WASHINGTON – When an airliner carrying 2.5 million doses of the coronavirus vaccine took off from Moderna from Dallas to Islamabad, Pakistan on Wednesday, federal officials had just gone through a dizzying bureaucratic back and forth getting them there.
The United States had a donation agreement with Moderna and Covax, the long-standing vaccine exchange initiative. Covax had previously entered into indemnity agreements with Moderna that protect the company from liability for possible damage caused by the vaccine. Officials at the American embassy in Islamabad had worked with regulators there to assess the Food and Drug Administration’s review of the vaccine; Pakistani regulators had to sift through tons of materials on the vaccine lots and the factory that made them before approving their use there.
Once signed, the result was what is known as a tripartite agreement: a type of agreement that increasingly engages the Biden government’s pandemic response efforts and underscores how demand for vaccines in the United States is lagging as many countries seek help ask of those who have a surplus.
Amid criticism from some public health experts that President Biden’s vaccine diplomacy has been slow and inadequate, the White House plans to announce Thursday that it has fulfilled the president’s pledge to start delivering 80 million doses by June 30 distribute around 50 countries, the African Union and the Caribbean consortium of 20 nations have been officially offered, with about half already delivered and the rest planned in the coming weeks, said Natalie Quillian, the deputy Covid-19 response coordinator of the Biden Government.
Efforts to share the dose have become a constant turmoil across the federal government, with vicarious meetings several times a week and daily operational reviews. The White House can hold up to 15 country-specific calls a day, starting at 7 a.m., often to the National Security Council, Centers for Disease Control and Prevention, the Department of State and Defense, and other agencies.
Approximately 75 percent of the doses are channeled through Covax, which has delivered more than 91 million doses to both affluent and lower-income countries. The rest is distributed through bilateral agreements that allow countries to retrieve and distribute cans more directly.
Researchers have estimated that 11 billion doses of vaccines are needed worldwide to potentially eradicate the coronavirus pandemic. In the past few months, tens of millions of doses of the three federally approved vaccines in the United States have gone unused, and more have come off the supply lines. White House officials said they want to ensure adequate supplies to Americans this spring before completing the overseas shipping overseas work.
To date, more than three billion vaccine doses have been administered worldwide, which is 40 doses per 100 people. Some countries have not yet reported a single dose, although the highly contagious Delta variant is spreading around the world, exposing other inequalities.
“If this is the pace at which it is continuing, then unfortunately it is much slower than necessary,” said Dr. Saad B. Omer, the director of the Yale Institute for Global Health, on the US effort.
Ms. Quillian said more doses would be shipped over the summer, in addition to the 500 million doses of Pfizer-BioNTech’s vaccine that the Biden government promised this month to distribute to about 100 countries next year. She described this phase of vaccination diplomacy as more procedurally complex than the domestic vaccination program. One of the challenges with bilateral agreements, such as the three million doses of the Johnson & Johnson vaccine sent to Brazil last week, is that the recipient country is negotiating compensation agreements with the manufacturers.
When the cans destined for Pakistan were declared for shipping last week, attention shifted to packaging and transportation to Dallas Airport. The health authorities in Pakistan and an organization behind Covax – UNICEF, the United Nations Children’s Fund – will deliver it, an effort the Biden government wants to oversee. Less than two percent of the Pakistani population are fully vaccinated.
Dr. Hilary D. Marston, a member of the government’s Covid-19 Response Team and a former National Security Council and National Institutes of Health official who helped coordinate the broadcasts, said the State Department and Centers for Control of Disease and Prevention had also worked with Pakistani officials to find out how many doses the country could store.
Pakistan is an obvious candidate for a vaccine donation, Ms. Quillian said. As a neighbor of India, which faced a devastating spike in virus cases this spring, Pakistan has likely been affected by the spread of the Delta variant, which was first identified in India. But the wider list of countries the United States has sent vaccines to required more consideration.
Jake Sullivan, the White House national security adviser, said at a news conference earlier this month that the government was initially prioritizing neighbors of the United States and Asian countries with spikes in virus cases.
The sharing of cans can sometimes appear to be an international matchmaking scheme. Some countries have requested the vaccine from Johnson & Johnson due to simpler storage requirements and its attractiveness as a one shot shot. Others have already approved one or more of the vaccines used in the US, which speeds the process.
“Any country we offered a vaccine to,” said Ms. Quillian, “if they asked for a specific type, we could accommodate that request.”
Officials can still face significant hurdles. Since the donated cans were manufactured and sold according to American legal and official procedures, they must be approved separately by the recipient countries. The process often involves working out kinks with overseas regulators.
Covax doses use can sometimes stall, as in South Sudan and Congo, both of which put some of the initiative back due to logistical problems and vaccine reluctance. There have been clearer successes in bilateral agreements that the US has already negotiated. South Korea, which received a million doses of the Johnson & Johnson vaccine from the United States, reported that it used up 99.8 percent of the doses in just a few weeks, White House officials said.
Dr. Omer said that because of the time it takes vaccines to generate an immune response, targeting donations to countries with outbreaks is insufficient.
“It has been six months, even since the vaccination program started, that we had some substantial movement on this issue,” he said of the can-sharing campaign.
Ms. Quillian defended the government’s timing. “It’s hard to remember three months ago, or even February or January. We didn’t have enough vaccine for this country, ”she said. “The president wanted to make sure that we can take care of ourselves first and show that it can work here, and then we always wanted to share when we have surpluses.”
The government of Biden, said Dr. Omer, said he needed to rely more on the CDC’s expertise in global vaccination campaigns, including its success in organizing the distribution of polio vaccines.
Dr. Michael H. Merson, professor of global health at Duke University and former director of the World Health Organization’s global program on AIDS, said a useful model for distributing vaccines overseas was the President’s Emergency Plan for AIDS Aid, or Pepfar. who worked with The Global Fund to provide, administer, and monitor the safety of antiretroviral drugs.
The CDC’s disease outbreak prediction operations recently received a financial boost from Mr Biden’s American rescue plan, which would enhance the White House’s efforts to identify potential virus hotspots overseas, White House officials said. A more organized program to do this work is underway, they said.