Biden to push global plan to battle Covid-19 as national gaps widen

WASHINGTON (NYTIMES) – Already grappling with divisions in his own country over vaccine mandates and questions about the ethics and efficacy of booster shots, US President Joe Biden is facing another front of discord: a split among world leaders over how to eradicate the coronavirus globally, as the highly infectious Delta variant leaves a trail of death in its wake.

At a virtual summit on Wednesday (Sept 22), while the annual United Nations General Assembly meeting is underway, Biden will try to persuade other vaccine-producing countries to balance their domestic needs with a renewed focus on manufacturing and distributing doses to poor nations in desperate need of them.

COVAX, the UN-backed vaccine programme, is so far behind schedule that not even 10 per cent of the population in poor nations – and less than 4 per cent of Africa’s population – is fully vaccinated, experts said. Millions of health care workers around the world have not had their shots.

The push, which White House officials say seeks to inject urgency into vaccine diplomacy, will test Biden’s doctrine of furthering American interests by building global coalitions.

Coming on the heels of the United States’ calamitous withdrawal from Afghanistan last month that drew condemnation from allies and adversaries alike, the effort to rally world leaders will be closely watched by public health experts and advocates who say Biden is not living up to his pledges to make the US the “arsenal of vaccines” for the world.

At the same time, the Biden administration is preparing to offer booster shots to millions of already vaccinated Americans, despite criticism from World Health Organisation officials and other experts who say the doses should go to low- and lower-middle-income countries first.

On Friday, a Food and Drug Administration panel recommended Pfizer booster shots for those over 65 or at high risk of severe Covid-19, a broad and ill-defined category. The agency is expected to authorise the shots this week.

Biden administration officials said they are determined to eliminate the disease both at home, including with booster shots, and abroad.

“We do understand that this has not been spread around equally,” Erica Barks-Ruggles, the State Department’s senior adviser on international organisations, told reporters on Monday, previewing the UN meeting.

Hours later, on a conference call with reporters, WHO’s chief scientist, Dr Soumya Swaminathan, disagreed.

“It’s a myth when people say we can do both – unfortunately, that’s not true,” Swaminathan said, referring to Biden’s booster strategy. “At the moment, we are in a zero sum game.”

She and other experts are calling for a coordinated global vaccination strategy in which doses would be distributed equitably around the globe, rather than each country tending to its own needs.

Officials said Wednesday’s summit would be the largest gathering of heads of state to address the coronavirus crisis. It aims to encourage pharmaceutical-makers, philanthropists and nongovernmental organisations to work together toward vaccinating 70 per cent of the world’s population by the time the UN General Assembly meets in September 2022, according to a draft document the White House sent to the summit participants.

“We also know this virus transcends borders,” Biden said on Sept 9. “That’s why, even as we execute this plan at home, we need to continue fighting the virus overseas, continue to be the arsenal of vaccines.”

“That’s American leadership on a global stage,” he said.

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Experts estimate that 11 billion doses are necessary to achieve widespread global immunity. The United States has pledged to donate more than 600 million – more than any other nation – and the Biden administration has taken steps to expand vaccine manufacturing in the United States, India and South Africa. In addition, the White House is in talks to buy another 500 million doses from Pfizer to donate overseas, but the deal is not final.

The 27-nation European Union aims to export 700 million doses by the end of the year.

But as recently as July, only 37 per cent of people in South America and 26 per cent in Asia had received at least one vaccine shot, according to Rajiv J. Shah, the head of the US Agency for International Development during the Obama administration.

The figure stood at just 3 per cent in Africa, Shah wrote in an essay published last month in Foreign Affairs.

An estimate by the ONE Campaign, which fights extreme poverty and preventable disease, showed that the leading seven developed nations would together be sitting on a surplus of more than 600 million vaccine doses by the end of 2021. That is enough to give every adult in Africa one shot.

Most doses that have been committed, however, will not be delivered to the needier nations, nor injected into arms, until next year. Given the sluggish distribution, said Dr. Kate O’Brien, WHO’s top vaccines expert, “we can see clearly from the data that’s coming out that we are very far” from vaccinating 70 per cent of the world’s population by the middle of next year, as initially projected.

That growing gap between the vaccine haves and the vaccine have-nots has led to a rift between wealthy countries and most of the rest of the world, one that has only deepened with the rampant spread of the Delta variant and potentially thousands of others that are on the rise.

Several of the most virulent strains were first identified in lower-income countries, including South Africa and India – both of which have fully vaccinated only 13 per cent of their populations.

More than 100 low-income countries are banking on Biden to lean on the European Union and Group of 7 industrialised states at the summit Wednesday to agree to waive intellectual property rights to vaccine production so that they can be shared with manufacturers in other, developing nations.

Some of the leading coronavirus vaccines are produced in Europe – including Pfizer-BioNTech in Germany and AstraZeneca in England – and officials there have been accused of putting potential profits ahead of beating back the pandemic.

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The EU again objected to a plan to waive the vaccine property rights at a closed-door World Trade Organisation meeting last week in Geneva, according to a senior European diplomat familiar with the discussion.

Wealthy nations have argued that the waiver alone will not produce vaccines, given that most developing countries lack technologies or other capabilities to manufacture them.

“Too much energy is being spent on an initiative that won’t provide immediate relief,” Gary Locke, the Commerce Department secretary and ambassador to China during the Obama administration, wrote on Sept 8.

He said the issue had become politicised: “But it won’t get shots into arms when people really need it – which is right now.”

Health experts have blamed the ban on vaccine exports from India, imposed in April, for stunting the global supply. Two months later, the Serum Institute of India, the world’s largest vaccine-maker, announced that it would divert its AstraZeneca vaccine production to domestic needs after a second wave of infections devastated India, reneging on hundreds of millions of doses that were designated for poor countries.

The Biden administration has been pressuring Prime Minister Narendra Modi of India to drop the ban, and on Monday, as the annual UN meeting opened, India’s health minister announced that Covid-19 vaccine exports would resume in October.

Modi, along with the leaders of Japan and Australia – members of the so-called Quad countries – will attend a meeting at the White House on Friday, two days after the president’s vaccine summit.

Senior US and EU officials also met in Washington on Monday, to discuss what several officials described as continued efforts to increase vaccine manufacturing.

That will be all the more necessary as the US and other countries begin recommending booster shots; Israel is already offering them to anyone older than 30. The WHO had asked wealthy countries to hold off on administering booster shots to healthy patients, until at least the end of the year, as a way of enabling other nations to vaccinate at least 40 per cent of their populations.

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