Experts give Biden high grades on global health leadership

U.S. President Joe Biden delivers remarks on COVID-19 vaccine production at the White House. Photo by: Adam Schultz / White House

U.S. President Joe Biden gets high marks for his administration’s domestic response to the coronavirus pandemic. In his first 100 days, he was able to double his initial target of 100 million vaccinations. But his global response to the pandemic could be better, experts say.

“I give him A-plus on his domestic response,” said Georgetown University professor and global health law expert Lawrence Gostin.

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He initially gave Biden a B-minus for the United States global response to COVID-19, as the new administration has yet to take any bold steps in launching a Marshall Plan-type response that would allow global access to the vaccines.

But Goslin later changed this to B-plus after U.S. Trade Representative Katherine Tai announced on Wednesday that the Biden-Harris administration would support the waiver on intellectual property rights for COVID-19 vaccines at the World Trade Organization.

“This is a vital first step. I never thought I would live to see the day that the US supported a waiver of intellectual property rights. Until now, the US has been the world's greatest defender of the pharmaceutical industry,” Gostin said.

“But this is just the first step. We will need to follow up by pushing pharma to transfer technology. And the US has to go big and bold on scientific sharing, financing, and technical assistance. Just bumped my grade to B+, and will go higher if [the] US follows through,” he added.

According to Our World in Data, over 248 million shots have been administered across the U.S., equivalent to over 44% of the population having received at least one shot of the COVID-19 vaccine. Meanwhile, only 0.3% of the population in low-income countries have received a COVID-19 vaccine, and COVAX, which is the only vaccine resource for some countries, faces challenges in securing supplies.

Biden assumed the presidency when America was suffering the worst COVID-19 crisis, with cases averaging over 1 million weekly, and his focus has been to address the situation domestically.

“If every US citizen is getting free vaccines, I mean, it seems just ethically consistent that everyone in the world, especially the poorer parts of the world, should also be able to get this [for] free.”

— Arvind Subramanian, former chief economic adviser to the government of India

But with the vaccine supply starting to outstrip demand in some parts of the country, experts said the U.S. now needs to do more, such as sharing excess doses, giving more money to COVAX, and supporting technology transfers so LMICs can produce their vaccines.

Some of these tasks won’t be easy. Tech transfers will require the cooperation of pharmaceutical companies. But experts said the U.S. can share its excess vaccine doses now, and it needs to have a more thought out global COVID-19 vaccine strategy.

“You can't cut [them] anymore slack because of time, because remember, every day that you don't act globally, the virus is spreading globally. And, you know, it means that this is going to come back and haunt all countries, including the United States,” said Arvind Subramanian, former chief economic adviser to the government of India.

Hard choices

Biden’s presidential win provided hope for the return of American leadership in global health. He retracted a letter on U.S. withdrawal from the World Health Organization, rescinded the Mexico City Policy that prohibited funding to nongovernmental organizations involved in abortion, and reinstated funding to the U.N. Population Fund.

The U.S. also joined and pledged $4 billion to COVAX, loaned doses of the Oxford-AstraZeneca vaccine to Mexico and Canada, and recently pledged to share 60 million doses of the vaccine to other countries once doses become available. In March, he announced a partnership between the U.S., India, Australia, and Japan to make available 1 billion vaccine doses to Asia by the end of 2022. His $1.9 trillion American Rescue Plan included $11.3 billion for the global COVID-19 response.

But the United States has yet to donate any doses to COVAX, and before Tai's announcement, the intellectual property waiver for COVID-19 technologies had been languishing at the World Trade Organization since last year. This now needs to be followed with technology transfers, experts said.

“If you give a dose to India or ... in Sub-Saharan Africa, you save a life. But if you give them the know how to make their own vaccines, you save a country, and ultimately, you save the world,” Gostin said.

But that’s a “hard task,” said Subramanian.

“The U.S. global strategy should have three components. I think the most difficult one, but maybe, in the long run, the most important, is how do you genuinely get global capacity to manufacture vaccines by … encouraging, incentivizing American pharmaceutical companies and the underlying patent holder to share their technology and actually convert the technology into real global capacity for vaccines,” he said.

“One other thing to watch would be will the Biden administration be able to use global health diplomacy to work with other donors to increase their own support.”

— Jen Kates, senior vice president, Henry J. Kaiser Family Foundation

In addition, while the U.S. is the largest donor to COVAX, its $4 billion contribution is still insufficient given the scale of the need to ensure free vaccine access for the rest of the world, which would require at least $75 billion, said Subramanian.

“If every US citizen is getting free vaccines, I mean, it seems just ethically consistent that everyone in the world, especially the poorer parts of the world, should also be able to get this [for] free,” he added.

Beyond COVID-19

Beyond dealing with the immediate COVID-19 crisis, the Biden administration has placed an emphasis on laying the groundwork for future crises. Under his COVID plan, he talked about revitalizing the Global Health Security Agenda, creating a facilitator at the office of the U.N. secretary-general for high-consequence biological events, and creating “an enduring international catalytic financing mechanism for advancing and improving existing bilateral and multilateral approaches to global health security.”

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It’s unclear how much progress has been made on these plans. But Biden’s recent proposal for discretionary funding for 2022 that included $1 billion for global health security implies “the administration is prioritizing global health security in a significant way,” said Jen Kates, senior vice president at the Henry J. Kaiser Family Foundation.

The Biden administration also recently appointed former U.S. Agency for International Development Administrator Gayle Smith as global COVID-19 response and health security coordinator at the State Department.

Beyond COVID-19 and health security, however, the global health community is waiting for what the administration’s approach will be to core global health programs, said Kates. Biden appointed Last Mile Health Co-Founder Raj Panjabi to lead the President’s Malaria Initiative. But he has yet to name the next U.S. global AIDS coordinator who would be in charge of the U.S. President's Emergency Plan for AIDS Relief.

The U.S. is the largest donor to global health programs, but as other donors reduce their funding — the United Kingdom has been announcing significant aid cuts to global health programs and institutions — Kates said it “puts a little bit of a spotlight on the U.S. going forward.”

“If the U.S. were to pull back even [to] a relatively small degree that could have a big impact. [But] it also just shows that the global health response is … so dependent on the United States … and going forward, one other thing to watch would be will the Biden administration be able to use global health diplomacy to work with other donors to increase their own support,” she said.

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.