What Trump plans to do with America's leftover COVID-19 vaccines

BURLINGTON, Vt. — U.S. President Donald Trump’s administration plans to release an international COVID-19 vaccine distribution strategy that will divide the country’s excess stock of doses between low-income countries, partners in vaccine development, and high-income countries that might want to buy it.

On Tuesday, Trump issued an executive order that outlines how the White House will prioritize access to vaccines purchased by the U.S. government for every American who wants one and then “facilitate international access to United States Government COVID-19 Vaccines for allies, partners, and others, as appropriate and consistent with applicable law.” Given that President-elect Joe Biden’s administration will have broad authority to overturn previous executive orders, it remains to be seen whether the plan will ever take effect.

While the executive order provides few details about the White House’s international distribution plans, a senior State Department official, who spoke to Devex on the condition of anonymity, shared more about a forthcoming strategy they said has been in the works for four to five months. It will likely involve a combination of vaccine donations to lower-income countries and vaccine sales to high-income countries, with decisions about which countries should receive them guided by public health, data, and foreign policy considerations.

“Americans are just now getting the vaccines, but we needed to put into place early a system to make sure that we've learned the lessons from the ventilator debacle, where decisions were seemingly made willy-nilly,” the senior State Department official said.

The administration’s effort to donate thousands of ventilators to other countries through the U.S. Agency for International Development faced criticism in the spring for lacking any clear strategy for determining which countries should receive them and in what quantity.

“We wanted to create a really disciplined, science-based, data-driven process that will allow for decision-makers to make the very best decisions,” the senior official said.

That process will be detailed in a strategy expected to be released in the near future, but a number of elements have already been decided through an interagency process.

A global public health coordinating committee that is run by the Department of Health and Human Services — and which includes the State Department and USAID — will be making the decisions about which countries should receive vaccines, and in what quantity, based on a “data-driven process.”

Those decisions will be informed, however, by foreign policy and economic considerations, the official said, noting, for example, that people from Latin American countries “come into contact more often” with the U.S.

The official said they expect at least 50% of the vaccines the U.S. distributes internationally to go to low-income countries, with Gavi, the Vaccine Alliance likely to be the “implementer of choice.”

In addition to those low-income countries, the administration envisions two other categories of likely recipients: countries with which the U.S. government has partnered in developing vaccines, such as Brazil and South Africa, and high-income countries that do not have access to the vaccines but may want to purchase them.

The official said that their current timeline predicts that every American who wants a vaccine could have access to one sometime in the spring and that facilitating international donations will begin after that. The U.S. government has purchased 800 million doses of vaccine from six different manufacturers, five of which the official said are in the late stage or on the verge of approval and one of which is further off.

The administration does not yet have a list of which countries will be prioritized, because there are remaining questions about how the manufacturing of vaccines will unfold and what that will mean for different countries’ opportunities to access them.

“We will have a very disciplined, data-driven, foreign policy-informed decision-making apparatus that will allow for vaccines to get where they're needed most,” the official said.

Many public health experts have argued that the most effective strategy for stopping the spread of the coronavirus and mitigating its impacts would be to prioritize at-risk populations in every country, instead of offering the vaccine to every American who wants one.

“At a moment that should be jubilant, the White House is putting in writing for all to see that the US government thinks the last healthy young American should be vaccinated before the first high-risk person in Africa, Asia, or Latin America,” Matthew Kavanagh, a professor at Georgetown University, wrote to Devex.

The administration’s view is that Americans paid for the vaccines and therefore have a “right to them,” the senior official said, adding, “It’s pretty much as straightforward as that.”

“I suspect every developed country out there will sort of make the same determination that we have made, which is ... we definitely want to be generous. But at the end of the day, this is a product that taxpayer dollars made happen, that we have already purchased, and therefore we should allow an American to have access to that first,” they added.

Asked why foreign policy considerations should enter into decisions about vaccine distribution during a pandemic, the official said the main concerns relate to countries that present logistical or legal challenges when it comes to U.S. foreign assistance, such as Iran, North Korea, and Cuba.

The Trump administration has refused to join multilateral vaccine distribution initiatives, such as COVAX, opting instead for a go-it-alone approach that critics describe as “vaccine nationalism.”

“Ultimately, these are donations from the American people, and so we think it's important for us to maintain some type of decision-making process and not outsource our decision-making process to others,” the official said.

The executive order lists agencies that will be involved in international vaccine distribution, including HHS, USAID, and the State Department, as well as the U.S. International Development Finance Corporation and the Export-Import Bank. Their roles will be described in more detail in the strategy that is still to be released, but the official said USAID will be “on the front lines” and working to ensure vaccine distribution is “synced up” with other development efforts.

“We're going to probably distribute vaccines to a lot of countries where USAID doesn't run health programs. They don't run health programs in Latin America, but that'll be an important part of our work. So it'll be a stretch for us all,” the official said.

DFC might provide capital for pharmaceutical development or distribution infrastructure, the official said, adding they do not expect the U.S. government will make loans to countries to enable them to purchase vaccines.

“We expect the vast majority of the excess vaccines to be donated to poorer countries,” the official said, adding: “We're not the debt trap country. That's not our business model. We're into the generosity model.”

When Biden takes office on Jan. 20, he will have wide latitude to overturn or modify previous administrations’ executive orders, including this one. The senior official acknowledged that it will be up to the incoming team to determine its own approach to vaccine distribution.

“The Biden team is filled with very smart people who've been working a lot on this stuff,” the official said.

“I think if they look at the plan, hopefully it will make good sense to them, and hopefully they'll keep the whole thing, or large portions of it, but obviously they get to make the calls on Jan. 21.”