The US should donate vaccine doses to India and other countries. Now.

The contrast is growing more galling by the day.

In the US, more than half of adults have received at least one vaccine dose, Covid-19 transmission is the lowest it’s been in 11 months, and many Americans are partying and traveling and reveling in their new vaccinated status.

Meanwhile, thousands of unvaccinated people in less wealthy countries — from India to Brazil — are dying every day amid overwhelming surges of Covid-19. Delhi’s crematoriums have run out of room. Sao Paolo has resorted to exhuming old graves to make space for new bodies.

“We have a split screen. The US is looking great — everyone can get a vaccine! At the same time, in India, Southeast Asia, everywhere, I have health care worker friends who may not see a vaccine until 2022 or 2023,” said Craig Spencer, a professor of emergency medicine at Columbia University. Nearly a dozen countries are “vaccine deserts” where nobody, not even doctors treating Covid-19 patients, has gotten a single shot.

Visitors wait in line at a bar in front of the Flamingo Hotel in Las Vegas on May 1. More than half of the adult population in the US has gotten at least one vaccine dose.
Roger Kisby/Bloomberg via Getty Images
Family members of someone who died of Covid-19 perform the last rites at a crematorium on May 9 in New Delhi. Many countries, like India, have had difficulties vaccinating their medical staffs, let alone their full populations.
Anindito Mukherjee/Getty Images

Against this backdrop comes the US decision to start offering vaccines to children ages 12 to 15. For some experts, many of whom have been calling on the Biden administration to send doses abroad for weeks, this latest development is almost unbearable to watch. It’s not that they think teenagers shouldn’t get the shot. It’s just that they think it shouldn’t be the priority right now.

Instead, they say, the US should donate doses to countries where the need is greater — immediately.

“Compared with children ages 5 to 17, people ages 75 to 84 are 3,200 times more at risk of dying from COVID-19,” three experts wrote in an article in the Atlantic. “For children, the risk of disease is not zero, but the mortality risk is comparable to that from seasonal influenza, and hospitalizations occur in about only 0.008 percent of diagnosed infections.”

Vinay Prasad, one of the authors of the article, told me that given these probabilities, it doesn’t make sense to vaccinate American children before vaccinating adults in India, where only 1 in 10 adults has received a dose. (The exception is American children with medical conditions that put them at risk.) “You will certainly save many more lives by diverting supply to older people globally.”

Our World in Data

It’s also in America’s best interest to vaccinate the world quickly, because the longer Covid-19 runs rampant, the greater the risk that new variants will emerge — some of which may partially evade vaccine protection.

As pediatricians argued in a Washington Post op-ed, “Ethical arguments aside, the fact remains that the greatest threat to children in countries with well-advanced vaccine programs comes from areas where Covid remains highly prevalent.”

Although there’s still important work to be done vaccinating Americans, we’ve now reached a point where vaccination is slowing as supply outstrips demand. The surplus in doses, combined with the fact that the remaining unvaccinated population is less at risk, means that the US sending doses abroad makes all the sense in the world.

What the Biden administration has done — and still needs to do

The Biden administration has already sent some relief abroad, including shipments of oxygen cylinders, rapid tests, treatments, and personal protective equipment to India.

It also made headlines recently for agreeing to waive vaccine patents. But even with the recipe freely available, Covid-19 vaccines are incredibly complicated to make, requiring deep technical know-how and scarce raw materials. So, while waiving patents may be helpful in the long term, it doesn’t help people who are getting sick and dying right now.

What’s more helpful in the short term is simply donating doses.

Biden has promised to do that. In April, he pledged to send 60 million AstraZeneca doses to virus-ravaged countries. But it’s now mid-May, and doses are still sitting in a stockpile. Although they have to pass a federal safety review before being exported, and it’s obviously crucial to ensure safety, experts still say Biden’s plan to donate these doses over the next several months will be too little, too late.

The US can afford to give much more, much faster. After all, roughly 73 million doses are already sitting in the US stockpile, according to CDC data. By July, Duke University researchers estimate, the US will likely have at least 300 million excess doses — and that estimate is assuming that the US will retain enough doses to vaccinate the vast majority of children. In other words, every eligible or soon-to-be-eligible American could get vaccinated, and there would still be 300 million doses left over — practically enough to give an extra dose to every person in the country.

A surplus of that magnitude is so staggering that not sharing it with the world starts to look morally unjustifiable.

Our World in Data

William Moss, a professor at Johns Hopkins Bloomberg School of Public Health, said it would be “a very obvious decision” for the US to donate all its doses of AstraZeneca since that vaccine is not even authorized for use in the US. Another promising option would be to donate Johnson & Johnson’s doses in spades. “The advantage of getting that to countries like India is that it’s a single dose, and the cold-chain requirement is less stringent,” he said.

Moss, Prasad, and Spencer all argued that the US should also send Pfizer and Moderna doses to countries like India — even if contractual language says doses manufactured in the US have to be given to Americans. They want the Biden administration to ignore that language, given the scale of humanitarian crisis we’re witnessing.

“Sometimes you don’t ask for permission; you ask for forgiveness,” Prasad said, adding that the optics of Pfizer or Moderna suing the US government over such a move would be so horrible as to be unthinkable. “No one will ever dare question this. I don’t think the companies will fight it in court, and I don’t think anyone will seek retribution after the fact.”

Arguably, the bigger challenge for Biden would be justifying dose donations to the American people. A recent poll found that 48 percent of Americans surveyed believe the government shouldn’t donate vaccines at all. It’s worth noting that more middle-age and older Americans opposed donations, compared to members of Gen Z and millennials. And more Republicans than Democrats believed the US should keep a stockpile instead of donating — even though half the Republicans polled said they’re hesitant to get the shot or don’t plan on getting it.

The emotional logic — and moral limits — of vaccine nationalism

All the experts I talked to said that the US is clearly engaged in “vaccine nationalism,” where every nation just looks out for itself, prioritizing its citizens without regard to what happens to the citizens of other countries, especially lower-income countries that can’t afford to buy doses.

“We are focusing on America First,” Spencer said. When it comes to Covid-19, Biden still hasn’t quite broken with that Trumpian approach.

Of course, Biden was elected to be president of the US, not of the world. It’s his responsibility to take care of US citizens first. And he is doing that. But we’ve now reached a point where the US has secured millions more doses than it needs to vaccinate Americans.

Experts acknowledge that it’s a totally natural impulse for American parents to want to protect their own kids and ease the emotional toll that pandemic restrictions have taken on them. “Some people say, ‘I want my 12-year-old to get back to life.’ And I think, ‘Of course, who wouldn’t! I think that’s right too!’” Prasad said.

But he wants parents to remember that many of the restrictions we put on kids were less about protecting them — they’re at low risk — and more about protecting older adults. With 72 percent of Americans over age 65 now fully vaccinated and case rates falling, he believes we can let kids resume most normal activities, unvaccinated. (Different experts, however, express differing levels of caution about various activities.)

In moral philosophy, there’s a classic dilemma known as the trolley problem: Should I make the active choice to divert a runaway trolley so that it kills one person if, by doing so, I can save five people along a different track from getting killed?

An aerial view of open graves at Vila Formosa Cemetery in Sao Paulo on March 12. Vila Formosa, the biggest graveyard in Latin America, has seen burials rise due to the surge of deaths related to coronavirus.
Alexandre Schneider/Getty Images

Prasad pointed out that in this classic formulation, we’re asked to weigh one life against five lives. Any deaths in the pandemic are tragic, but our current global situation is a trolley problem on a different order of magnitude. In this scenario, on one track are a small number of American kids who might get ill or die if they’re not vaccinated in the next couple of months; on the other are tens of thousands of Indians and Brazilians and others who are at greater risk of severe illness, many of whom will certainly die without the shot.

In the coming months, the US will be looking at vaccinating children ages 2 to 11. Parents have a chance to weigh in on that, and in Prasad’s mind, the question they should ask themselves is this: Are we really willing to sit on millions of doses and prioritize Americans at much lower risk rather than stem the wave of devastation and death we’re seeing in other countries?

“If you’re one of the many people who opposed blind American nationalism and America First policy under Trump, this is the moment to put your words into action,” he said. “Now is your chance to really oppose Trump’s vision of the world. Stick it to what he stood for and what he represents.”

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