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What the U.S. can — and cannot — do for vaccine equity per the State Department

Containers of Moderna COVID-19 vaccine doses, donated by the United States, arrive in Bogota, Colombia, in July. The U.S. plans to send more than a billion vaccines abroad by September 2022.
Containers of Moderna COVID-19 vaccine doses, donated by the United States, arrive in Bogota, Colombia, in July. The U.S. plans to send more than a billion vaccines abroad by September 2022.

The U.S. has given 200 million COVID-19 vaccine doses to countries in need and has said it will give a total of 1.1 billion by 2022. Yet public health specialists say several more billion doses are needed around the world. Steve Inskeep of NPR's Morning Edition interviewed Gayle Smith, coordinator for global COVID response and health security at the U.S. State Department, to learn more about global vaccine distribution.

Gayle Smith, coordinator for global COVID response and health security at the U.S. State Department, speaks at an event in Washington, D.C., in April. She says it is "absolutely urgent" to send surplus vaccines in the U.S. to countries in need.
Alexander Drago / POOL/AFP via Getty Images
Gayle Smith, coordinator for global COVID response and health security at the U.S. State Department, speaks at an event in Washington, D.C., in April. She says it is "absolutely urgent" to send surplus vaccines in the U.S. to countries in need.

Is the United States doing enough to share doses and encourage other countries to do the same?

I think we're doing a great deal. But we are not where we need to be on supply. We need to ramp up the sharing of doses from any country that is able to do so. There have been commitments from the U.K., the European Union. That's terrific.

We have worked also on increasing production of the Johnson & Johnson vaccine [in Africa].

Tom Frieden, former director of the Centers for Disease Control and Prevention, wrote the other day that of 6.5 billion doses globally, only 4% have gone to low-income countries. He blames Pfizer and Moderna for this inequity, because those companies have been selling to the countries that can pay the most. Is he right about that?

The global architecture of vaccine production is neither big nor agile enough to provide what's needed in a crisis like this pandemic.

I leave it to the drug manufacturers to offer their explanation of why that may be.

Some regions have been able to somewhat surmount that obstacle. In the case of the African Union, for example, they mobilized capital from within Africa to purchase 400 million Johnson & Johnson doses, which are now rolling out on the continent. It points to what we're going to need to do in the future: make sure we've got a better system that can reach more people more quickly.

If I look at The New York Times coronavirus vaccine tracker and run my cursor across Africa, I find that in country after country, a very small percentage of people are vaccinated.

The coverage numbers are way too low. That's one of the reasons we've got a primary focus on Africa.

Does the U.S. government have the leverage to tell a vaccine maker what to do – say, make more doses — or must you ask them to do things?

I think it's more ask than tell, but I think there are ways to ask with enthusiasm.

Ask with enthusiasm! I kind of like that.

The president came out and did two really critical things. First, he said we are going to start sharing doses in earnest.

He also convened a summit of world leaders in September, around the time of the U.N. General Assembly meetings, to tell them to do everything they can [to send doses abroad]. That was a call not only to governments and international organizations but to the private sector, including manufacturers.

There's a pretty clear message, not just from the United States but from countries all over the world.

I could imagine that someone who lives in a sub-Saharan African country – or in any number of countries around the world struggling with COVID — resenting the United States for getting several hundred million doses of vaccine for itself and only now shipping out its surplus. How would you respond to that person?

That's a fair question for someone to ask. The system doesn't seem to work the way it should. But we've also seen there's been tremendous appreciation for the United States in providing doses and making very clear there are no strings attached.

What would you say to Americans who ask: Why are we spending money to send hundreds of millions of vaccine doses overseas? It's not our business.

It is our business. This is a virus that doesn't know any borders. It doesn't know whether it's in the U.S. or Canada or Nigeria or Singapore. It's just looking for large, unvaccinated populations where it can infect people, replicate, mutate and get stronger and stronger.

As long as we've got low rates of vaccination anywhere, [COVID is] a threat to us. It is a huge threat to the global economy, to global stability. So it's absolutely in our interest from a public health perspective.

I would also say, as somebody who's been in this work for a long time, it matters that the United States is leading on this – not just from a self-interest point of view, but because of our values. Where you're born shouldn't determine whether or not you can get vaccinated in the midst of a global pandemic.

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