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Twenty years of global efforts to build and foster democracy in Afghanistan crumbled in a matter of days as the US and NATO forces withdrew before the August 31 deadline. As Taliban fighters raced into Kabul to recapture power, US strategic diplomacy was in tatters.

As evidence of the appalling decline of its role as a world leader, not only has the US lost the moral high ground in the fight against global terrorism, it has demonstrated selfishness in tackling the Covid-19 pandemic. 

Grim warning on vaccine inequality

As the Covid-19 vaccine roll-out got underway early this year, the Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, delivered a grim warning. Describing vaccines as a literal and figurative shot in the arm, he declared that the world was on the "brink of a catastrophic moral failure," the price of which will be "paid with lives and livelihoods in the world's poorest countries."

Urging all countries to work together in solidarity, Dr Tedros termed vaccine equity, "not just a moral imperative" but also a "strategic and economic imperative," because the unequal international distribution of vaccines, will “prolong the pandemic, the restrictions needed to contain it, and human and economic suffering.”

Global race against Covid-19

Although vaccines typically require years, if not decades, of research and testing before being approved for final use, scientists around the world embarked on an unprecedented race to produce safe and effective coronavirus vaccines in record time.

By early 2021, the roll-out of three major vaccines had begun in the West on a massive scale — Pfizer (US)-BioNTech (Germany), Moderna (US) and AstraZeneca-Oxford University (UK) — with developed countries pre-ordering most of the stock. The US government even bankrolled Moderna’s efforts, providing nearly US$1 billion in support for vaccine development. The Chinese and Russian governments also hastened the process of their own vaccine roll-outs by domestic manufacturers.

Stark contrast: rich nations vs poor nations

With developed countries having pre-ordered and pocketed most of the vaccine stock, developing countries will not have wide access to vaccine shots before 2023. In a January 2021 report by the Economist Intelligence Unit, Global Forecasting Director Agathe Demarais highlighted this stark contrast between rich and poor countries.

“Some of these countries—particularly poorer ones with a young demographic profile — may well lose the motivation to distribute vaccines, especially if the disease has spread widely or if the associated costs prove too high,” she said.

As Western nations focused on vaccine nationalism, securing doses for their own citizens, another trend to keep an eye on, is vaccine diplomacy. Bypassing international frameworks, Russia and China entered into a series of preferential bilateral arrangements with developing nations seeking to adopt a “transactional approach” for the delivery of vaccines, “using coronavirus shots as a bargaining chip to advance long-standing interests.”

Vaccine roll-out: driven by narrow nationalism

As of Wednesday, figures collated by Our World in Data, based on official numbers from governments and health ministries worldwide, show that 33 percent of the world population has received at least one dose. Around 5 billion doses have been administered globally, and around 36 million are now being administered each day. That is an impressive count for a vaccine which came into existence only a few months back. However, what is disheartening is that only 1.6 percent of people in low-income countries have received at least one dose. (See Our World in Data for the latest updates.)

Although the vaccine coalition COVAX initiative by WHO along with the vaccine alliance, Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI) pushed for global cooperation, developed countries competed with each other to secure doses for their own population -- totally disregarding the vulnerable and high-risk people in poorer nations.

Global vaccination agenda: offering lip-service

Leaders across the world have repeatedly underlined the urgent need to aggressively push a global vaccination agenda, particularly focusing on those most vulnerable in poor nations. Speaking at the White House in May this year, President Biden said that, “We need to help fight the disease around the world to keep us safe here at home and to do the right thing of helping other people.”

Stressing the importance of global vaccination, UK Prime Minister Boris Johnson pointed out in June that the world is looking to the developed world, "to rise to the greatest challenge of the postwar era: defeating Covid and leading a global recovery driven by our shared values.”

However, the actions of leaders in developed nations often don't match their words. 

Restricting vaccine ingredients

Developed countries like the US have also imposed various forms of export controls on vaccines and ingredients used for production of vaccines and other medicines. Adar Poonawalla, the CEO of Serum Institute of India, the world’s biggest vaccine-maker, tweeted to President Joe Biden, begging him “on behalf of the vaccine industry outside the US,” to “lift the embargo of raw material exports out of the US so that vaccine production can ramp up.”

Notably, as a World Bank working paper shows, vaccine-producing nations are "both the main source and destination of exports of key ingredients." The two top exporters of key ingredients are the United States and the European Union, which account for half of total exports, followed by the United Kingdom, Japan and China with significantly smaller shares.

The US Administration defended its decision to impose restrictions, arguing that its “first obligation is to take care of the requirements of American people," and pointing out that it was “hit harder than any other country around the world.”

The move by the US Administration, both under President Trump and President Biden, to invoke the Defence Production Act (DPA) helped American pharmaceutical companies to secure a variety of special materials and equipment that are needed for vaccine production. However, firms involved in the export of such products point out that the law hinders their ability to sell them abroad.

Under US law companies are required to seek permission, which causes delays. If the government decides that the goods are required for domestic consumption, they can be barred from exporting them altogether. Given the various approvals required for products used in vaccine manufacturing, it is nearly impossible for manufacturers to find replacements and substitutes quickly. It causes a ripple reaction leading to other countries following suit, causing disruptions and stockpiling in the global supply chain.

US role: woefully insufficient

A report in the New York Times says that of the 11 billion vaccine doses that experts say are needed to slow the spread of the virus worldwide, the US has either donated or pledged only about 600 million vaccine doses to other countries.

However, with the US government recommending booster dose for vaccinated Americans starting in September, there is outrage among public health experts who have urged the president to push aggressively to scale up manufacturing to meet global requirements.

A new report released by PrEP4All reveals that the Biden Administration is yet to use $16 billion allocated by Congress to vaccinate the world, and end the pandemic. Summarizing its findings, the report points out that production capacity for Covid-19 vaccines is woefully insufficient to meet global vaccine demand.

Though the US Government funding of manufacturing capacity in 2020 was essential to ensure the country was able to secure enough doses for the American population. It could similarly be used to build vaccine manufacturing capacity to meet global demand.

The report points out that with many countries unlikely to have widespread access to vaccines until 2023, continued transmission of the Covid-19 virus increases the risk of new variants evolving. This could undermine the ability of even our most potent vaccines to maintain population level epidemic control.

The report finds that the Biden Administration has thus far spent only approximately $145 million out of $16 billion allocated by Congress for vaccine manufacturing and other Covid-19 medical countermeasures. The report says that this apparent failure to continue adequate investment in scaling up production is inexplicable given the current crisis in global vaccine access.

According to the PrEP4All report, unspent Congressional appropriations are more than sufficient to build mRNA vaccine production capacity in six months, capable of vaccinating the entire world in a single year.

To quote the report’s author, PrEP4All, James Krellenstein, “We must not allow ourselves to play fiddle while the world burns. Unequal access to vaccines threatens lives everywhere. So long as Covid-19 spreads worldwide, even worse variants than Delta will emerge.”

Therefore, “it is imperative that the Biden Administration immediately scale up vaccine production for the billions of people who don’t have access. The health of our nation and the world depends on it,” Krellenstein points out.

Demand for sharing vaccine know-how

Although US-based companies have thus far expressed their unwillingness, there is a growing global demand that developed countries and manufactures waive IP barriers and share know-how on how to make vaccines, including ingredients, methods, sourcing, and technologies. Adopting this justice-oriented approach would enable low-and-middle income country manufacturers particularly in Africa, Asia, and Latin America to make vaccines for themselves.

Considering the pressing need, Médecins Sans Frontières (MSF) among other global experts and organizations have called on US-based Pfizer and German-based BioNTech to urgently share the vaccine technology and knowledge with manufacturers on the African continent to boost the global supply.

Refuting the argument that manufacturers in poorer nations are ill-equipped to manufacture technologically advanced vaccine production, Lara Dovifat, campaign manager for MSF’s Access Campaign, points out that, “Setting up mRNA vaccine manufacturing capacity in Africa is absolutely possible,” with at least seven manufacturers in African countries currently meeting the prerequisites to produce mRNA vaccines, if all necessary technology and training were openly shared. MSF has also called on the US government to demand that these companies follow through.

The Covid-19 pandemic has taught us that a virus knows no man-made boundaries. Rather than work on a collaborative global strategy, the US and other high-income nations have adopted a selfish and narrow-minded approach to developing and justifying the stockpiling of vaccines for their own population. Meanwhile, Russia, China and India indulged in competitive vaccine diplomacy to gain diplomatic and geopolitical influence. Facing a catastrophic second wave, India was forced not only to stop the export of vaccines, but start importing them.

If crisis and temptations are a true test of character for nations, the high-income vaccine developing nations and their leaders have failed this test. How fast they learn from their mistakes, only time will tell.