Nearly a year and a half ago, I wrote an obituary for a friend of mine who died of COVID-19 in the Democratic Republic of Congo. Mama Leki, a woman who wore vivid colors and had an even more vibrant laugh, had gone to Bukavu General Hospital—which had no ventilators—with a severe cough, even though many others in her town with symptoms were staying home for fear of being ostracized. Diagnostic tests for about 40 suspected cases, Mama Leki’s among them, were sent off to Kinshasa for analysis. No one knew when they might come back. She died the next day.
This was long before a COVID vaccine existed. But even if Mama Leki were alive now, it is extremely unlikely she would get one—Congo is far behind most of the world in terms of its vaccination rate, with only 0.1 percent of the country’s population having received at least one shot. That’s because Congo is suffering, like many other low-income countries, from a shortage of vaccines. Part of the reason, experts say, is because rich countries like the United States are holding back hundreds of millions of doses in reserve.
On Monday, Doctors Without Borders reported that even when “factoring in third-dose boosters for high-risk groups, high-income countries are hoarding an estimated 870 million excess doses—nearly 500 million in the U.S. alone.” On top of that, between March and September, state governments and pharmacies discarded 15.1 million doses, said NBC News, which obtained data from the Centers for Disease Control and Prevention. Worse yet, all the Moderna, Pfizer, and Johnson & Johnson supplies expire within six or seven months. If they don’t get used, they go to waste. So even if the U.S. government is planning to keep doses for potential future use at home, many in the current stockpile won’t last long.
In fact, right now, the U.S. is destroying doses rather than sending them to places that are in short supply, says Kate Elder, the senior vaccines policy adviser at Doctors Without Borders. She told me her group is receiving calls from local health clinics asking if they can donate their unused doses. They can’t, she said. Once a vaccine starts flowing through the supply chain, there is no guarantee that it has been handled properly, and it becomes a matter of liability. “A dose that’s wasted here in the U.S. is a dose that someone in a developing country doesn’t get,” Elder said.
Fifty-six countries have not met an important COVID target set by the World Health Organization: to have fully vaccinated 10 percent of its population by the end of September. Just 2.5 percent of people in low-income countries have received at least one dose—compared to nearly 70 percent of people in the world’s wealthiest countries. G7 countries have bought more than a third of the world’s vaccine supply, the BBC reported, even though they make up only 13 percent of the global population.
We could chalk up the low vaccination rate in low-income countries to corruption or a lack of capacity to properly store or administer shots, and shake our heads and feel absolved of blame—indeed, on Friday, the BBC reported that only $6 million of the $363 million in COVID funding the International Monetary Fund gave Congo last year has been publicly accounted for. But that would be shortsighted. While the reasons so many countries are barely vaccinated are complex, there is a basic premise underlying their lack of access to the vaccines: greed.
One money-grubbing arm in this two-pronged equation is that of the pharmaceutical companies. It’s not profitable, of course, for them to sell vaccines at cost, or to donate them, as is necessary to vaccinate people in low-income countries. And they are refusing to share the necessary technology and formulas with others, keeping billions of dollars in profits to themselves. The other greedy arm is that of high-income countries—especially the United States—which believe that they should be storing extra doses in case they are urgently needed in the future.
But that line of thinking may lead to an even bigger problem. If the rest of the world can’t get vaccinated, what is already a deadly, global pandemic could become a never-ending one.
As someone who has delayed getting a booster shot even though I qualify for one, I think a lot about how much supply the U.S. has versus what it is donating to the rest of the world. I don’t want to be the First World person who has had two shots but takes a third while much of the world’s most vulnerable population has not even had one.
But I’ve realized that getting my booster will not mean taking away a shot from a friend in Congo or another low-income country. Doctors Without Borders agrees that boosters are not the problem in terms of our current supply, but that hoarding is.
The Mayo Clinic defines the term hoarding disorder as “a persistent difficulty discarding or parting with possessions because of a perceived need to save them.” Perceived is the key word. And it seems that even the U.S. government knows what it’s doing and how it comes across. “We are preparing for extreme backlash from the world for not sharing,” an unnamed senior government official told Vanity Fair in April. “When they say we are hoarding, we are.”
A spokeswoman from the government’s COVID team refused to speak on the record, and multiple attempts to reach various departments involved in vaccine distribution went unanswered.
Elder said she understands that people are concerned about a future vaccine shortage but added that the American government “has set itself up very, very well to have prioritized, privileged access to supply lines.” In the meantime, Doctors Without Borders is watching counties across the U.S. destroy vaccine supplies as they reach their expiration dates, only to have the government refill their refrigerators. Those new vaccines may also eventually be destroyed, Elder said.
“Richer nations should share their doses, stat,” Gavin Yamey, who directs the Center for Policy Impact in Global Health at Duke University, wrote earlier this year in Nature. “Perhaps for every nine doses they administer, they can donate one dose to COVAX”—the multinational effort created to distribute vaccines evenhandedly around the world.
Yamey explained that the one-versus-nine donation rate “falls far short of ‘equitable,’ but it is within what is possible. This will help beyond dimming the chance of an outbreak from an imported variant that hoarded vaccines might have reduced efficacy against.”
He pointed to a January analysis of vaccine nationalism by the Massachusetts-based National Bureau of Economic Research. The study shows that allowing poorer nations to lag behind richer countries for years could cost the global economy $9 trillion. At the same time, Airfinity, a UK-based science analytics company, projects that if wealthy countries began donating their extra doses now, nearly 1 million lives could be saved by the middle of 2022.
White House Press Secretary Jen Psaki said in March, “Our first priority remains vaccinating the U.S. population . . . the pandemic knows no borders. And ensuring our neighbors can contain the virus is . . . mission critical to ending the pandemic.”
To that end, the U.S. has committed recently to sending at least 580 million doses to countries in need, bringing its total pledge to 1.1 billion. (In February, Shannon Brownlee and Jeanne Lenzer argued in these pages about the need to help the world get vaccinated.) But in order to vaccinate at least 70 percent of the world’s population—to reach expected herd immunity—the World Health Organization estimates that at least 11 billion doses are needed. Also, compare the number of doses the U.S. plans to donate with the nearly 500 million doses the country is currently withholding.
The White House has proudly declared that the U.S. is donating more vaccine than all other countries combined. That may be true—the rest of the world isn’t doing all that much—but the number of donations clearly falls far short of the global need, which is especially troubling when millions of doses are not getting used at all. Is that really something to be proud of? As Elder put it: “If you’re comparing yourself to the D squad—sure. But who wants to compare themselves to the D squad?”