Drew Angerer via Getty Images
A year ago the United States and the world watched in dismay at the images of mass graves dug in Hart Island, New York. The bodies of the forgotten victims of Covid were brought to the islet off the Bronx. That cemetery of loneliness and poverty already existed before the pandemic, but it had never been so central: suddenly the metropolis of metropolises no longer knew where to put those dead, too poor and too alone to get out of the way. Today, a year later, America is still dealing with its inequalities but is proceeding at a rapid pace towards a double promise: herd immunity, thanks to a phenomenal vaccination campaign, and economic growth based on the relaunch of work in key of equity, as required by the plan Build Back Better launched a few days ago by President Joe Biden. Twelve months in which the federal machine set in motion by Trump with the operation Warp Speed – the public-private partnership that has allowed such a success on vaccines – has confirmed the US primacy in research and biomedical production.
So far this primacy has been exploited almost only for internal use: on vaccines Biden has remained faithful to the doctrine America First of his predecessor, simply contributing $ 4 billion to Covax and sending 4 million AstraZeneca doses to neighbors, Canada and Mexico. Last month Washington announced plans to step up vaccine production in India destined for Asia, while it made no commitments to Europeans hoping to get something concrete from its videoconference participation in the EU Council. “We will share the vials as soon as possible,” that is, when every vaccinable American gets his (double) dose: this has always been the position of the White House. Now that the goal is within reach – from April 19, all Americans will be able to be vaccinated, regardless of age – the administration is starting to question how, where and to what extent to export excess doses.
The surplus of doses is already a reality. According to the calculations of Eric Feigl-Ding, epidemiologist and health economist member of the American Federation of Scientists, the United States has 45 million ready-to-use doses in excess, to which must be added orders for several million doses. In all – the New York Times reports – the US has ordered a billion doses from the three federally authorized manufacturers and from AstraZeneca, whose vaccine is not yet authorized for emergency use. To this figure must be added a further agreement with Johnson & Johnson for another 100 million doses. Overall, the supply would be enough to vaccinate 650 million people, nearly double the US population. Other than vaccine treasure: if the pace of production in American plants remains unchanged, the US will have a mountain of excess vaccines at home.
The US has so much vaccines available (over 45 million immediately available doses—with millions more on order!!!), that it could easily vaccinate couple dozen countries. Maybe sharing is caring?
— Eric Feigl-Ding (@DrEricDing) April 7, 2021
These are numbers that serve to understand the importance of the task that Biden has assigned to Gayle Smith, the global health expert tasked with exporting American success in vaccinations to the rest of the world. Smith, 65, has been appointed “coordinator of the global response to Covid-19 and of health safety at the State Department”: in essence, she will have to shape American vaccination diplomacy, establishing priorities and directions in a field that has so far been almost a taboo in Washington. In announcing the appointment, Secretary of State Antony Blinken did not give any indications on the directions of this diplomacy, but Smith’s biography allows for some ideas. A former journalist with a long experience as an envoy to Africa, Biden’s new “tsarina” had already been called for a similar post in 2014, when Barack Obama asked her to coordinate US aid to the countries most affected by the Ebola epidemic. Later it was also Obama who appointed her to head the USAID, the most important federal agency for cooperation with poor countries; a commitment continued with the role of CEO of the ONE Campaign founded in 2004 by Bono and Bobby Shriver to combat extreme poverty and preventable diseases, especially in Africa.
Smith’s choice leaves little doubt on what Biden’s priorities will be once the vaccine export is cleared: he will start from the poorest countries, with particular attention to Mexico and the Central American countries that worry most due to migration flows ; aid will be extended to Africa, inside and outside Covax; Indian production will be supported to counter the aggressive vaccination diplomacy undertaken by Beijing there too. As for the European vaccination misadventures, Washington does not seem willing to get the chestnuts off the fire in Brussels: however imperfect, the EU has its agreements with pharmaceutical companies, and over time the Europeans will also benefit from the American investments that have allowed such a increased production.
After all, it is undeniable that caution – or a “wall of hesitation”, as Feigl-Ding defines it – still dominates the American approach to exporting vaccines. The fact of continuing to raise the bar of the goal – the last upgrade is 200 million Americans vaccinated by the end of April – does not translate into an outward relaxation. The president – CNN explains – remains wary of sending vaccines to other countries before the completion of the internal vaccination campaign, with the administration’s health experts continuing to warn that extra doses may be needed as and when the virus mutates and the pandemic persists.
The discussion on where to send the excess vaccines – CNN still reports – should intensify in the coming weeks. Any decision – which administration officials say could come months later – will take into account a number of factors, such as US interests in different regions and levels of Covid-19 in individual countries.
For now, the White House continues to embody the quintessence of vaccine protectionism, explaining that it wants to keep enough vaccines in case of unforeseen developments in the pandemic. “Why are we not at the point of sharing the doses with all the countries of the world? Partly because we have to take a series of contingencies into account, ”White House press secretary Jen Psaki said Monday, citing the recent mess by Johnson & Johnson (15 million spoiled doses). “As we gain more confidence that we have enough vaccines, we will explore sharing options more broadly,” he added.
Another reason for this caution lies in waiting for the results of vaccine trials on adolescents and children. According to some experts, starting with Anthony Fauci, to achieve true herd immunity it may be necessary to extend the vaccination even to the very young, but it takes time to understand which drug is the most suitable. By the end of spring, Moderna and Pfizer are hoping for interim results on adolescents, while for children under the age of 12 it will be necessary to wait for the autumn, it being understood that the best product, in the end, could turn out to be J&J. The administration – explain the American media – does not want to find itself committing doses abroad that could be used to immunize the little ones, also in light of the onset of new variants.
Alongside the health discourse, the economic one always moves in parallel. Treasury Secretary Janet Yellen on Monday urged rich countries to speed up the distribution of vaccines to poorer countries, warning that failure to contain the virus abroad is bound to increase inequality, eventually damaging the United States as well. “Unless we act now, the world is susceptible to the emergence of a growing global divergence between rich and poor countries,” he said. Yellen’s warning, however, has a longer time span than the boom the US already smells. According to Jamie Dimon, CEO of JP Morgan, the American economy is about to experience a new “boom”. In the annual letter sent to shareholders, the banker writes that he “has no doubts that with excess savings, new stimuli, huge deficit spending, more QE, a potential new infrastructure plan, a successful vaccination campaign and the euphoria of end of the pandemic, the US economy will likely boom ”. This boom, continues Dimon, “may extend to 2023, as all spending programs extend to that year”, adding that the permanent effects of this strong growth “will only be fully known when we see the quality, effectiveness and the sustainability of government investments in infrastructure and more “. The caution or hesitation in sharing the surplus of vaccines probably also derives from this: increasing the advantage by eliminating the risk of new closures that would lead to a setback in the American race.
This afternoon, I stopped by a vaccination clinic at the Virginia Theological Seminary. It’s an example of the kind of partnerships we’re seeing around the country — people coming together across different faiths to serve those most in need. It’s America at its best. pic.twitter.com/iiT8r1OVnp
– President Biden (@POTUS) April 7, 2021