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A Case For 'Vaccine Diplomacy' Amid Impending U.S. Vaccine Surplus

MICHEL MARTIN, HOST:

If you are still waiting to get your COVID-19 vaccine, this might be hard to believe, but wait for it. The United States is fast approaching a COVID vaccine surplus. That's right. Sometime in the next weeks or months, experts predict there will be more vaccine doses available than Americans wanting shots. And in any case, the federal government has ordered enough doses to vaccinate every single adult and child and still have millions of shots left over.

So we want to begin today by asking what should be done about this looming vaccine surplus in the United States. Here to help us answer that question is Dr. Krishna Udayakumar. He is the founding director of the Duke Global Health Innovation Center and has been tracking vaccine purchases across the world. Welcome, Dr. Udayakumar. Thanks for joining us.

KRISHNA UDAYAKUMAR: Thank you. Good to be with you.

MARTIN: So before we get into the national vaccine surplus, I wanted to ask about the surpluses we're already seeing in states like Mississippi, where thousands of vaccine spots remain unclaimed. What's going on there? I mean, why is it that some states have more vaccines available than people lining up to take them?

UDAYAKUMAR: Yeah. If we just start by looking at the data, right now in the U.S., we've distributed almost 240 million doses of vaccine, and about 184 million of those doses have been administered - so about 77%. So through all of the different parts of our system, we've got about 50 million or more doses that have been distributed but not gotten into arms yet. And the rate at which each state is getting those doses administered ranges widely. As you noted, in places like Mississippi, Alabama, Wyoming, the rates are as low as 63 to 65%. And on the other end, you've got New Hampshire and Wisconsin that are up at 89 to 90% of their doses already administered.

MARTIN: Is there something that should be done - I'm sort of putting air quotes around that - about this state-by-state surplus? Because we're - you know, on the one hand, you're saying it's vaccine hesitancy in some places. And in other places, you know, we're hearing about people who really want the shots but have difficulty accessing them. So should anything happen at this point to redistribute supply in this country or not?

UDAYAKUMAR: Yes. I do think we need to start thinking about where the most urgent needs are as one of the variables that help to make decisions around distribution.

MARTIN: So based on the information that you've been tracking, when might we expect to see a vaccine surplus in the United States overall, and by how much?

UDAYAKUMAR: If you look at just the vaccine doses that have already been purchased by the U.S. government, going into the summer, we're going to have an enormous glut of vaccines, frankly. What we have seen is a total doses of 920 million that can be available by the end of July.

MARTIN: So if my math is correct, that's almost like you could vaccinate the entire U.S. population twice.

UDAYAKUMAR: We're getting close to that. You're right.

MARTIN: So why exactly has the administration ordered way more vaccines than the country needs? As we said, it's not a - that's not just a few extra doses. That's enough to vaccinate millions more people than the entire U.S. population.

UDAYAKUMAR: There are prudent reasons to over-purchase at this point in time. One, when many of the purchase orders were written, we didn't really have a predictable sense of which vaccines were going to be available when. So part of this was hedging bets by purchasing lots of different types of vaccines. And we have started to see that already pay dividends, where we've seen some vaccines either have bumps in the road with manufacturing or similar issues.

The forward-looking issues we really need to be attuned to, one, are the implications of variants, that certain vaccines may be more or less susceptible to certain variants, especially new variants that might still be emerging. So we do need to make sure that we have some ability to vaccinate again, and that might require new types of vaccines to be available.

The other one is we don't really fully understand the duration of immunity. So if we need to vaccinate nine to 12 months after the first dose, then going into this fall, into the winter, we may actually have to start thinking about a whole - another round of vaccinations. So there are scenarios in which we would need to vaccinate more than once for adults and some kids.

MARTIN: So I can imagine that there is pressure within the administration to hold onto those doses. But you're also starting to see complaints from around the world that less-resourced parts of the world don't have access to these vaccines in any meaningful way at all because the developed countries have soaked up all the supply. So what are the conversations that the administration is having about this? And, frankly, what do you think the administration should do?

UDAYAKUMAR: Yeah, we are in still a dire situation globally. Just four regions - the U.S., China, India and Europe - account for 70% of all vaccinated people in the world. And what's really struggling is COVAX, which is this global multilateral platform that was set up to try to get global equity. And it has been able to send 38 million doses of vaccine out to 104 of the poorest countries in the world, but that's less than 5% of all the vaccines that have been distributed so far. And our position has been that the U.S. has an enormous opportunity for global leadership by acting in an urgent way as the situation evolves really in the wrong direction in most parts of the world right now.

MARTIN: So what would be your argument for why the U.S. should take a step like that and share these excess doses, or at least what seem now to be surplus doses, with the rest of the world?

UDAYAKUMAR: However we may see the role of the U.S. in the world ideologically, there's really strong alignment to what the right thing to do is in this situation. If you look at the health implications, then the longer that this virus rages in other parts of the world, the more risk there is of new variants developing and risk to the health of Americans even if we're vaccinated with the current generation of vaccines.

And even if you want to take a self-interested economic perspective, our own recovery economically and growth in the intermediate to long term will be much higher and more robust if we're able to get through this pandemic globally. Who are we going to sell goods and services to? Where are the markets? Where are the growth regions of the world going to be if everybody else is still dealing with a pandemic? So isolation really has no role to play in the U.S. position no matter what ideological perspective you might bring to the conversation.

MARTIN: That was Dr. Krishna Udayakumar, the founding director of the Duke Global Health Innovation Center. Dr. Udayakumar, thanks so much for joining us.

UDAYAKUMAR: Thank you. Transcript provided by NPR, Copyright NPR.

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