Family members of a victim of COVID-19 at a crematorium ground in Bengaluru, India, May 2021 
Samuel Rajkumar / Reuters

If the COVID-19 pandemic has taught Americans anything, it should be this: the United States must support global health initiatives because all health is global. Now more than ever, Americans are reminded that the well-being of a bartender in Beijing, a gravedigger in New Delhi, a flight attendant in San Francisco, and a coal miner in West Virginia are interconnected. The Biden administration is surpassing historic milestones in vaccinating Americans against the disease. But a stark, uncomfortable truth persists: without immediate action to expand vaccination on a global scale, Americans still remain at risk.   

The most important health guidance to tackle an airborne virus that knows no borders comes not just from experts such as Anthony Fauci, the director of the U.S. National Institute of Allergy and Infectious Diseases, and institutions such as the Centers for Disease Control and the World Health Organization (WHO) but also from civil rights leader Martin Luther King, Jr. His warning that  “injustice anywhere is a threat to justice everywhere” readily applies to the global reach of the pandemic.

In India, injustice is everywhere as the country grapples with a record-setting second wave of the virus. Thousands gasp for oxygen from empty canisters that hospitals can’t refill. The smoke from funeral pyres fills the air of major cities and small towns alike. The tragedy is not India’s alone. Such outbreaks are breeding grounds for more dangerous and potentially vaccine-resistant variants of the virus. All countries must recognize that they are in a race against time to vaccinate humanity.

Unless the United States and other wealthy countries dramatically change course, this race will be lost. A staggering 82 percent of shots worldwide have been administered in high- and upper-middle-income countries. Only 0.3 percent of doses have been administered in low-income countries. At this pace, more than 85 countries will not have widespread access to vaccines before 2023.    

This perilous moment calls for American scientific, technological, humanitarian, and foreign policy leadership. The United States must urgently respond to India’s ghastly COVID-19 surge and demonstrate that it has learned a fundamental lesson from the past pandemic year: none of us are truly safe until all of us are safe.  

NOT JUST A NATIONAL CRISIS  

Failing to rise to the moment will lead to dystopian outcomes: nightmare scenes of corpses piling up outside overflowing crematoriums and bodies washing up on the banks of the Ganges River in India could foreshadow raging outbreaks in Africa, Latin America, and elsewhere. The WHO announced last week that the Indian variant of the virus had spread to 49 countries. That highly transmissible strain, which the WHO recently dubbed a “variant of concern,” is one of the causes of the terrible second wave of COVID-19 in India. The country has shattered global records for daily infections, repeatedly reporting 400,000 daily new cases alongside thousands of deaths every day. Those already grim figures, however, are almost certainly gross underestimates; for instance, the number of obituaries  is far greater than  the official number of COVID-19 deaths reported in many parts of the country, suggesting that the real totals are much greater.  

India’s crisis is slowing the wider global recovery from the pandemic. As one of the world’s leading pharmaceutical manufacturing countries, India was supposed to produce much of the supply of COVID-19 vaccines that would be distributed to poor nations. It had pledged to provide millions of doses through the COVAX Facility—a mechanism set up by the WHO to help vaccinate low- and middle-income countries—and via bilateral deals with the Serum Institute of India, a key pharmaceutical manufacturer. But India now needs those vaccines to control its own outbreak, as only a tenth of Indians have received one dose of a COVID-19 vaccine. As a result, the government suspended vaccine exports in April. That decision has unfortunate knock-on effects. A third of the human beings on this planet  will not receive the vaccine in the near future given India’s immediate need to vaccinate its own large population.

Even after suspending exports, India faces immense vaccine shortages that are predicted to last for months. The mass manufacturing  and distribution of vaccines remains the only way to prevent more deadly surges as the virus spreads through cities and into vulnerable rural areas. The Indian government’s principal scientific adviser, K. Vijay Raghavan, warned that even after current infection rates subside, another wave of the virus is “inevitable” and that India “should prepare for new waves.”   

The United States has been a leader in mobilizing humanitarian support for India, but it has a moral imperative to do more. It can immediately save lives by dramatically increasing USAID’s shipments of oxygen, ventilators, therapeutics, personal protective equipment, and other medical supplies to India. But Americans can also offer a more consequential kind of support: the United States should prevail upon its private sector to share with India and other developing countries the technology and knowledge needed to beat the pandemic.

NECESSARY TRANSFERS 

Last week, the Biden administration signaled that it would support waiving intellectual property protections for COVID-19 vaccines at the World Trade Organization. Countries such as India and South Africa had lodged a petition calling for such waivers so that manufacturers in developing countries could produce the much-needed vaccines. The United States has taken a historic step forward by backing this move. But it cannot wait for the WTO to negotiate an intellectual property waiver, which could take months. The United States must try to help ramp up India’s vaccine manufacturing capacity now.   

The keys to scaling vaccine production are first, dropping intellectual property protections to allow manufacturers around the world to secure licenses and produce vaccines to meet the world’s demand; second, sharing Western pharmaceutical companies’ know-how to help these manufacturers scale up production; and finally, increasing the supply of the raw materials necessary to sustain vaccine production. The United States needs to encourage urgent efforts on all three tracks to prevent manufacturing bottlenecks and get vaccines into as many arms as possible as quickly as possible.   

Messenger RNA vaccine technology, which India  does not yet have, is critical to defeating COVID-19. The only vaccine makers in the world that are meeting or even exceeding their production targets are the ones that use the highly effective mRNA platform. Because Pfizer-BioNTech’s and Moderna’s mRNA vaccines are made using synthetic processes instead of living cells, they can be rapidly produced in smaller facilities that do not cost as much to set up as those producing viral-vector vaccines. They can also be quickly adapted to tackle new variants of the virus.

U.S. Democratic Representative Ro Khanna in Lisbon, Portugal, November 2019 
U.S. Democratic Representative Ro Khanna in Lisbon, Portugal, November 2019 
Pedro Nunes / Reuters

The United States should press Pfizer-BioNTech and Moderna to make contract manufacturing or voluntary licensing arrangements with Indian firms for the duration of this crisis and the predicted next wave. An intellectual property waiver at the WTO will be critical to ensure the sharing of vaccine technology and knowledge worldwide, but India’s COVID-19 surge demands immediate action.  

 Washington has tremendous leverage to push these companies to share mRNA vaccine technology with manufacturers in India and around the world. After all, American taxpayers have invested in the vaccines’ development from the start. The U.S. government, via the National Institutes of Health, is a coinventor of the Moderna vaccine. The federal government assisted Moderna’s clinical trials and retains certain intellectual property rights pertaining to the vaccine.  In the case of the Pfizer-BioNTech vaccine, the U.S. government provided nearly $2 billion in purchase commitments, which gave the company the financial security to pursue aggressive development and production timelines. The Pfizer-BioNTech vaccine might not have been the first to earn authorization from the U.S. Food and Drug Administration had it not been for the support of American taxpayers.

When American taxpayers invested in the development of this vaccine, they did so in order to keep Americans safe—not to line the pockets of big pharmaceutical companies. The United States is rapidly approaching the day when every American who wants the vaccine can get one. Now, it’s time to use that investment to help save hundreds of thousands of lives around the world and keep Americans safe by preventing the emergence of vaccine-resistant strains.     

VACCINES AS A GLOBAL PUBLIC GOOD 

Leading global action to curb the pandemic won’t cost the United States much. The consumer rights group Public Citizen estimates that the United States can help support the production of billions of vaccines around the world for just $3 per dose. At that price, spending $25 billion would support a global vaccine manufacturing program. That sum would equip the Biomedical Advanced Research and Development Authority (BARDA), an office of the U.S. Department of Health and Human Services, with the funding needed to build on its prior success in leading global vaccination initiatives, such as the campaign it launched in 2006 to help developing countries make influenza vaccines. 

BARDA would determine where new manufacturing facilities should be built and where production lines could be added to existing facilities.  The agency would help coordinate domestic manufacturing and the issuing of licenses to manufacturers abroad, the transfer of technology and raw materials overseas, and the training needed to provide support in every stage of the manufacturing process at regional production centers around the world. With this strengthened manufacturing capacity in place, countries can better take advantage of the eventual waivers of intellectual property protections to boost vaccine supplies. 

By shaving years off the pandemic, this $25 billion effort to vaccinate the world would pay for itself many times over. The cost of inaction far outweighs the relatively small investments the United States can make now. The current trajectory of inadequate global vaccination risks a global GDP loss of as much as $9.2 trillion in 2021 alone; the U.S. economy stands to lose more than $650 billion. U.S. investment in global vaccine equity could save hundreds of thousands of lives, jumpstart the economy, and mitigate the risk of vaccine-resistant variants making their way to the United States. 

Visionary U.S. leadership to guide the world out of this pandemic will pay tremendous dividends in generating global goodwill for generations to come. The United States has the chance to ensure that India’s current crisis will not be repeated and instead marks the moment that the international response to COVID-19 fundamentally changed from one of vaccine nationalism to treating vaccines as a global public good. Vaccinating the world is the only way to stamp out the virus anywhere, so that it won’t threaten lives everywhere.

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