America Can—and Should—Vaccinate the World

After a virtual “Quad summit” last Friday, the leaders of the United States, India, Japan, and Australia announced that they would cooperate to deliver one billion vaccine doses in the Indo-Pacific, directly countering China’s lead in distributing vaccines to the region. The agreement brings together Indian manufacturing and U.S., Japanese, and Australian financing, logistics, and technical assistance to help immunize hundreds of millions of people by the end of 2022. Headlines over the weekend proclaimed that the administration of U.S. President Joe Biden was preparing to catch up in global vaccine diplomacy. Yesterday the administration took a further step in this direction, leaking to reporters that it would lend four million AstraZeneca doses to Mexico and Canada.  

These initiatives come not a moment too soon. In tackling the worst global crisis of a lifetime, the United States has so far been upstaged. Russia and China have aggressively marketed and distributed their vaccines to foreign countries, largely to advance foreign policy goals. Russia is using the jab to bolster its image and investment prospects and to drive a wedge between EU countries. China is donating doses to gain leverage in territorial disputes and expand its influence under the Belt and Road Initiative. Both Moscow and Beijing have moved to undercut the United States in its own backyard by supplying vaccines to Latin America.

The Biden administration is right to want to take the lead in vaccinating the world, for a host of reasons both self-interested and altruistic. But it should not fall into the trap of trying to beat Russia and China at their own game—handing out vaccines to specific countries based on their geostrategic importance and the amount of attention they are receiving from rival powers.  

Rather, Biden should pursue abroad the sort of “all in” unity approach that he has proclaimed at home. His administration should focus less on strategic advantage than on vaccinating the largest number of people worldwide in the shortest amount of time. In so doing, the United States would concentrate on what the world’s peoples have in common—susceptibility to this and many other viruses—regardless of the nature of their governments.

All In and All Out

The United States has successfully mobilized its own and international resources to respond to regional crises in the past. In 2003, President George W. Bush started the U.S. President’s Emergency Plan for AIDS Relief, the largest global health program focused on a single disease in history. PEPFAR brought together U.S. agencies, private companies, and local civil society groups to help sub-Saharan Africa and Southeast Asia get the AIDS crisis under control, saving millions of lives. In 2004, a tsunami in the Indian Ocean caused more than 220,000 deaths and billions in damage, and the United States led an urgent, similarly inclusive humanitarian relief and recovery effort that rescued victims, hastened reconstruction, and built lasting goodwill in South and Southeast Asia.     

Biden can improve on Bush’s precedent by going global, and he has already taken steps toward doing so. Under President Donald Trump, the United States refused to participate in the COVID-19 Vaccine Global Access (COVAX) Facility, an international partnership that aims to guarantee COVID-19 vaccine access for the entire world. The Biden administration reversed this stance immediately and contributed $4 billion, making the United States the largest donor to the effort. Still, even if COVAX meets the ambitious target of delivering two billion doses to developing nations by the end of 2021, it will be able to vaccinate only 20 percent of those countries’ populations.  

Just imagine, however, what could happen if Washington were to treat COVID-19 as the equivalent of the enemy in a world war or the pandemic as a global version of the regional AIDS and Ebola epidemics of years past. Imagine, in other words, what all-out mobilization would look like if the United States treated the COVID-19 pandemic like the global threat that it is.

The Biden administration is right to want to take the lead in vaccinating the world.

Washington would lead a multilateral, whole-of-society effort to help COVAX vaccinate the world. The government would activate the military and call upon allies in the G-7 and NATO for a major assistance operation that speeds the flow of vaccine supplies and strengthens delivery systems. As it has pledged to do in the Quad summit deal, the U.S. government would use the State Department, U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and other civilian agencies and development programs to help countries with their national vaccination programs. And it would enlist companies, nonprofits, and civil society organizations to help increase vaccine production, raise funding, and provide technical assistance to foreign counterparts.

The U.S. government should undertake exactly such an effort, right now: an all-out response for an all-in global vaccination campaign. Such a campaign would advance U.S. economic and security interests and reboot American global leadership after years of decline. Rather than perpetuate the transactional, friend-by-friend vaccine diplomacy of China and Russia, a U.S.-led vaccine effort could invigorate a new multilateralism that is more pragmatic and inclusive than the twentieth-century international order and better adapted to tackling twenty-first-century global threats. Washington would do well to remember that if COVID-19 does come back, authoritarian governments will be able to lock down their populations more quickly and effectively than democracies will, so even in competitive terms, America’s best bet really is to eradicate the novel coronavirus.

The United States has a momentous opportunity to prove both that democracy can deliver and that American ideals truly are universal. By offering a model of global cooperation that draws on a far wider range of resources than any one government can provide, the United States can lead a vaccine effort that builds on the strengths of its open and pluralist society. President Biden would demonstrate unequivocally that the United States is not only “back” but looking—and leading—far ahead.

The Case for Going Really Big

The COVID-19 pandemic is the most extensive humanitarian and economic catastrophe of modern times. Though it lacks the cataclysmic impact of a natural disaster, its toll is far worse and more widespread. A reported 2.6 million have died from COVID-19, though that is certainly an undercount; one analysis of premature and excess mortality estimates 20.5 million years of life have been lost. According to the World Bank, the pandemic pushed as many as 124 million into extreme poverty in 2020, the first year of increase in two decades. The Economist estimates that two years of COVID-19 will cost the world $10.3 trillion—a downturn the World Bank says is twice as deep as the Great Recession. Ultimately, the only way to arrest, let alone reverse, this collapse is global vaccination.

The Biden administration learned an important lesson from the government’s response to the 2008 financial crisis: do not be afraid to go big. The American Rescue Plan does just that, funneling $1.9 trillion into many different parts of the economy. The administration should heed the same advice when it comes to vaccinating the world. An all-out effort will have the greatest and quickest impact on the fight against COVID-19—and the impact it will have is squarely in America’s self-interest.

The United States has much to gain from an accelerated recovery of the global economy. A study from the Eurasia Group estimated that vaccinating low- and middle-income nations would generate at least $153 billion for the United States and nine other developed economies in 2021 and up to $466 billion by 2025. Even if the United States vaccinates its entire population, its economic recovery will still drag so long as its trading partners don’t have full access to the vaccine and the pandemic continues.

As Biden has said, “We’re not going to be ultimately safe until the world is safe.” Moreover, today’s pandemic will not be the last. The partnerships and public health infrastructure that the United States builds to inoculate the world from this coronavirus will also defend it against the next deadly pathogen or health threat. Protecting the nation against disease cannot be separated from protecting the world.

In 2018, the United States issued a National Biodefense Strategy that seemed to recognize this interdependence. The strategy called for developing agreements and partnerships to help foreign countries prepare for and respond to bio-incidents. Such collaborations not only prevent emerging threats but also contribute to a spirit of openness that can pay off in profound ways. There was no such openness between China and the United States when COVID-19 emerged in 2019. Had China swiftly shared its data and genome information with the World Health Organization and other countries, the initial outbreak might have been slowed.

How to End a Pandemic

Ending a pandemic and vaccinating the entire world is an extraordinary undertaking. It will depend a great deal on the COVAX Facility and Gavi, the Vaccine Alliance, which is the facility’s execution arm. Gavi was established with funding from the Bill & Melinda Gates Foundation two decades ago and is a crowning achievement of a whole-of-society approach to global problem-solving. It was specifically designed to deliver vaccines globally by combining the speed and flexibility of the private and civic sectors with the scale of the public sector. Still, the job before it is monumental and will require the kind of networked support that the United States brought into play in earlier humanitarian crises, such as the AIDS pandemic, the Ebola epidemic in 2014, and the Indian Ocean tsunami.

The United States could bring the formidable logistics capabilities of its military to bear on the effort to supply and deliver vaccines globally, including in difficult and remote locations. The U.S. military excels at exactly such tasks and has a global footprint, along with long-standing partnerships in countries ranging from Colombia to Egypt to the Philippines. As was the case in the 2004 Indian Ocean tsunami relief effort, U.S. forces could partner with foreign militaries to help expand and administer national vaccination programs. Washington could call upon allies in the G-7 and NATO to build a broad coalition that shares the costs. And in contrast to the interminable stabilization operations in the Middle East, this humanitarian assistance mission would be straightforward, with concrete objectives.

The United States already has thousands of civilian officials and locally employed staff with experience in humanitarian assistance operations and immunization campaigns stationed around the world, representing such agencies as USAID, the CDC, and the State Department. Because of past initiatives, such as PEPFAR and the Global Health Security Agenda, the United States has strong public health partnerships in dozens of low- and middle-income nations. As Samantha Power, former ambassador to the United Nations, has argued in these pages, that presence could be directed toward helping countries manage logistics and supply chains, initiate public information campaigns, train local health-care workers, and increase vaccine access for marginalized and isolated communities.

A serious global campaign would mark the beginning of a very different era of American leadership.

In the same spirit, the United States should work with countries to help develop and increase local vaccine-manufacturing capacity. Several Latin American countries turned to China and Russia for vaccines because they could not meet the strict terms or pay the high prices that Western drug companies demanded. Just as the Biden administration brokered a deal between Johnson & Johnson and Merck—two fierce industry competitors—to increase production of the one-shot vaccine, so should it push U.S. companies to establish production arrangements with foreign manufacturers. China and Russia have already made deals for local manufacturers to produce their vaccines. Companies in Argentina, Brazil, and Italy all plan to begin producing the Sputnik V vaccine.

Open, democratic societies have tremendous resources to mobilize in the effort to vaccinate the world. Sister cities, universities, religious denominations, corporations with global supply chains, charities with global networks, diaspora groups—all could be encouraged to reach out to partners abroad and figure out how best to contribute. Involving such diverse actors would help animate a new, more dynamic multilateralism.

The Biden administration is right to prioritize vaccinating every American. Ending the pandemic abroad won’t matter if the United States doesn’t vaccinate everyone at home, any more than the reverse. But the country absolutely has the ability to do both at the same time.

A serious global campaign to vaccinate everyone as soon as possible would mark the beginning of a very different era of American leadership. The United States would demonstrate its ability to lead through global institutions rather than against them—and those institutions would include more nimble ones than the bureaucratic behemoths of the twentieth century. The United States, alongside as many nations as it can convince to join it, would lead with all its resources and talent, whether public, private, or civic. It would focus more on people than on power games and measure its success in lives saved more than in governments recruited to “our side.” Call it a strategy of all for all.

The success of such an effort would undoubtedly confer enormous strategic advantage on the United States. PEPFAR, for example, dramatically improved the perception of the United States in many African and Asian countries. But the United States will have earned that advantage by living up to the universal commitments in its highest ideals—by being, in the words of Biden’s inaugural address, “a strong and trusted partner for peace, progress, and security” for everyone.