At the virtual COVID-19 summit on the margins of the U.N. General Assembly last week, U.S. President Joe Biden announced an additional donation of 500 million doses of the Pfizer vaccine to low-income and lower-middle-income countries, bringing total U.S. pledged donations to 1.1 billion shots.
"I made — and I'm keeping — the promise that America will become the arsenal of vaccines as we were the arsenal of democracy during World War II," Biden said at the summit.
Here are some facts and context surrounding that claim.
How many doses has the US pledged and shipped?
Of the 1.1 billion doses the U.S. has promised, nearly 172 million have been shipped to more than 100 countries, according to the State Department.
Most are distributed via COVAX, the global vaccine-sharing initiative co-led by Gavi, the Vaccine Alliance; the World Health Organization; and the Coalition for Epidemic Preparedness Innovations, and some through bilateral agreements.
This makes the U.S. the global leader in both pledged and shipped doses, according to data compiled by the Duke Global Health Innovation Center as of October 1.
The next-largest pledges come from the European Union (500 million), France (120 million), and the United Kingdom, Germany and China (100 million each).
Countries that have shipped the most donations after the U.S. are China (47 million), EU (33.8 million), Japan (21.5 million) and Germany (9.9 million).
The 1.1 billion doses pledged is in line with the administration's commitment to donate three shots for every shot administered domestically. So far, 392 million shots have been given in the U.S.
The question is when the U.S. will deliver on the rest of its commitment of almost 1 billion doses.
"The claim about being an arsenal of vaccines for the world is a great talking point," said Krishna Udayakumar, founding director of the Duke Global Health Innovation Center. "It would be great to see put into action."
The U.S. has shipped only 15% of the 1.1 billion doses it has promised. It is lagging behind other countries with considerably less ambitious donation goals, including China (46%), Japan (30%) and the EU (25%).
When and to whom will the rest be shipped?
The White House said 200 million more doses would go out by year's end, and the remaining 800 million will be sent by September 2022.
"The world can't wait that long," said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University. He said the U.S. should be ramping up shipments now, particularly if it wants to meet its target to support the WHO's goal of having at least 70% of the world's population fully vaccinated in every country and income category by September 2022.
The administration has not provided a plan identifying the countries slated for future shipments. Jeremy Konyndyk, executive director of the U.S. Agency for International Development's COVID-19 Task Force, said countries already signed up with COVAX and ready to receive and distribute the vaccines would be first in line. Those that are not will be supplied with vaccines as their capacity to receive them grows.
"It's really hard to project over that full time period where any individual country will shake out," Konyndyk said. "We're kind of working it out and making adjustments as we go along depending on how the pandemic evolves."
How much surplus does the US have?
The administration does not make public the number of doses it has in reserve and those it has secured for domestic needs in the production pipelines of vaccine manufacturers. The numbers are constantly in flux, an administration official told VOA.
Data from the Centers for Disease Control and Prevention show that 82 million doses have been distributed across the country but not yet administered. Humanitarian organizations allege that the U.S. is sitting on an even larger stockpile.
"They must now get these doses — and more of the 593 million excess doses the U.S. will have by the end of the year — out the door and into the arms of people in low- and middle-income countries," said Dr. Carrie Teicher, director of programs for Doctors Without Borders USA, responding to Biden's announcement of an additional 500 million doses.
Data compiled by analytics company Airfinity on COVID-19 vaccine stock in the U.S., EU, U.K., Canada and China — countries with the biggest surpluses — show an excess of close to 670 million doses by the end of September. This projection factored in those countries offering booster shots to people 12 and older six months after their second doses.
Airfinity data also predict that 241 million doses of vaccines stockpiled in the Group of Seven leading industrial nations will expire by December without immediate redistribution.
Is the global vaccine shortage a question of production capacity or distribution?
Airfinity data show vaccine manufacturers currently produce 1.5 billion doses per month. It forecasts a total global production of 12.2 billion doses for 2021, of which 6.5 billion are Western vaccines and 5.7 billion are Chinese.
This would mean the goal set by the WHO of 11.3 billion doses required to vaccinate the world's population could be achieved in months, providing wealthy nations do not continue to cushion their reserves to provide booster shots and guard against new variants before lower-income countries get their first shots.
"Wealthy countries bought up most of the world's supply of vaccines and have not moved fast enough in creating a global plan to get these vaccines delivered and distributed where they are needed around the world," said Sarah Swinehart, spokesperson for the ONE Campaign, an organization formed to fight poverty and preventable diseases.
High-income countries have now administered almost 100 doses for every 100 people, while low-income countries have administered just 1.5 doses, according to the WHO.
If there is high production capacity, why aren't producers exporting them?
"If we're going to be the arsenal of vaccines, we actually have to export vaccines, not just donate them once in a while," said Udayakumar of the Duke Global Health Innovation Center. Separate from the doses donated by the administration, American vaccine producers have exported 161 million doses for sale, far below China (1.1 billion) and the EU (nearly 800 million).
Most exports still go to higher-income countries, and some export restrictions are still in place. This week, the EU extended a mechanism to potentially limit vaccine exports until the end of 2021 because of the bloc's need to secure booster shots.
India, the world's largest manufacturer of vaccines, stopped exports in April to focus on inoculating its own population as infections surged. It will resume exports in October.
The WHO is also urging scaling up manufacturing through technology transfer. In June, it announced the first COVID-19 mRNA vaccine technology transfer hub, to be set up in South Africa.
The world health body also called for the so-called Trade-Related Aspects of Intellectual Property Rights Agreement waiver, or TRIPS waiver, the suspension of intellectual property rights for vaccines at the World Trade Organization, so that countries can access vaccine "recipes" and produce their own without fear of legal action.
The TRIPS waiver proposal, submitted by South Africa and India in October 2020, is supported by more than 100 countries, 100 Nobel laureates and prominent human rights groups, but it cannot move forward without the consensus of all WTO members. The EU, U.K. and Switzerland oppose the waiver.
Didn't the US support the TRIPS waiver?
We have not seen the full weight of the U.S. diplomatic corps engaging on this topic, said Matthew Rose, director of U.S. policy and advocacy for the Health Global Access Project. "In multiple TRIPS council meetings, the U.S. has been mostly silent in reaching a consensus and moving the council to text-based negotiations," he said.
In May, the U.S. said it broadly supported the proposal to waive TRIPS, but it has since declined to support the proposal as it is, in effect helping prolong negotiations.
Instead of leading, the Biden administration has largely stayed on the sidelines of TRIPS negotiations, said Abby Maxman, president and CEO of Oxfam America, an organization aiming to end global poverty. "We cannot vaccinate 70% of the world with the same tools that have vaccinated only 1% of Africa so far."
The office of U.S. Trade Representative Katherine Tai, who is leading the TRIPS waiver negotiations at the WTO, did not respond to a request for comment.
The TRIPS waiver received little attention at the COVID-19 summit that Biden convened. Except for Canadian Prime Minister Justin Trudeau and New Zealand Prime Minister Jacinda Ardern, no other leaders from wealthy nations, including Biden, mentioned it in their remarks.
White House press secretary Jen Psaki told VOA that the administration expects TRIPS waiver negotiations to be a lengthy process and that it has "never been the only basket that we're focused on."
VOA's Nike Ching contributed to this report.
Editor's note: This story has been updated to add the EU's share of donated vaccines.
