Updated at 9:00 a.m. ET on May 17, 2021.
The United States is rapidly encasing itself in a bubble of immunity. Heading into a quite possibly wonderful summer, more than half of adults are at least partly vaccinated against COVID-19, and their masks are coming off. Some will be rewarded with a million-dollar prize. The rest can wander into any CVS when they feel so moved. Soon that luxury will extend to tweens.
By July 4, according to President Joe Biden, the bubble will be near completion. As Americans celebrate their independence, though, all indications suggest that the coronavirus pandemic will be raging. Only about 3 percent of adults are vaccinated in India, where a dangerous variant is spreading and tens of thousands of people are lost every day (based on very rough estimates from overloaded crematoria). In parts of Africa, almost no one is protected. The virus is tearing across South America. The contrast with the U.S. could not be starker. And we are doing very little about it.
This has always been a tale of two pandemics: One for the rich people who can work anywhere while others bring provisions to their door; another for the poor who must work in risky conditions if they are to keep food on their own table. But until now, the fates of entire countries didn’t clearly track on the basis of wealth. The U.S., for example, has the most expensive health-care system in the world, and was also the hardest hit in 2020, while many countries with far fewer resources suffered far less. Writing in The New Yorker in February, Siddhartha Mukherjee pondered how India, by contrast, could have spent so little money (and done relatively little locking down), and yet seemed, at that point, to have escaped the worst of COVID-19. Was it something to do with the climate? Genetics, lifestyle, hygiene, immune-system differences?
The answer turned out to be: no. These factors almost certainly play some role in determining the scope of outbreaks from place to place and community to community. But the biggest variable may have been luck. And that luck was always temporary. Not until many months after New York City became the global epicenter of the pandemic did certain parts of the U.S.—especially in the Midwest—experience a first surge in cases. But ultimately no state was spared. And the virus is more likely to keep coming back to places where people think the pandemic is over without decisive action to drive down the virus everywhere.
This is the point we continually fail to grasp. Since the day Biden took office, and much more frequently of late, he has taken to repeating this sentiment. In January, he promised to lead a global effort to eradicate the virus: “History is going to measure whether we’re up to the task. I believe we are.” But no plan for eradication has been proposed. Instead, we’ve tried to have it both ways: saying that we care about global health and are doing everything we can to protect it, while at the same time hoarding hundreds of millions of vaccine doses, as well as the technologies and information necessary to produce more. We have even struggled to admit that Biden’s vaccine policy so far has largely amounted to a continuation of Donald Trump’s: America first.
The amorality of this tack is clearer by the day. In the early pandemic, when little was known about how to prevent or treat the disease, countries with material resources weren’t at quite as much of an advantage. A dearth of ICU beds could be compensated for by conscientious individuals. The countries that got by were those where citizens took basic preventive measures, governments supported people who needed to stay home, and robust, depoliticized lines of communication existed between health officials and the public.
Vaccines have changed the equation. Now even the U.S. is doing okay. Soon we will be vaccinating healthy 12-year-olds, while high-risk people in many countries continue to fill hospitals. Yet it’s uncouth to even mention this. After I tweeted this sentiment last week, the newscaster Mehdi Hasan cited my tweet in an interview with Anthony Fauci, who gave the administration’s standard line. He would “look at it another way,” he said, wherein we try to protect ourselves and those in other countries at the same time. “We’ve got to do everything we can to get people in low- and middle-income countries vaccinated as quickly as we possibly can,” Fauci said. That’s unrelated to the need to vaccinate kids in our own country.
Vaccinating kids is urgent. We obviously need to pursue vaccination both at home and abroad. But we are not. In April, the Biden administration announced that the U.S. would give away 60 million AstraZeneca vaccine doses (which we didn’t need) to other countries. Even that is enough to cover only about 4 percent of India’s population. Giving away surplus doses won’t solve the problem, any more than shipping unsold grocery-store blueberries back around the globe would solve world hunger. Waiting for a few wealthy countries to supply the world with vaccines in future pandemics would doom us to repeat tragedies such as the current horror in India.
Meaningful action would focus on building up production capacity and supply chains everywhere, not simply to honor the basic sanctity of human life, but because the emergence of variants and new viruses threatens us all, everywhere, constantly. That threat could be eliminated by ensuring that rapid vaccination is available worldwide. If we don’t establish a better system of production and distribution, every future pandemic will split us in two.
In this moment, disparities may seem inevitable. To some degree, they are. We can’t simply ship excess doses of the mRNA vaccines around the world, for example, on account of their cold-storage requirements and relatively short shelf life. Vaccine doses that Americans opt not to take won’t end up being flown to Africa; they’ll go to waste.
It’s also true that vaccines are being produced by dozens of companies around the world, and if these companies could simply ship more doses, they would. Pharmaceutical companies don’t intentionally leave money on the table. The big pharmaceutical companies, as well as Bill Gates, have made exactly this argument: Vaccines are already being produced as quickly as possible.
But if we’re maxed out on production, this is by design. It’s the result of decisions that the U.S. has made throughout the pandemic—most notably Trump’s refusal last September to sign on to a global coalition to ensure the equitable distribution of vaccines, known as COVAX—that have perpetuated a system of pharmaceutical sales built over decades. Taxpayer money is used to fund basic science research, and then pharmaceutical companies develop products based on this research and sell them back to the government. (Medicare is the largest drug buyer, and it is not allowed to negotiate what it pays.) U.S. taxpayers have already, under Trump, contributed some $14 billion to the development and manufacturing of patented COVID-19 vaccines. That’s in addition to the billions spent over decades on the NIH-funded research these technologies are based on.
The drug industry claims that if companies such as Pfizer didn’t stand to profit in the billions, they wouldn’t have invested to advance the technologies involved in developing and producing vaccines. But this same argument illustrates the danger of such a system: Our emergency-preparedness plan for a global disaster depends on an industry that will not come to the rescue unless it stands to cash in. To rely on a handful of private companies to end the next pandemic, too, amounts to a cosmic roll of the dice—especially when those companies will not make guarantees of equitable distribution, or of production past the point at which a profit can be made.
Adapting this system would bring us much closer to doing “everything we can” to get the world vaccinated, as Fauci suggested is the goal. Biden announced last week that his administration would take measures to waive patents for COVID-19 vaccines. This is an important, if incremental, step. “There’s a lot more that needs to happen,” U.S. Surgeon General Vivek Murthy told me. “Simply waiving intellectual-property rights does not guarantee that billions of doses will be available. We need to invest in expanding manufacturing capacity and the technology transfer; the know-how needs to actually flow from those who are making it now to those who will make it.” As the pharmaceutical industry has pointed out, making vaccines—particularly mRNA vaccines—is technologically difficult and requires investment. On its own, releasing patent rights is sort of like Tesla publishing its design secrets on Reddit. If other car companies wanted to produce exact replicas of Teslas, they could … eventually. But getting started would take a lot of time and money, and these companies wouldn’t make that investment unless they thought they could sell enough Tesla knockoffs to make it worth their while.
Vaccines are more like fire trucks than Teslas, though. When your house is on fire isn’t the time to start building a fire truck. If your neighbors see the blaze and hand you plans for how to build an aerial ladder platform, you are not grateful. Global manufacturing and distribution systems for vaccines cannot be built immediately, and the release of intellectual property at this point does not constitute a plan of action. The world stands waiting to see whether Biden will push the World Trade Organization to waive the patents—and do so in a way that encourages countries and governments to invest in long-term production. (Moderna has voluntarily shared its IP only “for the remainder of the pandemic.”) We’ll need to fortify and maintain supply chains, facilitate technology transfers, and build up genomic-sequencing capacities around the world so that new viruses or variants can be identified and boosters or new vaccines adapted accordingly.
This is not a small task. But this moment could forever change precedents for how vaccines and even other drugs are produced and sold—who can and can’t afford them. One of the few things on which Trump and Biden ostensibly agree is that drug prices are far too high. Fixing this is an issue that has long had broad, bipartisan support among nearly 80 percent of Americans. It’s in everyone’s interest to set up sustainable systems for development and production everywhere—of vaccines, at the very least—that can kick into action as soon as a new virus or variant emerges.
The components of this system should function more like fire departments than factories for luxury goods. Vaccine production needs to happen in emergencies regardless of profit or shareholder interests. Vaccines could be seen as public goods that are vital to global security, not as part of a humanitarian cause or charity issue. If the past year has taught us anything, it’s that every human has a personal interest in a world where every other human has quick and ready access to vaccines against emerging pandemic viruses.
An effective global strategy would allocate vaccines to the places where they would do the most to stop transmission, minimize death, and halt the spread of a dangerous virus before it can turn into a pandemic—let alone two pandemics. Such a system could stand as the enduring legacy of the Biden administration. If he’s willing to stand up to the industry.