The Washington PostDemocracy Dies in Darkness

Opinion The U.S. is far too fixated on vaccinating Americans. It must focus on the world.

A nurse draws a dose of the AstraZeneca coronavirus vaccine at Mbagathi Hospital in Nairobi on July 6. (Patrick Meinhardt/Bloomberg)
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Marty Makary is a professor at the Johns Hopkins School of Medicine, Bloomberg School of Public Health and Carey Business School. He is editor in chief of Medpage Today and author of “The Price We Pay.”

While the United States is running lotteries and celebrity ad campaigns to convince every American to get vaccinated, other parts of the world are digging mass graves for their victims of covid-19. Therein lies the greatest failure of the current U.S. pandemic response: It has become fixated on the disease at home while giving lip service and responding slowly to the threat abroad.

In the United States, the covid-19 threat is currently low. Nearly all at-risk Americans are protected. The virus is now circulating in young people for which the case-fatality rate is similar to seasonal flu, except daily covid-19 cases are a fraction of the daily influenza cases in a mild flu season (about 20,000 vs. 133,000 per day).

But it’s a very different pandemic overseas. Hospitals around the world are overrun, and the morgues are overflowing due to low vaccination rates. More than 70 countries and territories have vaccinated less than 10 percent of their population, with 12 unable to reach even 1 percent. We need to help them get vaccinated.

President Biden declared June a “month of action” in an attempt to reach his ambitious goal of vaccinating 70 percent of American adults with at least one dose by July 4. That effort came up short, but in the process, the government has hoarded vaccines in surplus, putting millions of vaccines on track to expire and end up in the trash, by order of the Food and Drug Administration. They should be on trucks headed to Canada or Mexico.

The waste is expected to continue into the fall. The United States purchased a whopping 200 million additional Moderna doses for boosters and child vaccinations, despite no evidence that boosters are needed for the general public.

Full coverage of the coronavirus pandemic

Let me be clear: As many nonimmune Americans as possible should still get the vaccine. But spending millions of tax dollars to pay people to get vaccinated — as California is doing — is not the answer. It is financial mismanagement and a tunnel-vision approach to valuing human life.

Biden recently announced a global vaccine sharing program to get more vaccine doses to other countries in need, and his administration plans to purchase an additional 500 million vaccine doses for donation. But this came several months too late and did not come with a global supply chain plan. It’s not as simple as ordering an Amazon delivery to Ghana. It takes months to establish distribution channels and set up vaccination sites. The United States planned for six months to distribute the vaccine domestically and still had many hiccups, including nursing homes getting the vaccine a full month after FDA approval. Imagine trying to do the same in a country with less developed infrastructure.

And vaccine supply is not the only issue. I’ve spoken with some of the leading experts on global logistics. They describe incredible challenges to distributing the vaccine around the world. There’s a lack of refrigerated vehicles and on-site cold storage. Transportation can be unreliable and law enforcement isn’t always in place to prevent the theft of vaccines.

What’s more, systematic corruption and misuse of funds notoriously cripple U.N.-led aid efforts and could threaten Covax, the U.N.'s global vaccine effort. As Ron Cruse, founder and chief executive of the supply-chain service company Logenix International, told me, “The scale of vaccine aid in this instance is not something the U.N. handles well, historically.” Already in Kenya, legislators are investigating the misappropriation of $69 million in Covax aid. Cruse added, “This kind of corruption can lead to a total breakdown in the supply chain of lifesaving medicine.”

These are the problems that the administration should be focusing on. It can help the world learn from our mistakes and incorporate the newest scientific findings on the effectiveness of the first dose and the power of natural immunity. For example, by now we know that anyone who already had covid should move to the back of the vaccine line. They already have immunity. Dose-sparing strategies and the appropriate vaccine allocation plan save more lives, period.

The administration should also reconsider requiring second vaccine doses for kids under the age of 18. We know covid-19 death in healthy kids is extremely rare, and a recent Israeli study of kids 12-15 found that a single dose of the Pfizer vaccine was 100 percent effective after three weeks. Plus, complications with myocarditis in kids after vaccination have clustered immediately after the second dose. So why is the United States using precious vaccines on second doses for healthy kids when the risk-benefit analysis for that second dose is not yet conclusive?

The domestic threat of covid-19 is markedly reduced. Given the contribution of natural immunity, the United States has much higher levels of population immunity than our vaccination rates suggest, with upward of 85 percent of adults now immune. If the United States really wants to tackle the coronavirus pandemic and reduce the risk of new variants developing overseas, it should stop running vaccine ads with celebrities and politicians and start turning its attention to the more challenging task abroad.

Read more:

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