Promises Don’t End Pandemics

The U.S. vowed to be an ‘arsenal of vaccines’ for the world. What are we waiting for?

Dodge ambulances lined up for delivery to the Army. Detroit, Michigan, August 1942. Photo: polkbritton

I recently started seeing friends indoors and unmasked for the first time in over a year. I rarely see severe Covid-19 patients anymore in the ER where I work as a doctor. And I can’t remember the last time I saw a patient die, something that happened many times on every shift early in the pandemic. Things are feeling so positive lately, I even bought tickets for Broadway shows this fall.

We are witnessing the last gasps of the pandemic in the U.S. thanks to an incredible vaccination campaign. Around the world, however, Covid-19 rages on. There were more new Covid cases in the last two weeks than the first six months of the pandemic.

Lofty promises won’t end this pandemic. The U.S. has helped, and is helping, but we need to do a lot more.

As Americans cast aside our masks and plan for a blissful summer, many will forget that the rest of the world still faces an out-of-control pandemic. By doing so, we risk losing sight of how the U.S. can help control Covid-19 globally. We’re already missing a crucial opportunity to extend a helping hand.

The state of the pandemic in the U.S.

With respect to the pandemic in the U.S., there is abundant reason for optimism. New Covid cases are plummeting in all 50 states, now averaging 30,000/day, the lowest level since June 2020.

CDC Covid Data Tracker

Similarly, new hospitalizations for Covid are dropping as well, down 18% compared to the previous week and nearly 80% down from early January’s peak. Most importantly, Covid deaths in the U.S. are at less than 500/day, the lowest level since March 2020.

We’re not completely out of the woods though — as long as there are new cases, more people will be hospitalized with Covid, and some will still die.

But the progress has been so profound that the CDC recently used our plummeting case rates to justify lifting mask restrictions for vaccinated individuals outdoors and indoors.

There’s no doubt that the rapid vaccine rollout has played a substantial role in getting us here. The U.S. has administered 279 million vaccine doses, reaching over half of the total population. And over 38% of Americans are fully vaccinated against Covid, a stunning achievement. Even as the pace of vaccination slows, more than 1.6 million Americans get a shot every day. Plus, now 12–15-year-olds are eligible for vaccines as well.

CDC Covid Data Tracker

The current state of the pandemic in the U.S. — especially compared to how we started 2021, with nearly 250,000 new cases and 3,400 deaths from Covid daily — is reason for optimism. But the pandemic isn’t over — even if we are seeing the last gasps. There will still be flare-ups, especially in communities where vaccination uptake has been slower. And Covid will be with us for a long time, certain to reemerge this fall and winter. But it’s clear that the worst is over, and for many of us, that means we can get back to living.

The state of the pandemic globally

In much of the world, however, the pandemic rages on. And in many places, it’s the worst it has ever been.

After nine consecutive weeks of rising case counts around the world — including a record 5.7 million new cases — numbers have plateaued and are on the decline. Even so, there have been more Covid cases in the last two weeks than during the first six months of the pandemic. Globally, more will die from Covid-19 in 2021 than in 2020.

Transmission is currently highest in Southeast Asia, where hotspots like India and surrounding countries are crushed under a heavy burden of new cases.

World Health Organization Coronavirus (COVID-19) Dashboard

The hard reality is that for many of the countries hit hard by Covid right now, there is not much hope on the horizon. While wealthy nations like the U.S. are vaccinating their way out of the pandemic, low- and middle-income countries have not been, and likely won’t be, so lucky.

Of the more than 1.5 billion vaccine doses administered globally, 84% have gone to wealthier nations, while only 0.3% have gone to low-income countries.

New York Times. Tracking Coronavirus Vaccinations Around the World.

And Covax, the global vaccine equity initiative, is warning it is already 140 million doses short of its target, as exports from vaccine-producing countries like India have stalled as domestic demand skyrocketed.

The U.S. likes to point out how we’ve donated more money and more doses than any other country. And even if that’s true, the reality is that just doing more than others isn’t enough.

As Americans venture back out into the world, turning off their TVs to reengage with friends and family, they risk losing sight of the pandemic’s continuing impact abroad. And without understanding the immediacy of the challenge, we risk forgetting the crucial role the U.S. has in ending the pandemic around the world.

How the U.S. can help

We’ve gone to great lengths to control the pandemic in the U.S. Now we need to do more to end it around the world.

We’ve made some initial commitments to that end, including donating $4 billion to Covax; launching the Quad Vaccine Partnership with Japan, Australia, and India to expand vaccine manufacturing abroad; and promising to donate the 60 million doses of AstraZeneca vaccine that’s sitting unused in American warehouses.

Recently the U.S. supported waiving intellectual property on Covid-19 vaccines, a first step in helping countries manufacture their own doses. But the U.S. must also commit to transferring the technical know-how necessary to expand vaccine manufacturing globally, something it hasn’t done yet.

And just this week, President Biden announced that another 20 million vaccine doses would be donated to Covax directly.

The U.S. likes to point out how we’ve donated more money and more doses than any other country. And even if that’s true, the reality is that just doing more than others isn’t enough.

The U.S. has way more vaccines on order than any other country, with supply contracts for over 1.2 billion doses. President Biden’s announcement to donate 20 million doses is a welcome change from how his administration has dithered on articulating a plan for our vaccine surplus. But such a small commitment just isn’t up to the task.

20 million doses is around what the U.S. allocates to all the states and territories in a single week. And the president committed to getting these doses out by the end of June, more than a month from now. But more doses are needed right now. And the U.S. is the country that has them.

Since early April, vaccinations have slowed in the U.S. even as vaccine supply has remained remarkably steady. And Americans are expecting the U.S. to do more, with two-thirds supporting sending more vaccines abroad.

This is particularly important as the U.S. amasses an extraordinary bounty of vaccines — a rainy day supply for boosters, vaccinating younger groups once approved, and other unforeseen scenarios. But we’ve passed the line between caution and hoarding.

I applaud the administration’s commitments, but we need action, and we need it now. So much of what we’ve heard to date are promises of a future mobilization. But the pandemic will not wait on us.

At his May 17 announcement on donating vaccine doses, President Biden vowed that the U.S. will be the “arsenal of vaccines” for the world, harkening back to our massive wartime contributions in World War II.

The sentiment is certainly welcome. But unless we do much more now to help the rest of the world control the pandemic, the sincerity and seriousness of this administration’s comments will remain in question.

In the same speech, President Biden said, “we know America will never be fully safe until the pandemic that’s raging globally is under control.” I’m glad he recognizes the reality. But lofty promises won’t end this pandemic. The U.S. has helped, and is helping, but we need to do a lot more.

I’m writing weekly for Medium about my experiences as an emergency medicine doctor during the Covid-19 pandemic. You can read my previous posts on vaccine disinformation, what herd immunity really means, and more, here. Or find me over on Twitter.

NYC ER doctor | Ebola Survivor | Director of Global Health in Emergency Medicine at Columbia University | Public Health Professor | Doctors Without Borders BoD

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