With a surplus looming, how should the US use excess vaccines?

With the United States racing towards its goal of having enough coronavirus vaccines available for all adults in the country by May 1, the debate over what it should do with excess supplies is intensifying.

The US is projected to have a hefty surplus of coronavirus vaccines in the second half of 2021, estimated at about 600 million excess doses, but the administration of President Joe Biden has offered little insight into how those shots will be allocated.

Global health advocates have said the shots could be used to help ease a global supply shortage, which is partly the result of production problems but also caused by some wealthy countries procuring vast quantities of vaccines from pharma companies.

The US, as well as countries like the United Kingdom and Canada, have ordered enough doses to vaccinate their populations more than once, while, several countries have struggled to secure access to doses, in what some critics have called vaccine apartheid.

Biden said last week: “If we have a surplus, we’re going to share it with the rest of the world.” But the administration has so far not offered details on what shape that sharing will take, how many doses it will be willing to part with, or if it would donate or sell its excess shots.

The US is reaching a “political and psychological threshold” that is allowing the administration, and the public, to begin to think globally after months of focusing on domestic crises, said J Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies.

“It’s been considered a hypersensitive issue to begin allocating surplus vaccines prematurely and politically dangerous to begin making allocations of future surpluses,” he said. “I think that’s changing. But it hasn’t changed by 180 degrees.”

Andrea Taylor, a lead researcher on a Duke University project that tracks global COVID-19 vaccine procurement, said it is not “clear cut” how the US can most effectively deploy its projected surplus.

“We’re actually working right now on scenario planning to answer this exact question: Once the US does get ready to start donating doses, what are the options? And what are the pros and cons of the different approaches?” Taylor told Al Jazeera.

Duke’s current data puts the total number of confirmed US vaccine orders – which include inoculants still in development – at 1.2 billion, far outpacing the population of about 328 million.

The advantage of donating through the World Health Organization’s COVAX initiative – to which the US has already pledged $4bn – is “ensuring the equitable allocation by population coverage … They are ensuring that all countries get enough to cover the 3 percent 5 percent 10 percent up to 20 percent of their population”, Taylor said.

The US, and other wealthy countries that are expected to have a surplus, could also consider deploying vaccines “in areas that are hit the hardest in terms of COVID burdens, countries where the health systems are on the brink of collapse, or that have a really high death rate”, she said.

Then, Taylor added, there is “this sort of soft diplomacy approach … US policymakers may want to think about certain countries where they have particular special trade relationships or that the [the US] wants to protect for our own global supply chains or self-interested reasons”.

She noted that the US approach is likely to be a “mix of the three”.

‘Unrelated’ but ‘overlapping’

For the time being, the US vaccine surplus exists mostly on paper.

However the US does have seven million “releasable doses” of the AstraZeneca-Oxford vaccine, which the company has been manufacturing in the country as part of a 300 million-dose order placed by Washington, the White House said on Thursday.

The company is expected to apply for emergency approval for its shot in the US in the next few weeks. In the meantime, governments already using the shot in their vaccine rollouts are struggling to secure enough doses to satisfy demand, a result of what the company has described as production delays at its plants in the European Union. European officials have reportedly heaped pressure on the Biden administration to share the doses it cannot yet use, to no avail.

Instead, on Thursday, the Biden administration announced it would “loan” 2.5 million doses to Mexico and 1.5 million to Canada.

At a news conference, White House Press Secretary Jen Psaki denied that the arrangement was a quid pro quo involving Washington’s request that Mexico – reeling from a sluggish vaccine rollout – do more to help stem a wave of migrants and asylum seekers crossing the southern border.

Psaki called the two issues “unrelated” but said they existed “in parallel”.

‘A form of geopolitics’

The US’s foray into vaccine diplomacy comes as some observers have expressed concern over Russia and China’s growing influence, with both donating vaccines to countries in Latin America and sub-Saharan Africa before they have inoculated their own domestic populations. Moscow, in particular, has also said it has sought to offer cheaper vaccine contracts to countries priced out by western producers.

Beijing has donated shots across South East Asia, where the US and its regional allies have sought to counter China’s influence by financially boosting manufacturing capacity in India, which has also donated doses abroad before inoculating its population.

“We have to acknowledge this becomes a form of geopolitics,” Dr Rebecca Weintraub, the director of Harvard University’s Global Health Delivery Project, told Al Jazeera. “As [the US] delays it allows certain countries to have more influence while so many are looking for supply.”

“But you have to also remember that that is not evidence-based vaccine delivery,” she told Al Jazeera. “The politicisation of the vaccine is to the detriment of all.”

US Secretary of State Antony Blinken has also criticised Beijing’s “strings attached” vaccine deployment, saying in Tokyo on Wednesday “that certain requests are made, and maybe stronger requests are made of countries in order to receive the vaccines”.

Still, Dr Michael Jennings, a professor in the department of environmental studies at SOAS University of London, said well-stocked countries will be calculating how much they want to put their “own national imprint” on vaccine deliveries, which becomes more difficult when distributing through initiatives like COVAX.

While receiving countries will be “cynical” of Moscow and Beijing’s attention, they will also notice the absence of wealthy western countries, he said.

“I think that actually is what might lead to realignments of power in the long run,” he told Al Jazeera, “not just the positive action that is being done by China and Russia and others in giving vaccines, but the inaction of the traditional donors who have a nice line in rhetoric, but the reality is quite divergent from the things that they say.”

‘Very, very soon’

Advocates have long called for wealthy countries to take a global approach to vaccinations, saying a nation-first strategy threatens to prolong the pandemic, which gives more time for variants of the virus to develop in unprotected populations that could undermine progress made by vaccine campaigns.

While the Biden administration has been clear it does not plan to start widescale distribution until the US has offered shots to its domestic population, Tom Hart, the North American Executive Director of the ONE organisation, said the administration should be working now to pin down the logistics of delivering surplus vaccines.

That is particularly true as the US is set to have a mixed bag of extra inoculants, including the Pfizer-BioNTech and Moderna vaccines, which require ultra-cold storage and careful transportation, as well as the Johnson & Johnson and AstraZeneca vaccines, which are easier to transport and store.

“It does look like by the May, June period, there will be enough doses to cover and meet domestic demand in the United States,” Hart told Al Jazeera. “So what we don’t want to do is on June 30, say ‘okay, now, what do we do with our surplus doses?’ Because that would delay relabelling, reshipping – figuring out how to get these surplus doses out to the places that need it – by several months.”

“Those months are lost lives and livelihoods, and it’s also risking additional variants, which is a real concern,” he said. “So those plans need to be in place very, very soon.”

ONE is advocating for excess doses to be distributed through the World Health Organisation’s COVAX, which Hart called the most “equitable mechanism” for delivery.