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Biden balances vaccinating Americans and donating vaccines globally


The Biden administration has now delivered 200 million COVID vaccines to countries around the world. It's part of a pledge of more than a billion doses, but health officials say they need 10 times that many shots to reach a goal of getting 70% of the world fully vaccinated by next September. Gayle Smith is the State Department official heading up the U.S. global vaccine effort. She talked with Steve Inskeep.


How significant is it to reach 200 million?

GAYLE SMITH: Well, I think it's really significant. We started in June. You know, the president announced initially that we would share 60 million doses, and that number has just continued to go up. A great deal of this is shared surplus doses from the United States. We've also added to the mix the purchase of now 1 billion Pfizer doses. So we will be providing a steady flow of vaccines from both sources throughout next year.

INKSKEEP: So 200 million is a very impressive number. It's enough to give complete coverage to a pretty large country. And yet the U.S. has pledged 1.1 billion, and health experts talk about several billion, many billion, being needed around the world. Is the United States doing enough?

SMITH: Well, I think we're doing a great deal. But, Steve, if you think about it, here's what we need to do. We are not where we need to be on supply. It's gotten somewhat better. We're not quite there yet. But we need to ramp up the sharing of doses from any country that is able to do so. So there have been commitments from the U.K., the European Union. That's terrific. We hope that those will move swiftly. We have worked also on increasing production. So we're working on all these levels of supply to ramp up the numbers and the volume as much as we can. So none of us has done enough yet. I think we've seen a marked change from where we were just a few months ago.

INKSKEEP: I'm thinking not just about the top-line number but also where it goes. Tom Frieden, who's a former director of the Centers for Disease Control, wrote the other day that of 6.5 billion doses globally, only 4% - 4% - have gone to low-income countries. And he's actually blaming Pfizer and Moderna for selling to the countries that can pay the most. Is he right about that?

SMITH: It is true that it has been difficult for many countries to make purchases. Part of that is volume. I leave it to the drug manufacturers to offer their explanation of why that may be. There are cases, though, where some regions have been able to somewhat surmount that obstacle. In the case of the African Union, for example, they mobilized capital from within Africa to purchase 400 million J&J doses, which are now rolling out on the continent.

INKSKEEP: That sounds impressive when the African Union talks about getting that many doses, but if I look at, say, The New York Times coronavirus vaccine tracker and run my cursor across Africa, I find country after country after country where 1% of the people are vaccinated - 2, 3, 4% of the people are vaccinated.

SMITH: You're a thousand percent right, and the coverage numbers are way, way too low. Now, that's one of the reasons we've got a primary focus on Africa. There's no question that the fact that Africa's coverage is so low is inexcusable and, frankly, wrong. So part of the deal is getting on top of that as quickly as possible. We're just pleased that we can do that in tandem with the African Union to get those numbers up as quickly as possible.

INKSKEEP: To what extent is the U.S. government able to direct vaccine-makers what to do, whether it is manufacturing capacity or where the vaccine goes?

SMITH: There's constant engagement with the producers to produce more, to make more doses available to developing countries - also and importantly, to speed up delivery times. That's one of the big challenges that we've all faced, is the predictability of supply is quite uneven. So there is constant engagement with them to work on all three of those fronts.

INKSKEEP: Does the U.S. government have the leverage to tell a vaccine-maker what to do? Or must you ask them to do things?

SMITH: I think it's more ask than tell. But I think there are ways to ask with enthusiasm.

INKSKEEP: (Laughter) Ask with enthusiasm.

SMITH: (Laughter).

INKSKEEP: I kind of like that.

SMITH: So I think there's a pretty clear message, not just from the United States but from countries all over the world, that there's a very high expectation that producers will do everything they can so that we can get these numbers up all over the world.

INKSKEEP: Is there a risk in the coming weeks and months of a conflict between vaccine supplies for the United States and vaccine supplies overseas precisely because the FDA and the CDC have, in recent days, approved extra shots for millions more people, and we can presume that the rate of shots in the United States is going to go up pretty rapidly for a while?

SMITH: Sure. There's always a risk. But I think the White House team that is managing the domestic side of the House has done a great job of ensuring that we've got ample supply, both for boosters but also for sharing more doses and moving these Pfizer doses out. One-point-one billion doses is a lot. And that's not the ceiling.

INKSKEEP: As the United States ships vaccine overseas, I want to ask you questions from a couple of different perspectives about this. I could imagine being someone who lives in a sub-Saharan African country or any number of countries around the world and resenting more than a little that the United States got several hundred million doses of vaccine for itself and now is shipping out its surplus to a country where people are dying. How would you respond to that person?

SMITH: You know, I think that it's a totally fair question for someone to ask another country. This system doesn't seem to work the way it should. I think that's right. But I think we've also seen that there's been tremendous appreciation for the United States providing doses and making very clear there are no strings attached and that we're going to continue the flow.

INKSKEEP: And let me ask a question from a different perspective. I could see an American listening to this broadcast right now saying, why are we spending money to send hundreds of millions of doses of vaccine overseas? It's not our business.

SMITH: Well, I would say, first and foremost, it is our business. And as long as we've got low rates of vaccination anywhere, it's a threat to us. It is a huge threat to the global economy, to global stability. So it's absolutely in our interest. I also think it really matters that the United States be out there and leading on this, not just with our self-interest from a public health point of view but with our values. And I would hope that we would all believe that where you're born shouldn't determine whether or not you can get vaccinated or not in the midst of a global pandemic.

INKSKEEP: Gayle Smith, coordinator for Global COVID Response and Health Security at the U.S. State Department. Thanks for taking the time.

SMITH: Thank you so much.

(SOUNDBITE OF THE ALBUM LEAF'S "SYNTHESIS") Transcript provided by NPR, Copyright NPR.