The Global Vaccine Rollout Is Failing—and That Puts Everyone, Everywhere, In Danger

The selfish reasons the United States and Europe must help poor countries deal with COVID-19.

A lab technician prepares stainless steel tanks used for manufacturing vaccines at French pharmaceutical company Sanofi’s world distribution center in Val-de-Reuil on July 10, 2020.
A lab technician prepares stainless steel tanks used for manufacturing vaccines at French pharmaceutical company Sanofi’s world distribution center in Val-de-Reuil on July 10, 2020. Joel Saget/AFP/Getty Images

The global vaccine rollout is failing. As if the more transmissible and possibly more deadly strains of COVID-19 now emerging from Brazil, South Africa, and the United Kingdom weren’t bad enough, many Western countries are now struggling with dangerous vaccine shortages—sparking ugly fights among them over access to supplies. The picture is even bleaker in developing countries, most of which have yet to receive their first doses. Several new studies suggest that the delays there could last for years, further immiserating states already pummeled by the global recession and unleashing unrest and violence that, like the virus, could easily spread.

The Biden administration may feel that it has its hands full just (barely) coping with all the problems within the United States. That’s understandable. Unless Washington and its allies quickly do more to address what’s happening in the planet’s poorest places, however, virtually everyone everywhere will soon face a lot more pain.

Start with the picture in the West. For weeks now, the United States has been struggling with both supplies and distribution: Many states can’t get their hands on enough vaccines, forcing them to cancel tens of thousands of planned shots, and some of those that do have plenty have failed to administer what they’ve received. Both problems have increased the probable death toll. On Tuesday, U.S. President Joe Biden announced a “wartime effort” to secure 100 million more doses each of both the Pfizer and Moderna vaccines. Even if he succeeds, however, the government’s estimates of when the country will achieve herd immunity—and thus return to some semblance of normality—have been pushed back months, to the end of the year.

Across the Atlantic, where vaccination rates are even lower, things have gotten so bad that, after AstraZeneca announced it would deliver 60 percent fewer vaccines to the European Union than promised in the year’s first quarter, the bloc’s officials exploded, threatening to impose export controls and implying that the firm had deliberately cut deliveries so it could sell its doses for more money elsewhere (read: the United Kingdom, which has inoculated a far higher percentage of its population than most countries on the Continent).

All these setbacks are dangerous and disappointing—but the rich world still has it relatively good. The delays it faces can be measured in months; a new study by the Economist Intelligence Unit estimates that the United States, the U.K., Israel, and the EU will all still achieve “widespread vaccination coverage” by the end of 2021

Developing countries won’t be so lucky. According to the same report, 84 of the world’s poorest states won’t get enough vaccines to achieve herd immunity until 2024—an inequity that Tedros Adhanom Ghebreyesus, the head of the World Health Organization, recently called a “catastrophic moral failure.”

The reasons for the delay are pretty basic: In their panic to protect their own citizens, rich countries are “hoarding” supplies, as South African President Cyril Ramaphosa put it at the World Economic Forum’s annual conference on Tuesday. A recent New York Times analysis shows that Ramaphosa wasn’t exaggerating: The EU has already signed enough future procurement contracts to vaccinate all its citizens twice over; the United States has locked in four times the doses it needs, and Canada six. Although the World Health Organization, in partnership with several nonprofits, has launched an effort, called COVAX, to secure more doses for poor countries, the project is seriously under-resourced—as of last month it was $4.3 billion short of its fundraising goal—and isn’t likely to begin delivering vaccines before February. And even if it eventually meets its targets, COVAX will only inoculate some 20 percent of the populations of the countries involved—a number far too small to provide any kind of mass immunity.

FP INSIDER'S COVID-19 INDEX outlines major bottlenecks affecting the global vaccine roll-out and profiles actions governments are taking around the world to manage the ongoing crisis.

FP INSIDER’S COVID-19 INDEX outlines major bottlenecks affecting the global vaccine roll-out and profiles actions governments are taking around the world to manage the ongoing crisis.

These delays, on top of the pandemic in general, will devastate many poor countries and their citizens. The World Bank predicts that the COVID-19 recession could push as many as 150 million people into extreme poverty over the course of 2020-2021. In 2019, remittance payments—cash that migrants working in rich states send home to relatives in poorer ones—supported some 800 million people and totaled $554 billion. In 2020, that figure was expected to fall by a fifth, the largest decline in history. Meanwhile, as the pandemic lingers, other key sources of revenue on which many poor countries depend—especially tourism and commodities like oil or copper—will shrink even more than they have already.

All these problems, and the misery they’re going to cause, should be enough to get richer countries involved. But the United States and the rest of the West have far less abstract, and more self-interested, reasons to do much more to help poor nations now.First, the longer the virus spreads unchecked throughout the developing world, the greater the likelihood that it will continue to mutate. New, even more dangerous strains will emerge—and inevitably find their way to the rest of the world. As Charlie Weller, the head of vaccines at Wellcome, the British health foundation, put it recently, “we cannot leave parts of the world without access to vaccines because it’s just going to come back to us.” Or as Northeastern University’s Alessandro Vespignani told the Wall Street Journal, “if we let the virus go wild and have a lot of cases in other places, that could boomerang.”

Second, a study released Monday by the National Bureau of Economic Research warns that the unequal distribution of vaccines around the world could cost the global economy a staggering $9 trillion dollars this year alone, due mostly to depressed consumer demand and disruptions in global supply chains. Although the reality that the pandemic will cause huge economic damage is hardly new—we’re living it already—the latest projections vastly exceed earlier ones. And the report includes a prediction that should be even more alarming from a narrow, Western perspective: nearly half the $9 trillion in losses will be suffered by wealthy countries, even if they manage to inoculate most of their own populations. Recessions in poor places that don’t get the vaccine, in other words, will hurt everyone

But the threats don’t end there. Tarek Ghani, chief economist at the International Crisis Group, recently argued that the pandemic could also undermine global security. COVID-19 is already destabilizing developing states in ways that could easily spill beyond their borders: by increasing unemployment, eliminating fragile middle classes, overstretching the resources of weak governments, triggering famines in places like Burkina Faso and Nigeria, and complicating delicate political transitions in Sudan and elsewhere.

So what can Biden and the rich world’s leaders—all of them already distracted and overwhelmed—do to help protect developing states and, in the process, their own?

Simply ordering up more vaccines isn’t going to work. Current and future supplies are already spoken for and, given the need to keep them refrigerated, would be hard to distribute in poor countries that lack the right infrastructure. The disappointing test results of China’s Sinovac vaccine also underscore just how hard new versions are to develop. And it’s just not realistic to expect the West share its contracted doses with poorer countries. While one could make an ethical and a pragmatic case that a frontline health care worker in Zimbabwe deserves a vaccine more than a healthy 50-year-old who is not an essential worker in New Jersey, making such a choice would, obviously, be a political nonstarter.

Fortunately, Washington has other options. For starters, it could back a proposal by South Africa and India to temporarily waive intellectual property rights for coronavirus-related medical products, which would allow poor countries to immediately start producing their own versions of already approved vaccines. Arnab Acharya and Sanjay G. Reddy, two economists, recently made a compelling case in Foreign Policy that lifting patent protection for such crucial medications for a short time wouldn’t necessarily eliminate the incentive for other pharmaceutical companies to develop vaccines in the future, as is commonly assumed. The key, they argue, would be for Western governments to generously compensate producers for the production costs and profits they’d lose in the process: an expensive proposition, to be sure, but cheap compared to the economic risk of doing nothing.

Still, such a move would face ferocious pushback from the powerful pharmaceutical lobby, a fight the Biden administration might not want to pick right now—especially since it has some less controversial alternatives. As Ghani of the International Crisis Group argues, Washington and its allies should focus on forgiving the debts of poor countries and offering them more financial assistance. As he points out, with borrowing rates at historic lows, this could be done relatively cheaply by expanding lending from the World Bank and the International Monetary Fund. And the extra cash could help buttress already shaky countries such as Iraq, Lebanon, or others.

None of these steps I’ve suggested will be easy to take, but that’s not the point. The point is that the dangers of not acting to help the developing world cope with the pandemic are far greater than most Western policymakers seem to assume. While focusing exclusively on your own people during a crisis is tempting, leaders of rich countries need to realize that, even seen through that narrow lens, poorer countries demand their attention and their help—because without it, Western citizens are also bound to suffer.

Jonathan Tepperman is an editor at large at Foreign Policy, a role he assumed in November 2020 after three years as the magazine’s editor in chief. He is the author of The Fix: How Countries Use Crises to Solve the World’s Worst Problems. Twitter: @j_tepperman