Majority of Global COVID-19 Vaccines Given In Just 4 Countries : Consider This from NPR More than half of worldwide vaccine doses have been administered in just four countries — India, China, the U.K. and the U.S. That kind of inequity will "extend the pandemic, globally," says Tom Bollyky, director of the Global Health program at the Council on Foreign Relations.

NPR's Tamara Keith reports on the growing pressure for the Biden administration to step up its vaccine diplomacy.

NPR's Lauren Frayer tours the largest vaccine factory in the world's top vaccine producing-country, India — a country poised for an even bigger role in global vaccine distribution. You can see photos and more from her report on the Serum Institute of India here.

Additional reporting in this episode from NPR's Jason Beaubien.

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4 Countries Dominate Doses As Pressure Grows For Global Vaccine Solutions

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4 Countries Dominate Doses As Pressure Grows For Global Vaccine Solutions

4 Countries Dominate Doses As Pressure Grows For Global Vaccine Solutions

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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In the U.S., 1 in 3 adults has now had a COVID-19 vaccine.


PRESIDENT JOE BIDEN: No other country has come close - 100 million shots in less than 60 days. And now we're...

CORNISH: On Monday, President Biden announced plans to send that number even higher - expanding the federal vaccine rollout to more pharmacies and setting up new mass vaccine sites. The goal, by April 19, is for 90% of Americans to have a vaccine site within 5 miles of where they live.


BIDEN: You know, we will administer more shots in March than any country on Earth.

CORNISH: And that's good news for people in the U.S., but it also underscores the global disparity in who's getting vaccinated and who isn't. More than half of all vaccine doses administered have gone to people in just four countries - China, India, the U.K. and the United States.

TOM BOLLYKY: And what that means is that it extends the pandemic globally.

CORNISH: Tom Bollyky is director of the global health program at the Council on Foreign Relations.

BOLLYKY: So even if we manage to vaccinate our own population in the U.S., if the pandemic is still raging abroad, it leaves us at a risk.

CORNISH: Some countries still have no vaccine at all; others barely enough for 2% or 3% of their population. Tom Bollyky says there are two ways to fix this - countries with resources to spare can give cash, or they can give doses.

BOLLYKY: Right now what we've seen is wealthy democracies are donating cash, while autocracies - nations like China and Russia - are donating doses. And where Russian and Chinese vaccines are going today, their influence may follow, and that puts U.S. interests at risk, too.

CORNISH: CONSIDER THIS - the U.S. vaccination program continues to pick up speed at home. Now there's growing pressure for more vaccine diplomacy abroad and the global race against time and variants.


CORNISH: From NPR, I'm Audie Cornish. It's Monday, March 29.


CORNISH: It's CONSIDER THIS FROM NPR. This isn't as simple as big, rich countries hoarding vaccines. After all, countries from Japan to Australia, South Africa and the Philippines - they all have less than 1% of their populations vaccinated. It's not like those countries can't afford it.


BRUCE AYLWARD: Right now this is not a financial issue. Right now this is a problem of access to the product itself.

CORNISH: Bruce Aylward with the WHO says early in the pandemic, some countries, including the U.S., snatched up contracts with as many vaccine manufacturers as they could. Essentially, they were spreading bets across the roulette table to make sure that they got access to winning vaccines. And countries that didn't do that are now left with very few options.


AYLWARD: The control of the supply is held by a limited number of countries that have procured most of the doses and the early access to those doses.


CORNISH: That's why the U.S. now has 30 million doses of a vaccine it can't yet use, a vaccine produced by AstraZeneca which hasn't been authorized for use here.


JEN PSAKI: I can confirm that we have 7 million releasable doses available of AstraZeneca.

CORNISH: This month, White House press secretary Jen Psaki said the U.S. will loan some of its AstraZeneca supply to Mexico and Canada, where the vaccine is authorized.


PSAKI: We are assessing how we can loan doses. It's not - it's - we are - that is our aim. It's not fully finalized yet, but that is our aim.

CORNISH: And all this has left the Biden administration walking a tightrope. The White House will be judged domestically on its ability to administer a successful vaccination program. But the president also campaigned on a promise to reassert American leadership on the world stage and has said repeatedly that a global pandemic needs global remedies. NPR White House correspondent Tamara Keith has this look at the Biden administration's approach to vaccine diplomacy.


TAMARA KEITH: Early on, the Biden administration said it would contribute $4 billion to COVAX, the global effort to vaccinate people in poor countries. But when it comes to vaccine doses themselves, the White House has had an "America First" approach. Here was President Biden earlier this month.


BIDEN: We're going to start off making sure Americans are taken care of first, but we're then going to try to help the rest of the world. Thank you.

KEITH: When the White House announced plans to loan millions of doses of the AstraZeneca vaccine to Canada and Mexico, COVID response coordinator Jeff Zients was careful to emphasize...


JEFF ZIENTS: No American will be without a vaccine because of this action.

KEITH: The fact that the AstraZeneca vaccine isn't yet authorized for use in the U.S. but is in Canada and Mexico smoothed over any potential domestic political backlash. And even as Biden said Americans need to come first, he has begun arguing the U.S. has an interest in vaccines getting to its neighbors and the rest of the world.


BIDEN: This is not something that can be stopped by a fence, no matter how high you build a fence or a wall. So we're not going to be ultimately safe until the world is safe.

KEITH: Before getting further into global vaccine sharing, press secretary Jen Psaki says the administration is focused on figuring out which vaccines work best against virus variants and which ones work best on children. But Carolyn Reynolds, co-founder of the Pandemic Action Network, says the U.S. has contracts for hundreds of millions more doses than it will need to vaccinate all Americans, and time is of the essence because virus variants could undermine the vaccines.

CAROLYN REYNOLDS: The faster that they are allowed to evolve, the longer it's going to take us to get out of this crisis. So it is in our national interest to be able to get the vaccine out there more widely around the world as soon as possible.

KEITH: Reynolds says the U.S. needs to do more than contribute money to the global effort. She says the best way to help is to contribute doses to COVAX rather than do a bunch of bilateral deals like the ones with Mexico and Canada.

REYNOLDS: We're not going to end this pandemic solving it country by country, region by region. It's really got to be a global response.

KEITH: There's an active debate about the best way for the U.S. to show global leadership on vaccines. Russia and China have made a show of distributing their vaccines to countries in need, in part to exert global influence. Amanda Glassman at the Center for Global Development thinks some bilateral vaccine deals would be good for the U.S. She recently spoke to a colleague in Senegal whose mother got a Chinese vaccine.

AMANDA GLASSMAN: Now, it's not a competition, but I would love to see our country, the United States, be in that same place and having those same kinds of conversations and being the source of something so important that someone can say their grandmother was vaccinated yesterday. That matters to people.

KEITH: U.S. vaccine sharing likely will include a mix of bilateral agreements and contributions to COVAX. Global health advocates just want the U.S. to hurry up and announce its plans.


CORNISH: That was NPR's Tamara Keith.

We mentioned the four countries where more than half of all vaccine doses have been given - the U.S., the U.K., China and India. India is in a unique position. It's also the world's leading producer of vaccines. The Indian government has been able to donate and sell some doses to other countries, something it says it will continue to do. But at the same time, this past week, the government announced a temporary pause on vaccine exports so that India can focus on domestic immunization. NPR's Lauren Frayer actually visited the factory where many of those vaccines are made.


LAUREN FRAYER: The Serum Institute of India was already the world's biggest vaccine manufacturer, even before this pandemic. The company says two-thirds of all children in the world get its vaccines. And most of them are made here, at a sprawling factory complex in western India. Inside...


FRAYER: These are conveyor belts with all these tiny, little vials just whizzing past.

UNIDENTIFIED PERSON #1: Going to our automatic visual inspection.

FRAYER: Automatic visual inspection.


FRAYER: So a machine is inspecting these.


FRAYER: It's a high-tech operation. They specialize in generic versions at low profit margins and export to 170 different countries. Last spring, a tiny package arrived here by courier from Oxford University in England.

UMESH SHALIGRAM: Yeah, yeah - not in bottle. It is a very small vial.

FRAYER: Chief scientist Umesh Shaligram describes what was inside - components of a viral vector vaccine against the coronavirus. Serum scrambled to start mass producing them immediately in huge floor-to-ceiling stainless steel vats of...

PEDDI REDDY: Human embryonic kidney cells.

FRAYER: Human embryonic kidney cells.

REDDY: Kidney cell line, yeah.

FRAYER: Scientist Peddi Reddy recalls how he was developing other vaccines in these vats when his supervisor told him to quickly convert everything over to the coronavirus vaccine while under lockdown as the pandemic exploded.

REDDY: It was difficult, and we had to follow very strict rules of isolation.

FRAYER: Did you work overtime?

REDDY: Yes, definitely.

FRAYER: And this was before clinical trials showed that the Oxford-AstraZeneca vaccine would work. It was a gamble with so much at stake, he says.

REDDY: Everybody's waiting for it. The whole mankind is waiting for it. The whole world is waiting for it.

FRAYER: And so this winter, when trials finally proved this vaccine did indeed work...

REDDY: We celebrated internally - not, like, party or something, but we had that moment of joy.

FRAYER: You didn't open a Champagne inside of this laboratory?

REDDY: No, no (laughter).


REDDY: No, no (laughter).

FRAYER: Serum hopes to soon be churning out a hundred million doses per month of this one vaccine, on top of all the other vaccines they're still producing here.


UNIDENTIFIED PERSON #2: This is a cold storage area. The capacity of cold room is 70 million doses.

FRAYER: So what we're looking at right here is enough to vaccinate whole countries.

UNIDENTIFIED PERSON #2: It's an ongoing process.

FRAYER: Out of cold storage, along these conveyor belts and out to 68 countries so far, racing against Russia and China in what some are calling vaccine diplomacy. India's huge capacity has attracted interest from the so-called Quad - the U.S., Japan, Australia and India. They announced financing to help another Indian producer make a billion more doses of another COVID vaccine. But while Indian manufacturers are partnering with global pharmaceutical companies, the Indian government is challenging them. At the World Trade Organization...

RACHEL THRASHER: There is an agreement that binds all WTO members to certain levels of protection for intellectual property - 20-year patents.

FRAYER: Rachel Thrasher is a legal scholar at the Global Development Policy Center in Boston. She explains how India and South Africa are asking the WTO to suspend those patents for COVID vaccines so that companies like Serum can crank out generic versions quickly and cheaply.

THRASHER: In certain countries, the majority of the population won't be vaccinated for something like five years. That gives those viruses a long time to mutate. So the argument they're making is not, hey, look out for us, but more this is in the interests of all of us.

FRAYER: Serum's executive director Jadhav says he supports that effort at the WTO.

SURESH JADHAV: What we require is a vaccine today, not tomorrow. You want to stop the disease and stop its spread, and that can happen only if there is no restriction on using the technologies.

FRAYER: Many global health experts agree. The pope has said he does, too. But some companies, including AstraZeneca, have pledged to sell their vaccines at cost, without profit. And suspending their patents, they say, is not the answer. It would kill innovation and would not speed up distribution. Bottlenecks have more to do with supply chains than access to the vaccine technology itself.

DANIEL HEMEL: I think both sides of this debate are overemphasizing the role of patents.

FRAYER: Daniel Hemel is a law professor at the University of Chicago. He says the Serum Institute's success shows a middle path. It got a license from AstraZeneca. It's been able to mass produce vaccines within the current regulatory environment.

HEMEL: It shows the potential of licensing arrangements. Without canceling patents, Serum Institute is able to gain rights to make vaccines on a large scale. That's a good thing.


FRAYER: Back at Serum's factory, as vials of coronavirus vaccines whiz off conveyor belts inside, chief scientist Umesh Shaligram points to construction underway outside on a new pandemic preparedness facility.

SHALIGRAM: Another year or two, when you come, you'll see that facility, actually.

FRAYER: The idea is to have extra machines, extra labs, all on hand to make billions of doses of vaccine against whatever virus hits next.


CORNISH: NPR's Lauren Frayer.



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