in the vaccine. In most countries in the developing world, [vaccines are] not as politicized as here [in the U.S.]. But it's still challenging. So we do outreach and rumor-tracking to address some of the misinformation that may be out there.

Speak more about that issue of vaccine hesitancy.

It's important to distinguish between hesitancy and accessibility.

We've been talking to many countries across Africa to understand the dynamics and patterns they're seeing with their populations.

One of the things we keep hearing is that right now, the problem isn't so much that people are hesitant to get the vaccine, it's that it's not very accessible to them. They may live in a rural area, or they may work on a schedule that makes it difficult for them to take time out of their day to get the vaccine. If you're a daily wage laborer, it's very difficult to forgo a day's wages in order to get vaccinated.

We need to do more to push the vaccine out to people like that in ways that are accessible to where they live and how they live. And there's not been enough of that done yet.

And there is a hesitancy element. We've supported programs — like in Ivory Coast — tracking in real-time some of the misinformation that is floating around on social media and then feeding that into targeted outreach campaigns to specifically counteract some of the misinformation that's out there.

And does it work? Can you can you measure it?

It's hard to measure any specific rebutting of a WhatsApp rumor, but what we have seen is a significant ramp-up in vaccine coverage [in the countries that the U.S. is working with].

In December of last year, with support from the U.S. government, Ivory Coast was able to increase its national [COVID immunization] coverage rate from 22 to 36% in a month. In Uganda, it was able to [increase its national coverage rate from] 14 to 47% in just six weeks. The government has now vaccinated the majority of its adult population. And it was able to do that with outside support.

This is what gives us confidence that this is a winnable fight. We're seeing progress like that.

I keep seeing reports of vaccine doses getting to parts of the world where they are desperately needed, but then having to be destroyed because they are expired are about to expire. How big a problem is that?

It is a solvable problem. A lot of those headlines about expiration brush over the fact that many of those doses that have been destroyed were donated with very short shelf life in the first place.

The standard best practice, and what we've been doing with U.S.-donated doses, is to ensure [they are donated] at least four to six months [before they expire]. That gives a country ample time to feed them into the national vaccination program and plan out the use of those doses. When you get doses that have fewer than two months left, it's very difficult [to distribute them].

The world needs to be preparing for an extended period of time when we're going to be at risk for more variants. That is so exhausting to think about. And I wonder how you're thinking about it.

It is exhausting. This is why we are so focused and committed on trying to accelerate vaccine uptake in every country. We don't know where the next variant will come from. We don't know how the next variant will perform. But every four to six months, we have seen a new and more dangerous variant emerge. The one constant throughout has been that the vaccines are very powerful at preventing severe illness and keeping people out of hospitals. So [vaccines are] really crucial.

There has been criticism that the U.S. is not putting enough money toward the global [vaccine] effort. Is that a fair critique?

We have been, by a long shot, the largest donor to the global effort. We just announced an additional $315 million that is going toward supporting vaccine uptake. Our administrator, Samantha Power, announced that in December — and that came on top of another $195 million that USAID announced at the president's COVID-19 summit back in September. We do feel we've been doing a lot, we've been doing our part.

It sounds like, in your view, supply is being resolved and there is enough money going toward this. What's the biggest hurdle then?

Well, the biggest hurdle will be sustaining that. The U.S. is doing a large share. And we want to see other donors step up.

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