When the Biden administration announced its decision to donate 500 million COVID-19 vaccine doses to 100 countries over the next two years, it demonstrated its commitment to returning the U.S. to a position of credibility and leadership in global health. This move, along with Vice President Harris’s recent trip to Mexico and Guatemala in the name of “vaccine diplomacy,” reflects a strong shift in the nation’s moral posture away from a simplistic and reckless nationalism and toward greater global health solidarity.
Instead of organizing health policy around the idea that countries should be self-sufficient, we’re witnessing a resurgence of a recognition that people are interdependent and, moreover, linked by a shared vulnerability to illness and frailty. And what’s more, we cannot survive, much less flourish, without collective action.
Even if this donation was also motivated by prudence and a pressing concern to protect public health, that requires recognizing the interdependence of the health of populations around the world. Either way, resisting a narrow nationalism is the right move for the U.S. and the world to fully recover from the pandemic.
But this is not enough. While some might call distributing doses to lower income countries a matter of justice, the U.S. must resist a narrative of good will or charity and commit to a meaningful shift in our advancement of global health equity. That requires thinking well beyond the current pandemic.
The current distribution of health resources around the world is woefully inadequate. In rich countries, average health spending is $2,937 per capita, while many poor countries cannot afford more than $41 per capita as of 2017. Moreover, research and development dollars do not align with global need. Most of the funding goes towards chronic diseases of rich patients because pharmaceutical companies find these to be the most lucrative investments. So people like us can choose from a great number of allergy medicines that we’ll continue to pay for every year.
At the same time, there are few medicines for many of the world’s worst killers — including many diseases that pose serious pandemic threats, from SARS to antibiotic resistant strains of tuberculosis. It was only when Ebola – which kills half of the people it infects (unlike COVID-19, which kills closer to 1 percent) – started to reach rich countries that any medicines were developed.
Biden has a unique opportunity to change the game by supporting a global pandemic preparation and response treaty at the World Health Assembly this November. A treaty should include two things: First, we should put in place basic health systems for everyone – ensuring that we can vaccinate people against a host of preventable diseases well beyond COVID-19 – that will let us respond quickly in pandemic times.
This includes investing in global manufacturing, transportation and distribution capacity. It is a great thing, for instance, that the international community is investing in vaccine manufacturing capacity in Africa. But we also need to put cold chains and other basic infrastructure in place.
Second, Biden should rethink incentives for pharmaceutical research and development investing in a global fund that will reward companies for new innovations based on their global health impacts. Tying these rewards to requirements for these companies to put resulting products in the public domain would delink profits from sales volumes and allow for generic competition on prices so people in poor countries can access essential medicines for a host of deadly global diseases.
Moreover, this requirement is justified given increasingly large public investments in new drug development. We should not transfer this wealth to the private sector unconditionally at the expense of public and global health.
It is imperative that global solidarity continues to guide Biden’s efforts to respond to global public health crises. But even for those who are more narrowly self-interested, investing now in basic health systems and providing new incentives for pharmaceutical research and development is a wise move.
The Biden administration should act now by leading the effort to create a treaty for better pandemic preparation and response this fall. Doing so will not only show the world our country’s commitment to global solidarity but also help save millions of lives before the next pandemic starts.
Lisa Eckenwiler, Ph.D., is professor of philosophy at George Mason University, vice president of the International Association of Bioethics and a member of the Independent Resource Group for Global Health Justice. Nicole Hassoun is a visiting scholar at the Mario Einaudi Center for International Studies at Cornell University, professor at Binghamton University and author of “Global Health Impact: Extending Access to Essential Medicines.”