Five ways U.S. can help end COVID globally

As America starts the process of returning to normal life amid a successful COVID19 mass vaccination program, many of the world’s poorer countries are still suffering through deadly waves. The World Health Organization estimates that 11 billion doses of vaccine are needed to achieve global herd immunity. Yet only 0.4% of the world’s current supplies of vaccines have been administered in lowincome countries.

The United States could quickly reassert its former role as a global health leader by helping to vaccinate the world. Here are five ways America can enhance COVID19 vaccine equity globally — and help end the greatest threat to global health in more than a century.

Donate surplus doses:

The Duke Global Health Innovation Center estimated in midApril that high and middleincome countries had secured 6 billion out of 8.6 billion doses of different vaccine candidates, leaving lowincome countries with large populations with little supply. By the end of July, the U.S. alone will have an estimated 300 milliondose surplus, even after vaccinating 12 to 15yearold children. Doses in the U.S. are approaching expiration dates, while health care workers without access to vaccines are dying elsewhere.

President Biden initially pledged to share 80 million doses of vaccine with the rest of the world by the end of June — with a first allocation of 25 million doses announced June 3. Biden further pledged to buy 500 million doses of vaccine to distribute to the global community in advance of the G7 summit. The U.S. needs to lead the critical discussion on how each wealthy country should donate doses to the global supply.

Develop distribution strategies to maximize impact while supplies limited:

The U.S. should coordinate with COVAX, which serves as a dosesharing facility for the world, to decide on strategies to distribute vaccine in a way that maximizes impact while supplies are still limited. One way is to delay vaccination of those with previous COVID19 infection in global settings, since immunity from natural infection is associated with low rates of reinfection. Once supplies increase, a single dose of a twodose regimen can be given to those with previous infection to boost immune responses.

A second strategy is to rapidly distribute vaccines to countries experiencing current surges (“ring vaccination”) which can have an immediate impact on controlling spread and disease. Lastly, we should focus on first vaccinating healthcare workers and vulnerable populations (older, those with comorbidities) in countries without active surges.

Help waive patents for vaccines: Waiving patent rights temporarily on vaccines allows poorer countries to manufacture on their own. That’s not happening. Instead, pharmaceutical companies who hold patents on COVID19 vaccines are reaping billions of dollars in profit. A WTO provision to waive patents during medical emergencies has existed since 1995. But it hasn’t been used in the case of COVID19. In October 2020 (before India’s latest wave), India and South Africa formally proposed to the WTO Council that intellectual property provisions for vaccines be temporarily waived. This request was denied.

COVID feels achingly familiar to the HIV crisis in 1996, when the U.S. and Europe had access to lifesaving antiretroviral therapy (ART), but places where the epidemic was more widespread (such as SubSaharan Africa) did not. Waiving patents took years of debate, which resulted in millions of African lives lost.

Unlike with HIV, waiving patents for COVID19 vaccines needs to happen soon. The U.S. has already indicated its support to waive protections, but it needs to further apply pressure on countries reluctant to follow suit.

Encourage an increase in manufacturing capacity:

Pharmaceutical companies making mRNA vaccines are not producing enough vaccine for the entire world. Manufacturing is complicated, but there has also been recent attention to producing varianttargeted boosters, even though boosters may not be needed for COVID19 for some time. The U.S. could encourage publicprivate partnerships through voluntary licensing agreements to increase manufacturing capacity. The U.S. could also support increased production in materials (like the lipid particles encasing the mRNA in the mRNA vaccines) to accelerate global manufacturing.

China and Russia each have vaccine candidates that they are distributing worldwide, which means the U.S. can keep its focus on boosting mRNA vaccine supplies, given the challenges of creating key ingredients to these vaccines.

Support philanthropy:

Direct vaccine donations from pharmaceutical companies to places with COVID19 surges would be an admirable gesture, as would donations from wealthy companies to purchase vaccine supplies. The five Big Tech companies — Apple, Amazon, Google, Microsoft, Facebook — had a combined income of $1.2 trillion during the year of the pandemic. Even a $25 billion investment (just 2% of that revenue) for Moderna doses (a patent currently held by the US government) would massively boost supplies for the world.

The U.N. secretary general said in February that “vaccine equity is the biggest moral test before the global community” at this time. The blueprint is there for the U.S. to reassert itself as a global health leader and help end the pandemic. We now face the moral test of our willingness to follow through.

Monica Gandhi is an infectious diseases doctor and professor of medicine at UCSF. She serves as the director of the UCSF Center for AIDS Research and medical director of the Ward 86 HIV Clinic. Twitter: @MonicaGandhi9