Biden will address the United Nations on Sept. 21 and is one of the more than 100 world leaders expected to appear in person. The next day, the White House will host a virtual summit to further coordinate global vaccination initiatives. Attendees, including numerous heads of state, top health officials and leaders from the private sector, are being asked to record a short video “outlining your commitment to ending COVID-19 in 2022 and building back better global health security to prevent the next pandemic,” according to the White House invitation.
The need is great. Even as the world’s wealthier nations contemplated rolling out programs for booster shots to strengthen the immunity of their populations amid the advance of more transmissible coronavirus variants, poorer countries lag far behind. “Only 20 percent of people in low- and lower-middle-income countries have received a first dose of a vaccine compared with 80 percent in high- and upper-middle income countries,” the World Health Organization said in a statement last week.
But as it tries to rally international support in producing and distributing vaccine doses, the Biden administration has to sit with an uncomfortable, parallel reality: On the domestic front, the United States’ once-world-leading inoculation drive seems to have run out of steam.
After racing ahead of all other major countries earlier this year, the United States is about to have the lowest proportion of fully vaccinated people out of all the Group of Seven nations. There was a moment in the spring in which Canadians, Europeans and Asians alike could only look on wistfully at Americans lining up for their vaccines, emboldened by the tantalizing promise of a summer with fewer travel restrictions and pandemic stresses. The Biden administration’s accelerated approach to vaccinating the United States seemed so effective, its vaccine stockpile so deep, that critics lambasted the White House’s single-minded “vaccine nationalism.”
The picture in the United States by summer’s end is, of course, far less rosy. Entrenched vaccine hesitancy among millions of Americans and the devastating spread of the delta variant have led to ICU beds filling up in many states and a national daily coronavirus death toll of well over 1,000, by the latest count. So far, more than 660,000 Americans have died of covid-19, the disease caused by the coronavirus.
Biden and his allies pin the blame on right-wing media and some rival Republicans, who have politicized both the administration’s attempts to encourage mass vaccinations, as well as its latest efforts to implement federal vaccine mandates.
“This is a pandemic of the unvaccinated,” Biden said last week. “And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot.”
Other wealthy nations are hurtling ahead. The rate of fully vaccinated people in Japan, which lagged far behind the E.U. and the United States for much of the year, is set to surpass the roughly 54 percent plateau where the United States now languishes. “If Japanese vaccinations continue at the current pace, the country will … approach 80 percent in November,” noted Nikkei Asia. “The benefits of the mass vaccination drive are already evident. Only 4.5 per 100,000 fully vaccinated people contracted new coronavirus infections during the first three days of September. This compares with 59.9 per 100,000 among Japan’s unvaccinated population.”
In various European countries, a hard-bitten minority has balked at vaccinations and protested vaccine mandates. Yet even though the United States maintains much harsher travel restrictions on Europeans than the reverse, the European Union overtook the United States in its overall vaccination rates by the end of July.
Countries with far more meager resources than the United States, like Cambodia and Mongolia, also have greater shares of their populations fully vaccinated against the virus. A larger proportion of Cubans have received at least one shot than those living in the country that has subjected it to a decades-long economic blockade.
In the United States, the pandemic has only accentuated political divides and social inequities. Republicans accuse Biden of engaging in “un-American” politics by forcing people to take a vaccine (no matter that vaccines for other diseases are already mandated in many circumstances in American life). A lack of social protections, including paid sick leave, has also meant that many Americans who cannot afford to miss work are wary of taking a shot whose side effects may force them to briefly convalesce. All the while, hundreds of thousands of doses in various American states went unused and expired.
“The lessons from epidemics and pandemics is that politics, culture, and socioeconomic variables matter as much as the health aspects of whatever the health issue is,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told Vox earlier this summer. “You cannot separate out the qualities or characteristics of communities from how the response is structured and talked about.”
As Biden faces the rest of the world, the task is no less challenging. About a third of the global population is fully vaccinated. Officials at Covax, the WHO-backed entity tasked with delivering vaccines to much of the world, have complained that their efforts are being stymied both by wealthy countries that hoarded much of the early supply, and other bureaucratic and political obstacles, including export bans imposed by countries like India.
“India’s ban has been particularly devastating for lower-income countries that are bearing the brunt of the latest wave of the pandemic,” wrote my colleague Andrew Jeong. “Covax officials said last week that India’s export curb was one of the reasons the program would only have access to about 1.4 billion doses by the end of 2021, far short of the 2 billion doses it had planned for.”
Among other bits of diplomatic cajoling, the Biden administration is expected to try to incentivize India to lift its controls. “One missing part is leadership and accountability,” Krishna Udayakumar, director of Duke University’s Global Health Innovation Center, told my colleagues. “If the global covid response remains rudderless and fragmented, without real levers for accountability, all the well-meaning commitments in the world will have little impact.”