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“We need to go big.” When President Biden attempted to rally support for new vaccination pledges around the world Wednesday, he focused on scale, telling the audience that it was not the time for “half-measures or middle-of-the-road ambitions,” but enormous new goals.

One of those goals, according to the White House, is to have 70 percent of the world’s population fully vaccinated by this time next year. And to reach it, the United States would step up its own commitment, Biden announced, purchasing a further 500 million doses of the Pfizer-BioNTech vaccine to donate — bringing its total number of pledged doses to donate to over 1.1 billion.

“This is an all-hands-on-deck crisis,” Biden said at the summit, dubbed the Global COVID-19 Summit: Ending the Pandemic and Building Back Better and timed to coincide with U.N. General Assembly in New York.

The demand for more global action comes at an awkward time. With the spread of the delta variant fueling the authorization of booster shots and moves to vaccinate children in the United States and other nations, calls to share doses with low- and middle-income nations are running into new forms of demand at home. Some weren’t so sure that the calls to share will win out under the current situation.

Githinji Gitahi, global chief executive of the Kenya-based health development nongovernmental organization Amref Health Africa, said wealthy nations were speaking from two sides of their mouths: “On one side, they are saying they want vaccine equity and that we want vaccines for everyone. On the other side, they are actually practicing vaccine apartheid.”

Many public health experts reacted with disappointment to Biden’s summit. “Is the U.S. government doing everything it can do to end a global pandemic?” Peter Maybarduk, the director of Public Citizen’s global access to medicines program, asked in an interview. “No. There are many tools left unused on the table.”

The weight of expectations was enormous. When the White House’s summit on covid-19 was announced, it appeared to be another sign that the United States was stepping back into an international public health leadership role it had abdicated under President Donald Trump. The Biden administration had already pledged at a Group of Seven meeting in June that the United States would donate half a million doses to the world, marking the largest donation of vaccines in history.

Wednesday’s announcement broke that record. It also came with a slew of other enormous commitments from the United States and allies, including an additional $370 million on an effort to help with vaccine administration globally and another $380 million to assist Gavi, the vaccine alliance backing the COVAX vaccine-sharing scheme with the World Health Organization.

But so far, at least, enormous pledges have failed to have the impact their scale suggests. On Wednesday, the nonprofit Kaiser Family Foundation (KFF) released an analysis that said the United States had so far donated just 140 million doses. The half-billion doses announced by Biden on Wednesday will not make an immediate dent: 800 million of the 1.1 billion U.S. doses are not expected to ship until next year, according to the White House.

“While the doses provided so far make the U.S. the single largest donor of vaccines worldwide, these donations remain a fraction of what the U.S. has promised to provide by the end of this year and into next and are far from sufficient to meet global needs,” the KFF wrote.

At the summit Wednesday, some global health experts repeated a more ambitious target previously set by the United Nations to have 40 percent of people in all countries vaccinated by the end of this year and 70 percent in the first half of 2022. WHO Director General Tedros Adhanom Ghebreyesus said for that target to be reached, there would need to be “2 billion doses for low- and lower- middle income countries, right now.”

Tedros and U.N. Secretary General António Guterres, who also spoke at the summit, both said wealthy nations needed to do more to ensure donated doses actually reached those in need. “High-income countries have pledged more than 1 billion doses, but less than 15 percent of those doses have materialized,” Tedros said.

“Today’s summit was full of speeches but tragically lacking in action,” Abby Maxman, president of Oxfam America, said after the summit, adding that while Biden’s 70 percent target was commendable, “we have yet to see an effective plan to meet this goal.”

To many experts, donations alone will not be enough. On Monday, a group of leading public health experts at a briefing organized by Physicians for Human Rights (PHR) called on Biden and the leaders of other wealthy nations to increase the supply of vaccines.

“We have to rapidly scale up production and distribution of effective vaccines to all countries, regardless of income level. The virus that causes covid doesn’t check your bank account,” Tom Frieden, the former director of the U.S. Centers for Disease Control and Prevention, said at the briefing.

One way that could happen, proponents of this solution say, is if the complicated mRNA technology used to create highly effective vaccines made by companies like Pfizer-BioNTech or Moderna was shared with manufacturing bases in low- and middle-income countries, including with a new hub being set up with the backing of the WHO in South Africa.

So far, however, U.S. and European officials have offered little visibility into how this would work.

“That’s something that’s in the hand of the companies,” Thierry Breton, the top European Commission official in charge of Europe’s internal market, said during an interview in Washington this week. “We do not intervene here.”

On Wednesday, Biden offered only a little more detail.

“We’re working with partner nations, pharmaceutical companies and other manufacturers to increase their own capacity and capability to produce and manufacture safe and highly effective vaccines in their own countries,” Biden said at the summit.

Many want Biden to do more. But some saw hope in the mentions of manufacturing from the United States and the European Union. Biden said Wednesday the United States wanted to become “the arsenal of vaccines, as we were the arsenal of democracy during World War II.”

Maybarduk, though, said the U.S. hadn’t yet adopted a wartime-style mobilization for industry.

“If this had been a war, we would have expected just that. But health is different somehow, even if the death totals are worse,” he said.

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