The United States is sprinting headlong toward the development and distribution of Covid-19 vaccines. But under an “America First” president, public health experts worry, the United States could seek to gobble up early supplies — and set the stage for prolonged devastation in the rest of the world.

Under “Operation Warp Speed,” the Trump administration hopes to have 300 million doses of vaccine ready for domestic use by January 2021. That outcome would largely satisfy domestic needs in the United States, experts say, but it would mean prioritizing low-risk individuals in one the world’s richest countries over high-risk health care workers and other vulnerable populations elsewhere in the world.

Such concerns prompted more than 140 world leaders and other dignitaries on Thursday to sign an open letter to all governments demanding that Covid-19 vaccines be considered a “global good” to be shared equitably. The letter came just a day after Paul Hudson, CEO of pharmaceutical giant Sanofi, angered the French government by indicating the U.S. would have first access to his company’s output.

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“I do think that there’s a significant risk, at least under the current plan, that the U.S. will vaccinate not only health workers and high-risk populations and priority populations for breaking transmission chains, but also low-risk individuals first,” said Tom Bollyky, director of the global health program at the Council on Foreign Relations.

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Bollyky warned any U.S. effort to inoculate its entire population could incentivize other countries to refuse to share peripheral materials needed for mass vaccination, including vaccine vials and syringes.

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While it’s impossible to know which, if any, of the current vaccine candidates in development will prove effective and reach the market, the United States, along with China and India, appear poised to perhaps have first access to vaccines, given the scale of vaccine production capacity in those countries. Furthermore, in the United States, President Trump could invoke the Defense Production Act, giving the administration broad power to force companies to manufacture vaccines for domestic purposes — even against their will.

Pandemic planners for years have recognized that in the event of a dangerous pandemic, countries would be under pressure to nationalize essential products made within their borders. It happened in 1976, during the swine flu scare, when it was thought the world was on the brink of a 1918-like influenza pandemic. The United States — intent on vaccinating “every man, woman and child” — would not allow vaccine producers to export their product.

Determined to protect U.S. interests, the Biomedical Advanced Research and Development Authority, an agency under the Department of Health and Human Services, has spent billions of dollars to support the creation or expansion of vaccine manufacturing operations on U.S. soil, the agency’s former director, Robin Robinson, told STAT recently.

While the U.S. is perhaps being the most forthright about its intent to meet domestic needs first, experts believe many countries may succumb to the same type of pressure, especially if vaccine becomes available when a resurgence of transmission is underway.

“This may not be just a phenomenon of the U.S.,” said Bollyky, who noted several countries have barred exports of personal protective equipment worn by health workers and ventilators.

Scott Dowell, deputy director for surveillance and epidemiology at the Bill and Melinda Gates Foundation, said the foundation is working to try to ensure countries without production capacity have access to Covid-19 vaccine. One of its approaches is to support production capacity in small countries — places like Singapore and Switzerland — so that even if output is nationalized, local needs will be met quickly, after which, vaccine exports could begin.

Using the earliest available doses for health workers around the world would be in everybody’s best interest, Dowell said, though he acknowledged that arguments of equity may not “carry much water” these days.

“If you end up using your first 100 million or 300 million doses on low-risk teenagers in Switzerland, Singapore, the U.S., or other places — that could be a year’s worth of vaccine,” Dowell noted. “So you could lose a year immunizing really low-risk groups rather than using your vaccine in the most effective way that you could.”

Prioritizing vaccine in ways aimed at minimizing the impact of the pandemic globally would be to everyone’s advantage, experts argue. “If Covid-19 is circulating in any country, we’re all still at risk,” said Dowell.

Bollyky noted that the earliest vaccines to hit the market may not be the most effective ones, which would mean people vaccinated with them might still be susceptible to infection. Some vaccines that take longer to develop may actually produce a more robust immune response. “And if the U.S. doesn’t share in a timely manner initially, others will not either,” he noted.

Vaccinating all the citizens of a few countries won’t solve the economic problems of those nations. If the pandemic continues to rage in most parts of the world, global travel will remain disrupted, supply chains broken, economies in tatters.

“This is a global problem. It requires a global solution,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“It is the job of countries and political leaders to protect their own people and I certainly understand that,” Berkley added. “But it is also the job to have a longer-term view and understand the global nature of infectious diseases, as well as the global nature of science.”

“If we nationalize science, we will not optimize science,” he said.

Bollyky said there needs to be a public dialogue about how to deploy Covid-19 vaccines when supplies are scarce so that people can understand the consequences of the various approaches to their use.

“At the end of the day, if this comes across as some tree-hugging argument, it’s just not going to resonate,” he said. “And that’s not just here in the U.S., it’s in other countries as well.”

Dowell agreed, saying there are “huge incentives” for countries to maximize the impact of the rollout of Covid-19 vaccines.

“In the big picture, I’ll be surprised if we don’t see a planetary public health intervention implemented more effectively and faster than we’ve ever seen before,” Dowell said, though he acknowledged it will be “messy, for sure.”

  • Pretty presumptuous- to think the USA will be first to develop a vaccine! There ar many more smart brains in many other countries that might be first. Maybe in this case, we vaccine the rest of the world first and send leftovers to uncooperative USA – stuck with their macho president.

    • Considering that the US funds most big pharma R and D I think the rest of the world will come short on that exchange, Try buying the Chinese version and see if it, like their defective masks and PPE work. Meantime the Europeans have tons of time , like the US and the British in Oxford, to pay for developing their own vaccines if they want first dibs. Or do you propose that Euroland gets a subsidized ride like they do in defense/

    • @Gary

      No matter who “develops” a vaccine, everyone will instantly begin manufacturing it.
      The information about the vaccine will be on line immediately.

      You can hardly think that if a successful vaccine is developed in say, Switzerland, every other country will just lapse into a funk, waiting for Switzerland to manufacture hundreds of million doses … but not manufacturing any of our own.
      That doesn’t make any sense at all.

      It is the US that has the money to manufacture huge amounts rapidly and (unlike China) correctly.

      So we will have 300 million doses before anyone else whether we are the ones who “develop” it or not.

      Some countries will not be able to manufacture any vaccine at all, but they will get free vaccine from the US and other advanced nations as soon as we all have manufactured a surplus above what we need for our own citizens.

      We will donate this to other places out of the goodness of our hearts.
      I am at a loss to imagine what else anyone could reasonably expect.
      ————-

      It was notable how much glee you felt when you imagined the suffering of the people of America.

  • The premise is silly. The US taxpayer if they fund the vaccine that stops this virus should be the first to get it. If we were funding , as we are, a far higher amount than equally rich Europe, why should they get to be in the same vaccine order as the people that paid for it? I would have no problem with the US government being very generous and saying , “here is the vaccine formula, and the samples” make your own with the vaccine factories that I am sure you prudently have built.”. If like many countries they have spent that money, they are simply trying to freeload. By the way The idea that vials etc would be withheld unless we gave them a proportional share of the vaccine is laughable. There are multiple domestic and international sources for that type of thing and Pres Trump has prudently started the process to build up a supply of over 300,000,000 dispensing kits. I suggest other nations do the same using their own money.

    • Of course there are Covid-19 vaccines being developed in “Euroland” and Asia-Pacific – in advanced stages. The US leadership is under-estimating qualified, professional research expertise and drive outside the US borders. The US should be more worried about how it can get those really good vaccines from abroad. “Warp speed” does not work in drug and vaccine R&D. This quick-fix push comes from an incompetent, a spoiled brat wanting his toys back NOW. Good luck sitting on the side lines with such a bad coach.

    • @Stuart Mills

      The US will not have to get any vaccine from abroad even if it is first created there.
      The scientific information about the vaccine will be published on line immediately, by the US or any other nation that is the first to come up with an effective vaccine.

      We’ll just go ahead and manufacture all we want rght here in America, and also manufacture a surplus to give away free to any nation that does not have the capability to manufacture their own.

  • Which Americans would you have us sacrifice to your global compassion? Our President has a duty to protect Americans first. Then we can set about helping other countries. (As usual!)

  • Wait. Let me see if I get this.

    I am supposed to continue to pay for the American social structure and technology that makes the development of the vaccine possible …
    … and I am expected to pay for the vaccine itself …

    … but I can’t get vaccinated because someone in Peru wants a “fair share” of my property?

    Okay, I guess — as long as “fair” means “not fair” and as long as “share” means “gimme what is rightfully yours.”

  • 1) If China had to decide if it should put itself ahead of other nations would they? Question answered- it’s called C19.
    2) Just who in the US should be denied the vaccine in the expert-proposed fairness plans- please provide names.
    3) The US has underwritten the international pharmaceutical industry for decades. If drug company ROI was limited to nationalized healthcare from Canada, UK and the rest of the world, investment would crater.
    Just really a dumb article and premise.

    • Edward. these people don’t care if the top two names on the “Do Not Vaccinate” list are Edward Fotsch and Anna Graystone.

      They care about virtue signaling.
      They care about One World policies as envisioned by Communists and socialists.
      They expect to take good care to see that their names aren’t on that list, or the names of their children.
      They aren’t the people they have in mind when it comes to vaccinating someone else — at our expense — so we have to go without.

  • The likelihood of a vaccine is slim and we’re wasting energy worrying about its distribution?

    • That is always a possibility like HIV. But I think it likely that either the Moderna vaccine or the Oxford vaccine candidates will be in business by the end of the year as might one or two Chinese given the head start they gave themselves . Who gets those first few million injections is a hot issue

  • Stop your entitlement statements. This is a worldwide challenge needing much more wisdom than that simple argument. For the sake of a baseline, I will assume this vaccine will be similar to the yearly influenza inoculation and its relatively low efficacy rate. Start with the most vulnerable and study a large group throughout the globe where it’s feasible. As we have seen this virus already has over a half dozen mutations and we need an scientific breakdown funded by an international funding pool as a non profit endeavor.
    In the short term; the U.S.A. needs to follow the intense testing with a track/trace and self quarantining protocol. Sacrificing lives for economical concerns lacks the humanness needed to release the entitlement mindset and lack of empathy for other families loved ones.

  • The US already provides far more international aid than it receives, now we are supposed to give a vaccine developed here to other countries before our own people are vaccinated? Utterly ridiculous and no other country is going to do that either. If China develops the first vaccine I guarantee you they will not be shipping it here at the expense of risk to their own population, nor, frankly, from the perspective of the Chinese people, should they and if they tried the Chinese people should simply not tolerate it. Ditto for France, the UK or anywhere else. As far as the ‘cases in any country are a risk to the world argument’ in the the context it’s made here, i.e. assuming the existence of a vaccine: Vaccinate and CLOSE THE BORDERS until mass vaccination is completed and herd immunity established. You simply do not travel internationally, period end of story. Illegal immigration simply can no longer be tolerated either and all needed force up to and including routine use of deadly force should be used to prevent it. Period end of story. This is all much easier to effectively implement and enforce than the half measure, economy destroying, and largely ineffective ‘stay at home’ non-sense we have now which has wrecked the economy while having zero chance of dropping infection levels below the threshold where they will just climb again as soon as we “reopen”. State governments are already giving up, throwing in the towel and reopening with infection rates that are obviously high enough that infections will go right back up because they realize the economic cost of continuing the shutdown is unsustainable. One of two things is going to happen: Herd immunity will be achieved by infection, or, herd immunity will be achieved by a combination of vaccination and infection. There is no other practical option. The problem of international spread back to the US is quite minor and much easier to mitigate than what we are dealing with now. The goal should be mass vaccine production for domestic use first and a complete shutdown to international human travel into our borders.

  • President Trump is absolutely Right. He is President of the United States and his job is to take care of United States. Moreover, US spend billions and billions on the Vaccine. If we get a vaccine, it will belong to American taxpayers and thus, they must get it first. Every country is expected to do the same. China will come up with fake vaccines very soon that will be available to the world and at least will work as a good placebo!!

  • Hi this is all very interesting. I have a few comments.
    If drug development takes 10 to 12 years how can this vaccine be developed with warp speed? Different steps, skipped steps?
    What about those that refuse vaccines or fear vaccines?
    what if not everyone gets vaccinated?
    Are vaccines 100% effective? Maybe this one will be?
    How would this be different than annual flu vaccine where seems it’s available to all?
    How is flu vaccine Distribution handled worldwide. Is this a WHO concern? Should it not be the same approach ?

    • No, Simply new technologies that we are spending billions on. Example Moderna’s mRNA vaccine approach is a brand new rapid fire vaccine approach.

    • No reputable source has said that development of a vaccine is going to take 10-12 years.

      Those that refuse vaccines will have to achieve immunity through infection and may die, that’s there choice.

      Children will require mandatory vaccination or, at a minimum, they cannot go to public school as has been the norm for decades before governments started caving to the ‘bring back rubella, polio, measles and everything else’ anti vaccination nuts. If it had been left up to these nuts small pox would still be killing 500,000 people a year instead of being extinct in the wild.

      Vaccines do not have to be 100% effective to establish herd immunity. A vaccine which is even 80% – 90% effective will reduce a public health crisis to a relatively minor public health problem.

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