Who should we export the vaccine to?

It's time for the U.S. to become the Arsenal of Immunity for the entire globe.

The U.S. vaccination effort is flagging. It looks like we peaked at about 3.4 million doses per day, and are now drifting downward:

Now, this isn’t a good thing; we still need to vaccinate as many as 60 million more people before we reach the level where Israel started to see its cases go into rapid and terminal decline. No one’s really sure of the cause yet; it could be that the Johnson & Johnson pause crimped supply, or increased vaccine hesitancy, or it could be that we’re simply running out of people interested in getting a shot. We should definitely take whatever measures we can to sustain the rate of vaccination, whether that means paying people to get vaxed, setting up mobile vaccination sites, etc.

But the peak in vaccination rates, along with ongoing massive increases in supply, mean that it’s time to start exporting vaccines.

U.S. export controls over vaccines and the materials used to make vaccines have always been controversial. Personally, I thought many of the controls were morally justifiable at first — like it or not, nations have a responsibility to look after their own populations first, and until the day when we have better global governance, we shouldn’t expect that to change. But this always should have been a very temporary measure — something to drop as soon as it was clear that the U.S. was clearly on track to vaccinate enough people to get its epidemic under control. And we’re there now.

We need to start working to vaccinate the rest of the world, and pronto. But the rest of the world is a big place, to put it mildly. So we have to decide how to prioritize transfers of vaccine doses, raw materials, and intellectual property.

Note that a little bit of this is already happening. The U.S. has already released some of its stockpiled AstraZeneca doses to Mexico, Canada, and Japan. But we will need to do much more.

As I see it, there are four basic considerations here: Humanitarianism, geopolitics, money, equity, and U.S. health. We want to help save the most possible people, but we probably also want to conduct positive “vaccine diplomacy” that will burnish our image and our international relationships. We also want to prevent COVID from being reintroduced to the U.S. to whatever degree possible. Exporting preferentially to poor countries with weaker health systems, especially those that can’t make vaccines on their own, probably seems fair to many people. And our companies will want to make a profit to justify the herculean efforts they’ve exerted to make this vaccine.

There’s actually one final consideration here, which is what other countries are able to make on their own. Russia and China are manufacturing their own vaccines, and so don’t need our help (and might not want it, given nationalism). India’s companies are licensed to make the AstraZeneca vaccine and some others, but its factories need raw materials.

One move that would clearly suit all of these goals is to waive intellectual property rights for other countries. Essentially the only reason not to do this is to protect U.S. drug companies’ profits. I’m not one of the people who thinks drug company profits are a bad thing; indeed, I think these companies should be richly rewarded for saving so many lives from a deadly plague, both because they deserve it and because it sets a good precedent. But there’s no reason that profit has to come out of the pockets of poor countries. The U.S. government can and should pay Moderna, Pfizer, and Johnson & Johnson a bunch of money while also issuing a global IP waiver. Some are arguing that this could weaken the U.S. push for global IP protections in future trade negotiations, but this is nonsense; everyone knows COVID is a special case.

But for vaccine doses (some of which have been stockpiled) and for the raw materials used to manufacture vaccines, there’s more of a tradeoff, because these things — unlike ideas — are in limited supply. Given the above considerations, I can see four basic approaches we might take:

Approach 1: Let the market handle it

This is the simplest approach, but it has obvious drawbacks. Basically, it just ignores all of the important considerations except for money. And since we should waive international IP protections anyway, and since materials manufacturers are going to get paid for exports one way or another, money doesn’t seem like a big deal here. The only advantage to simply lifting controls and letting the market handle exports is that it’s simple and quick, where as efforts to direct exports to one country or another might end up slowing down the process.

Approach 2: Export to neighbors first

Since Canada and Mexico share large land borders with the U.S., there is obviously going to be a lot of human movement between these two countries, despite official travel restrictions. Thus, an unvaccinated Canada and Mexico put the U.S. at risk of COVID reintroduction. So from a self-interested standpoint, it makes sense to prioritize these neighbors when exporting doses and materials.

Approach 3: Vaccinate countries with bad outbreaks first

This is obviously the humanitarian choice. And though I’m not an epidemiologist, it seems like trying to squash large outbreaks might also help stop variants from mutating and escaping our immunity. One downside of this policy is timing; by the time we get significant numbers of doses and materials to places like India and Brazil that are having big outbreaks right now, they might have already mostly gotten those outbreaks under control. And if we don’t know where the next big COVID explosion is going to be, trying to chase the virus around with vaccine exports might be a losing battle.

Approach 4: Vaccinate allies and potential allies first

Some people worry that China and Russia are “beating the U.S. at vaccine diplomacy”. The obvious antidote to that would be to allocate vaccines strategically, to countries that we really want to think well of us. That could mean allies like Japan, or it could mean key potential allies that we’re courting, like India and Vietnam. The potential downside is that if we make it explicit that we’re doing this, it could provoke resentment and a backlash among countries who don’t get prioritized.

So these are the four basic approaches. They don’t conflict; in fact, the best strategy is probably to prioritize countries that fit several of these criteria at once. Given that, I can immediately think of a sort of “short list” for vaccine export priority:

Tier 1: India, Mexico

India is obviously the worst-hit country here, with COVID exploding at an absolutely astounding rate:

At this rate, millions of Indians may die. India has the capacity to manufacture vaccines but needs specialized components, and has been begging the U.S. to lift its export controls on these materials. India is also an incredibly key U.S. ally, and on top of that it’s a low-income country that needs our help. So we should immediately lift all export controls to India, and sell them U.S.-made or stockpiled doses at discounted prices as well.

Mexico is not having a large outbreak right now, but has not done a great job of getting vaccines to the mass of its people so far. That puts the U.S. in the danger from reintroduction of the virus, so it’s in our interest to get Mexico vaxed as soon as possible. In addition, it might go a slight way toward repairing some of the goodwill that was lost during the Trump years. So we should be selling large numbers of doses to Mexico at discount prices very soon.

Tier 2: Canada, Japan

Canada had the foresight to order a lot of vaccine doses in advance, but logistical difficulties delayed their arrival. Now they’re finally getting the doses and administering them quite rapidly, and their latest explosive outbreak of infection seems to have peaked. Still, our failure to sell Canada doses early on probably damaged our relations with them a little, and it would be a nice gesture to sell them stuff now. Besides that, it might slightly accelerate their vaccination effort, which would in turn make the U.S. a little bit safer.

Japan has been very slow with vaccination (a topic for a whole other post). It’s an important ally and trading partner and could use our help. Canada and Japan are wealthy countries, so they can pay full price, but they need us to let them buy.

Tier 3: Everyone else

A large variety of other countries need our vaccines and materials for various reasons — African countries because they’re generally low-income, Europe because they didn’t order enough doses up front, Turkey because they’re our ally and they’ve been having a large outbreak, etc. etc. We should eventually export vaccines to everyone in the world, becoming the “arsenal of immunity” the way we were the “arsenal of democracy” in World War 2. Our unique success in vaccine development and mass production — notably beating out our main rival, China — puts us in a position to reclaim at least part of the mantle of global technological and industrial leadership that we’ve been losing in recent years.

The ability to execute a swift pivot from inward-focused vaccine rollout to “vaccinator of the globe” will be an important test of the Biden administration — both its commitment to humanitarianism and global leadership, and its ability to execute policy shifts quickly and effectively.