The case for US Covid Vaccines Overseas Donation

A Senate committee harassed federal officials over the shortage of vaccines to protect Americans from a pandemic virus. Two months later, the U.S. public had lost interest in the virus and millions of vaccines were in storage – though poor countries still needed them.

This happened during the 2009/10 swine flu pandemic. One officer in the hot seat was Dr. Nicole Lurie, who was responsible for preparation and response in the Department of Health and Human Services. Today she is a senior advisor at the Coalition for Epidemic Preparedness Innovations, which is helping to vaccinate the world against Covid. And she worries that history will repeat itself.

Lurie told Congress at the time that vaccine production was unpredictable. In any case, the swine flu virus turned out to be relatively tame, but experience has a lesson for today, she said: Pandemics are changing direction quickly, so it is best to be prepared for threats and opportunities – anywhere in the world.

In particular, Lurie and others are calling on the Biden administration to make plans to move excess US vaccine supplies overseas after vaccinating Americans. They find that by the end of July, the government had received at least 700 million doses of vaccine – more than enough to fully vaccinate every adult and child in the United States. The current focus must be on the United States, which has seen more cases and deaths than any other country. In the long term, however, global immunization will be of vital importance.

“We have to take care of the problem everywhere in order to solve it everywhere,” said Dr. Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative, made a remark echoed in a petition by leading US scientists. “Even if we get high vaccine coverage here, we are still vulnerable to imported variants that are less responsive to first-generation vaccines. It will be an ongoing problem. “

Vaccine experts and activists give the Biden administration high marks for reintegration into the World Health Organization and its global partners. They also understand that the United States must take care of itself first.

“Until we have enough for Philadelphia, I don’t see they want to give away vaccines,” said Feinberg, 64, lives in Philadelphia and had to be vaccinated until March 18. “We still have a long way to go.” . ”

However, in the months ahead, many believe that the Biden government should at least partially move towards a global approach. The Trump administration has carefully distributed its vaccine development risk, spending $ 14 billion on contracts with eight different companies. Five now have vaccines approved for use in the US or overseas.

“Now that there are five vaccines that work, coverage looks a lot more like hoarding,” said Tom Hart, North American executive director of One, a global group fighting poverty. “You don’t need more than a vaccination or two to get immune. Once you get immune, you have to share. “

Biden is fundamentally committed to sharing the vaccine doses with the world. On day one, the government released a national security memorandum urging state secretaries and HHS to immediately “provide Biden with a framework for donating surplus vaccines to countries in need once there is adequate supplies in the US.”

In a largely symbolic move, the government said Thursday it planned to ship 1.5 million doses of vaccine to Canada and 2.5 million to Mexico. The donation would come from an AstraZeneca-made vaccine cache that has not yet been requested for use in the US.

The government has also promised cash for vaccines to other countries. She has pledged $ 4 billion to the COVAX facility, the coordination group that aims to distribute 2 billion Covid vaccines to low and middle income countries by the end of the year. Half of this money was paid out.

The government is also helping to expand vaccine manufacturing in developing countries – an important goal in protecting these countries from Covid, as well as routine teething problems and future pandemics.

Biden and the leaders of India, Australia and Japan have just signed an agreement calling on US International Development Finance Corp., which supports projects in poorer countries, to manufacture Biological E., an Indian pharmaceutical company of 1 billion covid vaccine doses by the end of 2022. Johnson & Johnson, Novavax and AstraZeneca have worked with several Indian manufacturers in unusually collaborative agreements over the past year.

But donating a vaccine would be the quickest way to help – and the picture is bleaker here. The government has not said when or how it will determine that there is “an adequate supply” of US vaccines that can be shared.

Federal officials are working on the framework for future donations, an HHS official said.

“Our main focus is to vaccinate Americans first. However, the US will not be completely safe until the whole world is safe, “said the official, who spoke on condition of anonymity.

White House press secretary Jen Psaki said last week that Biden “wants to be over-prepared and oversupplied” with extra doses that could be used for “booster shots”. That is a fuzzy target, however, as it is unclear when or if or what type of refresher shots might be required.

It is also not clear whether all vaccine donations are handled through COVAX, which decides where to send them, or whether they are distributed bilaterally to allies like Mexico.

It’s a shame, said Hart of One, because sharing vaccines could pay off in goodwill building. China and Russia, who have already donated or sold their vaccines in Africa, the Middle East and Latin America, “are expanding their sphere of influence through vaccine diplomacy,” he said. “People are not easy to forget when you saved their lives and that of their families.”

Now is the time to ponder these issues, Lurie said. For months during the swine flu pandemic, tens of millions of unused U.S. influenza vaccines were held in warehouses awaiting shipping overseas due to the cumbersome regulations of the U.S., World Health Organization, and overseas governments.

“There were 68 steps that no one knew about,” Lurie recalled. “My favorite was the fumigation certificate required for the wooden pallet for exporting cans to the Philippines.”

Merck had similar problems when it tried to ship its Ebola vaccine to West Africa during the 2014-16 epidemic there. Trade and trade rules, Food and Drug Administration regulations, and other bureaucracy make shipping an unlicensed vaccine out of the country very complex, said Feinberg, who was a senior Merck scientist at the time. “It took a long time to jump through the hoop to even send the vaccine to Guinea, Liberia or Sierra Leone.”

The donations to Canada and Mexico appear to come from roughly 30 million doses that AstraZeneca reportedly has stored in Ohio as the company prepares to submit data to the FDA to approve the vaccine. The US could make good use of these cans by exporting them if not used here, Lurie said. “That would be a good alternative to the vaccine that is only in a warehouse.”

However, several countries have suspended the use of the AstraZeneca vaccine while the European drug regulators study reports that the vaccine could cause blood clots. Exporting US-made shipments of this vaccine would be a mistake now, Feinberg said, as it could undermine confidence in the perception that the US is offloading a vaccine that the FDA did not consider worthy.

“The administration has carefully addressed the main issues,” he said. “In the long term and maybe even in the short term, this is perhaps better than a one-time donation.”

This story was produced by KHN publishing the California Healthline, an editorially independent service of the California Health Care Foundation.

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