With a surplus looming, how should the United States use the excess vaccines? | News on the coronavirus pandemic

As the United States rushes toward its goal of having enough coronavirus vaccines available for all adults in the country as of May 1, the debate over what to do with excess supplies is intensifying.

The United States is expected to have a significant surplus of coronavirus vaccines in the second half of 2021, estimated at around 600 million excess doses, but President Joe Biden’s administration has given little information on how these vaccines will be allocated .

Global health advocates have said vaccines could be used to help alleviate a global supply shortage, which is in part the result of production problems, but also caused by some wealthy countries purchasing large amounts of vaccines. from pharmaceutical companies.

The United States, along with countries like the United Kingdom and Canada, have ordered enough doses to immunize their populations more than once, while several countries have struggled to gain access to doses, which that some critics called apartheid vaccine.

Biden said last week, “If we have a surplus, we’re going to share it with the rest of the world.” But so far, the administration has not given details on what form that split will take, how many doses it will be willing to part with, or whether it will donate or sell its excess doses.

The United States is reaching a “political and psychological threshold” that allows the administration and the public to start thinking globally after months of focusing on national crises, said J Stephen Morrison, director of the Global Health Policy Center of the United States. Center. for strategic and international studies.

“It was seen as a hypersensitive matter to start allocating vaccine surpluses prematurely and politically unsafe to start allocating future surpluses,” he said. “I think that is changing. But that hasn’t changed 180 degrees. “

Andrea Taylor, senior researcher on a Duke University project that tracks global purchases of COVID-19 vaccines, said it was not “clear” how the United States can most effectively deploy its projected surplus .

“We are currently working on scenario planning to answer this exact question: Once the United States is ready to start giving doses, what are the options? And what are the advantages and disadvantages of the different approaches? Taylor told Al Jazeera.

Current data from Duke puts the total number of confirmed vaccine orders in the United States – which include inoculants still in development – at 1.2 billion, far exceeding the population of around 328 million.

The advantage of donating through the World Health Organization COVAX Initiative – to which the United States has already committed up to $ 4 billion – “ensures an equitable allocation by coverage of the population … They ensure that all countries get enough to cover the 3% 5% 10% up to to 20% of their population, ”Taylor said.

Workers unload boxes of AstraZeneca-Oxford vaccine as country receives first batch of coronavirus vaccine from COVAX program in Abidjan, Cote d’Ivoire [File: Luc Gnago/Reuters]

The United States, and other wealthy countries that are expected to have a surplus, may also consider rolling out vaccines “to areas hardest hit in terms of COVID load, countries where health systems are on the verge of failing. collapse, or have a really high death rate, ”she said.

Then, Taylor added, there is “that kind of soft diplomacy approach … American policymakers may want to think of certain countries where they have particular trade relationships or where the [the US] wants to protect for our own global supply chains or for personal reasons ”.

She noted that the US approach is likely to be a “mix of the three”.

“Unrelated” but “overlapping”

For the moment, the surplus of American vaccines exists mainly on paper.

However, the United States has seven million “releasable doses” of the AstraZeneca-Oxford vaccine, which the company manufactured in the country as part of a 300 million-dose order from Washington, the White House said Thursday. .

The company is expected to seek emergency approval for its U.S. firing in the coming weeks. In the meantime, governments that are already using the vaccine in their vaccine deployments are struggling to get enough doses to meet demand, due to what the company has described as production delays at its factories around the world. ‘European Union. EU officials have reportedly pressured the Biden administration to share doses it cannot yet use, to no avail.

Instead, on Thursday, the Biden administration announced it would “loan” 2.5 million doses to Mexico and 1.5 million to Canada.

At a press conference, White House press secretary Jen Psaki denied the arrangement was a quid pro quo involving Washington’s demand that Mexico – reeling from slow vaccine rollout – do more to help stem a wave of migrants and asylum seekers crossing the southern border.

Psaki called the two issues “unrelated”, but said they existed “in parallel”.

“ A form of geopolitics ”

US foray into vaccine diplomacy comes as some observers did expressed concern on the growing influence of Russia and China, with vaccine donations to countries in Latin America and sub-Saharan Africa before they inoculated their own national populations. Moscow, in particular, has also said it is looking to offer cheaper vaccine contracts to countries whose prices are paid by Western producers.

Beijing has donated blows across Southeast Asia, where the United States and its regional allies have sought to counter China’s influence by stimulating manufacturing capacity in India, which also donated doses overseas before inoculating its people.

“We have to recognize that this is becoming a form of geopolitics,” Dr Rebecca Weintraub, director of the Global Health Delivery Project at Harvard University, told Al Jazeera. “As [the US] delays, it allows some countries to have more influence as so many people seek supply. “

“But you also have to remember that this is not an evidence-based vaccine delivery,” she told Al Jazeera. “The politicization of the vaccine is to the detriment of all.”

US Secretary of State Antony Blinken also criticized Beijing’s “conditional” vaccine rollout, saying in Tokyo on Wednesday “that some demands are being made, and perhaps stronger demands are being made on countries to receive the vaccines. “.

Still, Dr Michael Jennings, a professor in the Department of Environmental Studies at SOAS University in London, said well-supplied countries would calculate to what extent they want to put their ‘own national footprint’ on vaccine deliveries, which becomes more difficult during distribution. through initiatives like COVAX.

While host countries will be “cynical” of Moscow and Beijing’s attention, they will also notice the absence of rich Western countries, he said.

“I think that’s actually what could lead to long-term realignments of power,” he told Al Jazeera, “not just the affirmative action by China and Russia and others to administer vaccines, but also the inaction of traditional politics. donors who have a nice retort in rhetoric, but the reality is quite different from what they say. “

‘Very, very soon’

Advocates have long called on wealthy countries to take a comprehensive approach to immunization, saying that a national strategy first threatened to prolong the pandemic, leaving more time for variants of the virus to develop in populations without. protected that could undermine the progress of immunization campaigns.

Although the Biden administration has made it clear that it has no plans to begin large-scale distribution until the United States offers injections to its national population, Tom Hart, North American executive director of the organization ONE, said the administration should work now to pinpoint the problem. logistics for the delivery of surplus vaccines.

This is especially true as the United States is on the verge of having a mixed bag of additional inoculants, including the Pfizer-BioNTech and Moderna vaccines, which require ultra-cold storage and careful transportation, as well. than the Johnson & Johnson and AstraZeneca vaccines, which are easier to transport and store.

Shipment of nearly four million coronavirus bites arrives in Nigeria on COVAX [File: Kola Sulaimon/AFP]

“It looks like by May, June, there will be enough doses to cover and meet domestic demand in the United States,” Hart told Al Jazeera. “So what we don’t want to do is June 30, say ‘okay, now what do we do with our excess doses?’ Because that would delay relabelling, re-shipping – figuring out how to get these out. excess doses to places that need it – several months. “

“These months are lost lives and livelihoods, and that also risks causing further variations, which is a real concern,” he said. “So these plans need to be put in place very, very soon.”

ONE advocates for excess doses to be distributed through the World Health Organization’s COVAX, which Hart has called the “fairest mechanism” of distribution.

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