Biden Says U.S. Leads The World In Vaccine Donations — And Promises More

Aug 3, 2021
Originally published on August 3, 2021 5:13 pm

Updated August 3, 2021 at 5:00 PM ET

The U.S. has delivered 110 million COVID-19 vaccine doses to 65 countries, from Afghanistan to Zambia, President Biden announced Tuesday at the White House.

The U.S. donations prove that "democracies can deliver," Biden said. He added that the U.S. has acquired another 500 million Pfizer vaccines that will be donated to low- and middle-income countries by the end of the month, emphasizing that global vaccination is essential: "You can't build a wall high enough to keep us safe from COVID in other countries."

These initial U.S. donated doses are just a first step for the projected 11 billion vaccines needed to vaccinate 70% of the world's population and bring the pandemic under control, according to the World Health Organization.

And providing doses to other countries is a quasi-Herculean task. "Sharing vaccine doses isn't quite as easy as just putting them on a plane and calling somebody at the other end and telling them when they'll arrive," said Gayle Smith, the global COVID-19 response coordinator at the State Department.

There have been some delays. Biden first announced that the U.S. would distribute 80 million doses to countries in need by the end of June, only later to say the goal had simply been to "allocate" them by the end of June.

Legal and regulatory hurdles loom for such sophisticated medical goods, Smith said — both for the U.S. to export them and for countries to receive them. And it's an urgent matter: Doses must be distributed before their expiration date, with cold chains set up to keep them from spoiling. Solutions have to be devised country by country, sometimes with elaborate legal agreements.

On this global stage, the Biden administration can't call all the shots. "In some countries, it's actually required ... to take new laws to their parliaments so they can accept these vaccines, so it's a complicated logistical exercise, but I think we've shown it's entirely doable," Smith said in an interview with NPR.

These first 100 million deliveries reflect Biden's effort to establish the U.S. as "the world's arsenal of vaccines" and are essentially a warmup for the hundreds of millions of shots that the U.S. has pledged to deliver later this year and next.

The number of doses delivered so far puts the U.S. ahead of the combined total of every other country making donations, Biden said at the news conference Tuesday. But the pace of the shipments is much slower than it should be, said Dr. Krishna Udayakumar, founding director of the Duke Global Health Innovation Center.

"When the world needs 10 billion doses to get to where we need to go, it puts that in context," he said. "We're a hundred times off where we need to be."

Biden echoed that point at his news conference. "There's a need for several billion doses," he said Tuesday, noting that the U.S. will help countries such as India manufacture more vaccines in addition to donating doses.

And certain parts of the world are severely lacking in vaccines. The breakdown of distribution at this point illustrates how far many countries are from any meaningful level of protection. Worldwide, fewer than 1% of vaccines have gone to people in low-income countries, while more than 80% have been given to people in high- and upper middle-income countries.

More shots, more money

As the highly contagious delta variant surges, global health experts are calling for a bigger investment in the pandemic response.

"Right now, it doesn't seem like the effort is matching the level of crisis that some parts of the world are seeing," said Jenny Ottenhoff, senior policy director for global health and education at the ONE Campaign.

The speed with which those doses arrive could determine the trajectory of the pandemic — and how many more people will die.

The numbers are daunting. At least 800,000 COVID-19 fatalities are projected in the next two months, according to new estimates from the Institute for Health Metrics and Evaluation at the University of Washington.

In an open letter released on Tuesday, a group of prominent global health experts wrote that the Biden administration and its G-7 allies have "taken important but modest steps to close the global vaccine gap," which still "fall far short of the true scale and urgency required."

The letter urged the White House to ramp up U.S. donations quickly by at least 1 billion doses by mid-2022, strengthen global coordination of vaccine supply chains and pour resources into ensuring that "doses are translated into vaccinations."

A man passes donated Johnson & Johnson vaccines after their arrival Friday at the Phnom Penh International Airport in Cambodia — the first batch of 1 million shots.
Heng Sinith / AP

Logistical challenges loom

As the Biden administration prepares to move hundreds of millions of more doses, the challenges in delivering these first 100 million doses should serve as a wake-up call, said Prashant Yadav, a senior fellow at the Center for Global Development who studies health care supply chains.

"Just having surplus doses and a plan on how to allocate them is not sufficient. It requires a lot of other things to fall in place," Yadav said. "Similar types of logistical challenges will remain in place for that massive quantity. And so the bigger question is, are we now planning based on what we've learned?"

In July, the White House released a "framework" for the pandemic response, but the Biden administration still seems to lack the kind of "superstructure" needed to manage the complex demands of the global vaccination campaign, said Stephen Morrison at the Center for Strategic and International Studies, who also signed the letter.

"It's been somewhat ad hoc," he said. "We need to be staffed up at a higher level with a command-type approach, similar to what we've taken domestically, and we don't have that yet."

The U.S. has the opportunity to take on a "more engaged" role with the global vaccination rollout, Yadav said. But that would require a much larger investment in the federal agencies currently orchestrating the vaccine-sharing programs, he said.

A health worker vaccinates a woman last week in Thimphu, Bhutan.
Upasana Dahal / AFP via Getty Images

White House plans to "accelerate, accelerate, accelerate"

Smith said the aim is to "accelerate, accelerate, accelerate" to get more vaccines to more people faster.

"I don't want to understate in any way how proud all of us are that we not only hit the 80 million, but we are at 110," Smith said. "But I think none of us thinks that we can check the box now. There's still a massive amount to do. This last quarter of 2021 is critical. So we've got to keep going, and we've got to do more in any possible way we can do it."

As long as the virus is moving faster than the drive to vaccinate the world, it is winning, she said.

And that puts more pressure on the Biden administration. "Without U.S. leadership, I don't see another plausible pathway where we're going to turn the corner on this pandemic any time in the next six, 12 or 18 months," said Udayakumar of the Duke Global Health Innovation Center.

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Last year, the United States was leading the world in deaths from COVID. This year, the U.S. still faces a resurgent pandemic. But millions of doses of vaccine have allowed the U.S. to resume a more accustomed role on the world stage. Thanks to technology and money, Americans who choose vaccinations are protected. And the U.S. is able to share that protection with the rest of the world. Today, President Biden announces the U.S. is on track to deliver 110 million doses to countries around the world. We're joined now by NPR White House correspondent Tamara Keith. Tam, good morning.


INSKEEP: Where did those doses go?

KEITH: Yeah. This is a milestone. More than 100 million delivered, 10 million more on the way out the door. They've gotten more than 50 countries from Afghanistan to El Salvador and Zambia. And, you know, the initial goal was to ship 80 million doses to countries in need by the end of June. That proved to be a bit of a challenge. They got them allocated, but it wasn't until well into July that they finally got them delivered. But in recent days, the pace of vaccine-sharing has really picked up, which has allowed them to get this 110 million number out there, which the president will be announcing. But I'm told by others that this is just not enough. Dr. Krishna Udayakumar is a global health expert at Duke University. He told me this is too little and too late.

KRISHNA UDAYAKUMAR: It's more than any other country in terms of donations. And yet when the world needs 10 billion doses to get to where we need to go, it puts that in context that we're 100x off where we need to be.


KEITH: The Biden administration has secured a contract with Pfizer for another half a billion doses. And those are starting to go out this month. But it could take as much as a year for all of them to be delivered. Meanwhile, the delta variant is ravaging countries in Africa and other places with low vaccination rates. And as long as COVID is spreading out of control, there is a very real risk that another variant like the delta variant could develop, which is why global health experts always say that no one is safe until everyone is safe.

INSKEEP: I'm reminded of something Bill Gates said not too long ago, that he thought the U.S. would be safe by the end of 2021 - but the rest of the world, maybe not until the end of 2022. Why is it taking so much time to get vaccines elsewhere?

KEITH: Well, first, the U.S. prioritized vaccinating Americans. But then when the administration turned to sending those doses to other countries, the bureaucratic and logistical barriers were significant. I interviewed Gayle Smith, who is the global COVID response coordinator at the State Department.

GAYLE SMITH: Sharing vaccine doses isn't quite as easy as just putting them on a plane and calling somebody at the other end and telling them when they'll arrive. Because these are sophisticated medical goods, there are a number of legal and regulatory steps that have to be gone through.

KEITH: So they had to build teams of lawyers and regulators to work through contract issues on the U.S. side and regulatory approvals on the receiving end. In some cases, she said, the countries getting the vaccines had to pass new laws to allow them to accept them. And it was a process that was repeated country by country. In theory, now that these pipelines have been opened up, the next plane full of vaccines will be easier to send. But, of course, it also doesn't end with a pallet of vaccines with an American flag on the side on a tarmac. Those doses have to get into people's arms, which has been an additional challenge in some places.

INSKEEP: How does the administration respond to those concerns?

KEITH: Essentially, they agree that more needs to happen. Today, they want to celebrate this milestone. But Smith told me they are working to accelerate the pace of vaccine-sharing without overpromising. They also want to see other developed countries step up and share more doses more quickly. It's all pretty daunting. But Smith says these first 100 million doses show that it can be done.

SMITH: We're not saying 110 million, check the box, we've done our bit. No. We're not there yet. And so long as the virus is moving faster than we are, we've got to keep going. And we fully intend to do so.

KEITH: Advocates say they want to see more leadership from the U.S., increasing its shipment, putting pressures on other countries to do the same.

INSKEEP: NPR White House correspondent Tamara Keith. Thanks.

KEITH: You're welcome. Transcript provided by NPR, Copyright NPR.