Biden's 'America First' Vaccination Strategy Promotes Global Inequity

The debate within the United States regarding specific qualifications for vaccine access is based on pretenses of equity at the expense of the most vulnerable communities globally. The Biden administration and high-income states are actively contributing to what equates to a global injustice against poor and impoverished communities all over the world by using their economic power to purchase billions of vaccines before low-income countries. Instead of continuing the "America First" strategy of the previous administration, Biden, alongside wealthy countries, should consider scientific and morality-based policy approaches that promote global vaccination campaigns.

Instead of continuing the "America First" strategy of the previous administration, Biden, alongside wealthy countries, should consider scientific and morality-based policy approaches that promote global vaccination campaigns.

Unfortunately, the Biden administration appears focused on perpetuating vaccine nationalism, a term used to define the nationalistic impulse of states to hoard vaccines during times of crisis. This is best reflected by the administration's January 26 announcement of its intention to purchase an additional 200 million doses of Covid-19 vaccines to expand access for U.S. citizens in support of an equity-based vaccine strategy at home--an admirable venture.

However, while it is supposedly "not the objective" of the current U.S. administration to crowd out poor countries, gobbling up nearly 1.6 billion doses of various Covid-19 vaccinations directly conflicts with the administration's so-called equity-based approach. In fact, purchasing enough vaccine doses to inoculate the U.S. population nearly three times over is the definition of injustice against communities waiting to purchase even a single dose in other countries.

Such an impressive statistic by the U.S. government reflects a glaring global trend--one of wealthy states using their economic power to purchase unprecedented quantities of Covid-19 vaccines that outstrip their national populations. To date, high income-countries have purchased over 4.2 billion vaccines for a combined population of only 1.236 billion people. This includes Canada, which has purchased enough vaccines to inoculate its population five times over.

These decisions come with costs, even if states have secured vaccine doses through "advanced purchases," a method of obtaining vaccines still in development to mitigate against the risk of a failed trial. Unfortunately, that cost is the perpetuation of global inequality between states, best reflected by middle- and low-income countries' efforts to obtain just 2.371 billion vaccines for a population of almost 6.6 billion people. Low-income states have particularly faced difficulties obtaining vaccine doses, obtaining 670 million doses for roughly as many people.

Fortunately for these states, some international programs exist to address vaccine inequality. This includes COVAX, a pillar of the Access to Covid-19 Tools (ACT) Accelerator started by the World Health Organization (WHO), European Commission, and France in response to vaccination inequalities experienced during the H1N1 Swine Flu a decade ago.

The goal of COVAX is to obtain and distribute vaccines to low-income states to vaccinate 20 percent of their respective population's most vulnerable citizens. This will ultimately be achieved through the collective purchasing power of its funding mechanism, known as the COVAX Facility, which consists of high- and medium-income countries.

Yet while COVAX is an effective global approach to a global issue, it has struggled to produce concrete results in practice. To date, COVAX has secured 1.3 billion vaccines for low-income countries with options for another 900 million--originally its goal. Currently, it plans to ship over 300 million doses by the end of June 2021. However, due to supply and manufacturing constraints, actual vaccine dissemination of over 2 billion doses may not be achieved until the end of 2022.

This delay will result in fatal consequences for those most vulnerable in the poorest parts of the world and is a direct result of vaccine nationalism. From an economic standpoint, the costs of unequal vaccine distribution are massive. The International Chamber of Commerce (ICC) predicts that the global economy stands to lose as much as $9.2 trillion if high-income states fail to address vaccine inequality between states. This price tag is directly correlated with an underfunded ACT Accelerator and COVAX Facility, which the ICC deems as the best mechanism for enabling equitable access to Covid-19 tests, treatments, and vaccines.

Currently, ACT Accelerator donations total $6 billion--a $27.2 billion funding gap. A Eurasia group analysis of 10 major economies estimates that funding into this and other mechanisms that increase equitable access to Covid-19 vaccines can total roughly $153 billion in 2021 and $466 billion by 2025. The contrast between these reports is astronomical and shows the importance of global coordination mechanisms, as well as buy-in from high-income states.

At the same time, economic arguments pale in comparison to epidemiological considerations. New variants of Covid-19 are appearing as the virus mutates--an unavoidable reality as the disease spreads unmitigated between individuals, communities, and countries. As Tedros Ghebreyesus, director-general of the WHO, has stated, a "hermetic seal" is not possible between states, meaning mutations that harm vaccine efficacy will find their way around the globe if the spread of Covid-19 is not addressed everywhere.

Ultimately, the United States and high-income countries cannot address injustice at home while ignoring it abroad.

While recognizing that no easy answers exist regarding the pandemic, negative developments can be prevented with a change of course by the United States and other high-income states. This involves supporting COVAX and the ACT Accelerator to ensure vaccines and medical supplies flow to medium- and low-income countries. This needs to run in parallel with efforts to boost vaccine manufacturing, such as the application of eminent domain on vaccines as a public good.

The latter point is being tested in various forms, such as the push by South Africa and India to institute a patent ban on Covid-19 vaccines at the World Trade Organization (WTO). Ultimately, a solution directed toward open-source vaccine knowledge that allows for wider vaccine manufacturing is necessary to reach drastically needed production levels, especially considering India's Serum Institute is the largest producer of vaccines in the world and can fill this drastically needed role.

Whether these efforts are realized remains to be seen. Ultimately, the United States and high-income countries cannot address injustice at home while ignoring it abroad. It makes moral and logical sense to address the issue of vaccine nationalism and major disparities across nations before the pandemic and its negative effects worsen globally.