What America’s Vaccination Campaign Proves to the World

Illustration of a vaccine needle with an American flag
Adam Maida / The Atlantic

Every so often, an emerging technology changes the global balance of power, alters alliances, and shifts the relationships among nations. After World War II, nuclear weapons overthrew all of the existing geopolitical paradigms. The countries that got the bomb were considered global powers; countries that did not have it sought it, so that they could be considered powerful too.

Now a different technology is shifting global politics: the coronavirus vaccines—or, quite possibly, vaccines more broadly. Unlike nuclear weapons, vaccines don’t have the potential to end life on Earth, and their production and distribution will never require rigid rules to limit who gets them. Indeed, the international institutions being created to govern vaccine distribution are designed to promote proliferation, not restrict it. Nevertheless, global politics will be shaped by the vaccines, as will domestic politics in some countries, and in ways that might outlast this particular pandemic.

One major change is already evident. During 2020, Donald Trump’s chaotic, mendacious response to the pandemic, the wave of COVID-19 denialism that swept across America, and the high U.S. death rates were a shock to anyone, anywhere, who still expected competent American leadership. Clips of Trump’s infamous comments about bleach (“And is there a way we can do something like that, by injection inside or almost a cleaning, because you see it gets in the lungs and it does a tremendous number on the lungs?”) were replayed all around the world and translated into dozens of languages. The Trump administration’s refusal to join any of the international efforts to fight the pandemic left a gaping hole that for many months was filled by Chinese planes delivering face masks and doctors.

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The U.S. became an outlier, even among democracies. A clear line emerged between countries that had high levels of social trust and decent public-health systems—Taiwan, Germany, New Zealand, Norway, South Korea—and those, including the U.S. and Brazil, that did not. Whereas South Korean public-health officials supplemented the country’s contact-tracing system with credit-card and phone-location data to help keep case numbers down, nobody in the United States has enough faith in government contact tracers to make those kinds of data available in the first place. That difference was reflected in domestic registers of satisfaction with government performance. It also contributed to an international perception of American decline.

But if the United States is very, very bad at social trust and public-health systems, it is very, very good at large-scale logistics. And skill at large-scale logistics, far more than social trust, has turned out to be a big advantage in this new stage of the pandemic. Mass production of vaccines, mass distribution of vaccines, “mass vax” centers in stadium parking lots, even string quartets playing for the 10,000 New Yorkers getting their vaccines every day at the Javits Center—all of this we can do, now that we have a president who wants to do it. With zero percent interest rates and the deficit a term belonging to the distant past, Americans can also throw money at problems like nobody else.

The result isn’t always pretty. In many states, even eligible people seeking a vaccination appointment have had to play an online version of the Hunger Games. Attempts to create some kind of logical order to the distribution process fell victim to overcomplicated criteria, cheating, and the proliferation of registration websites. But once the federal government entered the arena, much of that ceased to be relevant. If you are delivering 4 million vaccine doses a day, it matters less who goes first, because everyone who wants a shot is going to get one soon enough. Although some local drives have been tailored to particular communities—efforts to vaccinate Native Americans have been one of the underappreciated successes—the experience, for many people, has resembled nothing so much as shopping at a remarkably efficient big-box retailer: customers in, customers out, no time for neighborly chitchat, but everyone gets the product they wanted. Instead of orderly distribution, we got speed, which amounts to the same thing.

Other countries had a similar attitude. Israel also paid top price for vaccines, not least because Prime Minister Benjamin Netanyahu hoped to use the vaccine rollout to win an election campaign. Great Britain opened its wallet too, not least because Prime Minister Boris Johnson hoped that the vaccine rollout would flip his bad polling numbers, make up for his country’s high death rates, and help hide the economic losses caused by Brexit. All three countries have won some admiration, but so far not many friends.

On the contrary, a form of what is either admiringly or disparagingly called “vaccine nationalism” was baked into the American vaccine program, like the British and Israeli programs, from the start: Whatever it takes, whatever it costs, and screw everyone else. The Trump administration refused to join COVAX, the international consortium that seeks to distribute vaccines around the planet. At one point, Trump made noises about getting exclusive access to a vaccine under development by a German company. Except for some rhetorical and symbolic gestures, President Joe Biden hasn’t really moved away from this position either. He has decided to send Mexico and Canada several million doses of the AstraZeneca vaccine—which the U.S. hasn’t yet approved and may not need—and made a few other promises to “work together” with other nations down the road.

Much has been written about how the European Union chose a different path, jointly purchasing vaccines for all its members on the grounds that a bidding war among European countries would leave the smaller ones without anything. The EU also convened the meetings that created COVAX and, expecting reciprocity, allowed European manufacturers to export to Britain and elsewhere. In Europe, pride at having done “well” in the first phases of the pandemic has now turned to anger, in some countries, at the failure to distribute vaccines faster. But vaccine nationalists are not only on a different path from the EU. They have also gone in a different direction from Russia and China, two countries that are so convinced of the global importance of this moment that they have been selling and distributing vaccines abroad even before their own populations are vaccinated. As of late March, China had produced 250 million doses of its vaccines and sent 118 million abroad, to more than four dozen different countries. Russia, whose own vaccination percentage is in the single digits, has also been boasting of its exports to 22 different countries, as well as deals to produce its Sputnik V vaccine in South Korea, India, Serbia, and possibly Italy.

Read: Vaccine nationalism is doomed to fail

And no wonder: Unlike Biden, Johnson, Netanyahu, or any of the EU prime ministers, leaders in Beijing and Moscow don’t need to worry about electorates who might judge their vaccine distribution. The Chinese may have also concluded that their contact-tracing, border-control, and quarantine systems are so successful, they don’t need to hurry with mass vaccination. More to the point, both countries have already identified the vaccines as a game-changing technology, and have already decided that the foreign-policy benefits of vaccine distribution abroad are too important to waste.

That decision is shaping other countries’ policies. Three-quarters of the vaccines supplied to Chile, the country with the highest vaccination rate in Latin America, are Chinese CoronaVac shots. Serbia, which is not part of the EU, is using Russia’s Sputnik V to power ahead of other European countries. San Marino, a microstate that is also not part of the EU, bought Russian vaccines for its 29,000 citizens and has become the envy of Italy. The United Arab Emirates, a world leader in mass vaccination—ahead of both the U.S. and the U.K.—has not only used China’s Sinopharm vaccine but is planning to co-produce a version under the name Hayat-Vax, from the Arabic word for “life,” a decision clearly made with an eye toward marketing in the Arab world.

Some of these new pacts are commercial, no different from AstraZeneca’s arrangement to produce millions of doses in partnership with the Serum Institute of India. But many are political. After Algeria accepted a gift of vaccine doses from China, Chinese state media quoted the country’s foreign minister, Sabri Boukadoum, declaring that he “opposes any interference in other countries’ internal affairs”—meaning that he will not support human-rights groups and others who criticize China—and will “strongly support China on issues involving China’s core interests,” an allusion to Hong Kong and Xinjiang province. Serbia’s pro-Russia foreign minister chose to use the moment of his inoculation with a Sputnik V vaccine to demonstrate his support for Russia more broadly: “I wanted to get the Russian vaccine, because I believe in Russian medicine.”

Neither Russia nor China is particularly shy about its political goals. In addition to pushing sales of Sputnik V, the Russians are running a full-scale disinformation campaign, wearily familiar from all the other Russian disinformation campaigns, that is designed to discredit Western vaccines. Quasi-academic publications as well as Russian state media have sought to create a miasma of distrust around the mRNA technology behind the Pfizer-BioNTech vaccine in particular. A recent article in one Russian state-backed publication speculated that the pandemic was created to service Western interests, including those of pharmaceutical companies. Both Russian and Chinese state-media Twitter accounts have tweeted sensationally, and misleadingly, about Pfizer too. And that’s just the visible stuff. Because trolls linked to Russian security services have been masquerading as anti-vax conspiracy theorists on American social media as far back as 2015, no one should be surprised if they are doing the same now.

This time, the goal may be to create doubt not just in the U.S., but around the world. One recent study showed that nearly a quarter of Jordanians and Kuwaitis believe that Western vaccines cause infertility; nearly a third fear that they contain microchips that will control recipients’ brains. Iran’s supreme leader has also called Western vaccines “untrustworthy.” Iran is betting instead on the Cuban researchers who, in pursuit of this globally prestigious technology, are in the final stages of testing several vaccines. They too see a chance to broadcast the advantages of their political system. One of their most advanced vaccines is called Soberana 2—the name invokes the Spanish word for “sovereign”—while another, Abdala, has been named after a poem by José Martí, a Cuban independence hero.

But an opportunity for the U.S. might lie precisely here, in the authoritarian drive to politicize the vaccines. The best answer to Russian and Chinese strongmen who offer thousands of vaccines to countries that say nice things about them is to flood the market with millions of American doses, helping everyone regardless of what they say about the U.S. or anyone else. After Trump, the American political system won’t win much admiration again anytime soon. But if American democracy is no longer a trusted product, American efficiency could be once again. Within a matter of weeks, a majority of American adults will have had their first dose of a vaccine. What if the U.S. then begins to pivot from mass-vaccinating its own citizens to mass-vaccinating the rest of the world? Americans can’t do social trust, but we can do vaccines, plus the military logistics needed to distribute them: planes, trucks, cold-storage chains. The best cure for propaganda and disinformation is real-life experience: If people see that the vaccines work, they will eventually get one. We can end the global pandemic, improve the economy for everybody, protect ourselves and everyone else, and create the relationships that can help us deal with crises to come.

The U.S. might even have an opportunity to turn a mass-delivery effort into something more permanent. If the World Health Organization has become too bureaucratic and too reliant on China to enjoy the complete confidence of the rest of the world, then let’s use this moment to build COVAX into something new, something more trustworthy: an institution that provides smarter delivery systems, more efficient biomedical cooperation, and links among production centers in Europe, India, Africa, and elsewhere in the world. Vaccine nationalism is small-minded, self-centered, and ultimately self-defeating, because COVID-19 will not cease to be a problem until no one has it. This is the moment to think big, the moment for generosity and big ideas. As our massive logistical investment in refrigerated transport begins to pay off, the question for Americans is not just how we can enter the game, but how we can change it.