September 30, 2021
Dear Speaker Pelosi, Senator Schumer, Senator Murray, Representative McCarthy, Senator McConnell and Senator Burr,
The recently completed Global COVID-19 Summit must mark the beginning of a new era of U.S. leadership on COVID-19. Such leadership, accompanied by far more ambitious action, is critical to meet the agreed global targets, including on vaccinating the world, which is our pathway out of this pandemic. For the vast inequities in vaccination, the urgency of vaccinating the world, and the devastation the pandemic is causing, and could yet cause, demand even more ambitious targets and, above all, action – from the world, and from the United States.
Even as the United States takes forceful action to get every eligible American vaccinated, most of the world’s poorer and vulnerable populations still cannot access the vaccine. Over 30 times more doses have been administered per person in high- income countries than in low-income ones. Far more action will be needed to truly make the United States the “world’s arsenal of vaccines” that the President has promised than the two forthcoming donations of 500 million doses each of the Pfizer vaccine.
Moreover, even as global vaccine supply ramps up, there will not be enough doses of strict regulatory agency-approved vaccines until mid-2022. Yet each day’s delay brings more deaths – and the risk of dangerous new variants that, like the Delta variant, could bring our own country new traumas, and even render current vaccines ineffective. And it takes time to get doses, once produced, into people’s arms. For the American people, and for the world’s billions of people who cannot access the vaccine yet, we will need to achieve – and surpass – the 70% global vaccination target agreed at the Global COVID-19 Summit. We should lead a global effort to vaccinate at least 80% of the world’s population, in all income groups, as soon as technically feasible, with the aim of mid-2022, and not later than next September.
This will require urgently expanding COVID-19 production capacity, within the United States and globally through funding and technology transfer, which should enable large numbers of new doses to become available beginning in approximately 6 months. This should include a capacity to produce at least 8 billion mRNA doses per year, and should also include large-scale increases in production capacity for other safe and highly effective vaccines, particularly those that can be rapidly scaled up. Critically, increasing COVID-19 production capacity would protect against the genuine possibility of SARS-CoV-2 variants evolving against which current vaccines provide little protection, thus requiring vaccines to be modified and as quickly as possible and vaccinating and re-vaccinating the world – equitably.
Yet six months for ramped up production is too long to wait. Until supply is ramped up, donations are the key to accelerating global vaccination. The United States will have hundreds of millions of excess doses by the end of 2021. As soon as they become available, we should donate all to COVAX, other mechanisms for low- and middle-income countries, and low- and middle-income countries being hard-hit by COVID-19 but without enough vaccine, whether in Latin America, Africa, or Asia. Similarly, if the United States is ahead of such countries or any other lower-income countries, COVAX, or the African Union in any vaccine manufacturer supplier line, we should let those countries and entities go first. And the United States should provide COVAX all needed funding.
An adequate supply is not enough. The infrastructure to ensure that vaccine doses delivered become vaccine doses administered remains deeply inadequate, from having sufficient numbers of trained vaccinators, cold storage and supply chains, and data systems to extensive education to reduce vaccine hesitancy, a largely social media misinformation-driven phenomenon that is global. The United States should provide the funding that this requires, working with international partners and ensuring that between U.S. and partner resources, the needed funds are provided within two months.
Finally, despite critical vaccine donations, dropping opposition to an intellectual property rights WTO waiver, and renewed global leadership, the administration’s global vaccination plan remains unclear. Congress needs to exercise its oversight responsibility to understand the delays and, most importantly take, and ensure that the administration takes, the necessary, immediate steps to increase global vaccination, which should include the elements contained in this letter.
Specifically, we call upon Congress to:
- Incorporate into the forthcoming continuing resolution or soonest available legislative vehicle, including an emergency supplemental if required, the $34 billion included in the Nullifying Opportunities for Variants to Infect and Decimate (NOVID) Act for increased U.S. vaccine production, robust support for technology transfer and any related support needed to increase production globally, in all regions, and sufficient funding for end-to-end vaccine delivery and administration of vaccines in lower- and lower-middle-income countries. Training to support technology transfer should include but go beyond training at U.S.-based facilities and the WHO-supported technology transfer hub in South Africa. The appropriations level may be reduced if the Biden administration demonstrates that it has unspent funds from the American Rescue Plan that it will use for these purposes.
- Retain, but augment with the additional billions of dollars needed, the $2 billion line item in the current Build Back Better package to support expanded global and domestic vaccine production (Sec. 31025, paragraph (b)(2)). The current level funding could produce one billion doses of the Pfizer-BioNTech vaccine or 500 million doses of the NIH-Moderna vaccine in 12 months.
- Use all tools available to Congress to ensure that the United States promptly donates the hundreds of million surplus vaccine doses that we will have available by the end of 2021, in addition to current donations and pledges, and use any needed legal tools or funding to accelerate delivery of the already pledged Pfizer doses. These tools may include, among others, the continuing resolution and hearings to exercise Congress’s oversight responsibility.
- Through hearings and other oversight tools available to Congress, hold the Biden administration responsible for producing a public plan, within two weeks, that should be consistent with a target of global vaccination with 80% population coverage by mid-2022, and not later than next September. The plan should include the elements contained in this letter, namely:
- 1) increased U.S. production capacity and technology transfer sufficient to meet that target, including production of at least 8 billion mRNA COVID-19 doses annually, as well as significant capacity increases of other safe and highly effective vaccines, particularly those that can be rapidly scaled up;
- 2) sufficient funding and support to lower- and lower-middle-income countries to enable end-to-end vaccine delivery and administration, including communication strategies;
- 3) providing additional funding to COVAX as needed;
- 4) allowing COVAX, the African Union, and individual lower-income countries, or other middle-income countries being hit hard by COVID-19 and unable to access enough vaccine, to receive additional doses before the United States if they are ahead of us in the manufacturers’ queue;
- 5) donating excess U.S. vaccine doses, where most urgently needed, and;
- 6) working with COVAX, WHO, and other partners, lead a global effort to provide all necessary funding and take all necessary steps to enable global vaccination as quickly as technically feasible, and in line with an 80% global vaccination target. This should include developing a global strategy to ensure that as supply comes on line, doses go to where they are most urgently needed and are distributed equitably, and that all countries have the necessary support for vaccine end-to-end delivery and administration.
- Call Moderna top executives to Congress for oversight hearings regarding their refusal thus far to license their mRNA vaccination technology to enable manufacturers in low- and middle-income countries to produce their vaccine.
It is too late to undo the immense cost of the inequitable distribution and production of COVID-19 vaccines of the pandemic thus far. But it is beholden of the United States, with its unmatched financial and scientific capacities, and history of global health leadership, to prevent further avoidable death and disease from COVID-19 – including in the United States.
Tom Frieden, MD, MPH, President and Chief Executive Officer, Resolve to Save Lives
Michelle A. Williams, SM, ScD, Dean of the Faculty, Harvard T.H. Chan School of Public Health
Sten H. Vermund, MD, PhD, Professor and Dean, Yale School of Public Health; Professor of Pediatrics, Yale School of Medicine
Linda P. Fried, MD, MPH, Dean, Columbia University Mailman School of Public Health
Jim Curran, MD, MPH, Professor and Dean, Rollins School of Public Health, Emory University
Victor J. Dzau, MD, President, National Academy of Medicine
Georges C. Benjamin, MD, Executive Director, American Public Health Association
Wafaa El-Sadr, MD, MPH, MPA, Director, ICAP at Columbia University; Director, Columbia World Projects; University Professor of Epidemiology and Medicine, Mathilde Krim-amfAR Chair of Global Health, Columbia University
Anne-Marie Slaughter, M.Phil, D.Phil, JD, Director of Policy Planning, U.S. Department of State (2009-2011)
Lawrence O. Gostin, JD, Founding O’Neill Chair in Global Health Law, Faculty Director of the O’Neill Institute for National and Global Health Law, University Professor, Georgetown University Law Center; Director, World Health Organization Collaborating Center on National and Global Health Law
Michele Barry, MD, FACP, FASTMH, Drs. Ben and A. Jess Shenson Professor of Medicine and Tropical Diseases, Director of the Center for Innovation in Global Health, Senior Associate Dean for Global Health, Stanford University; Founder, WomenLift Health
Keith Martin MD, PC, Executive Director, Consortium of Universities for Global Health
Eric Goosby, MD, Professor, School of Medicine, University of San Francisco; Faculty Director, UC Berkeley-UC San Francisco Center for Global Health Delivery, Diplomacy and Economics, Former United States Global AIDS Coordinator
Jeffrey Koplan, MD, MPH, Professor of Medicine and Global Health, Emory University
Robert S. Lawrence, MD, MACP, Professor, Johns Hopkins Bloomberg School of Public Health; Founding Director, Johns Hopkins Center for a Sustainable Future
Eric A. Friedman, JD, Global Health Justice Scholar, O’Neill Institute for National and Global Health Law, Georgetown University Law Center
Gregg Gonsalves, PhD, Professor, Yale School of Public Health; Adjunct Professor of Law, Yale Law School; Co-Director, Global Health Justice Partnership; Co-Director, Collaboration for Research Integrity and Transparency
Amy Kapczynski, JD, Professor of Law, Yale Law School; Co-Director, Global Health Justice Partnership; Co-Director, Collaboration for Research Integrity and Transparency; Co-Director, Law and Political Economy Project; Co-Founder, Law and Political Economy Blog
Arachu Castro, PhD, MPH, Samuel Z. Stone Chair of Public Health in Latin America, Director, Collaborative Group for Health Equity in Latin America, Tulane University School of Public Health and Tropical Medicine
Sheila Davis, DNP, CEO, Partners In Health
Saad Omer, MBBS, PhD, Director, Yale Institute for Global Health
Alison C. Roxby, MD, MSc, Associate Professor, University of Washington
James Krellenstein, Co-Founder & Managing Director, Strategy & Policy, PrEP4All
Christian Urrutia, Co-Founder & Managing Director, Development & Operations, PrEP4All
Amir Mohareb, MD, Infectious Diseases Physician, Mass General Hospital / Harvard Medical School
Veronika Wirtz, MsC, PhD, Professor, Boston University School of Public Health
Steven Shea, MD, MS, Professor, Columbia University Mailman School of Public Health
Adrienne Shapiro, MD, PhD, University of Washington, Departments of Global Health and Medicine, Division of Infectious Diseases
Penny K. Kessler, MPH, COVID Coordinator/Contact Tracer, St Clair County Health Department
Joseph Osmundson, PhD, Clinical Assistant Professor, NYU
Primah Kwagala, Director, Women’s Probono Initiative
Nagesh Borse, PhD, MS, MA, Director, Global Health Knowledge Exchange.
Brook K. Baker, JD, Senior Policy Analyst, Health Global Access Project
Marilyn Parsons, PhD, Professor Emerita, University of Washington
Kenneth H. Mayer, MD, FACP, FIDSA, Fenway Health
Ingrid V. Bassett, MD, MPH, Associate Professor of Medicine; Massachusetts General Hospital
Serena Koenig, MD, MPH, Associate Professor, Brigham and Women’s Hospital/Harvard Medical School
Risa Hoffman, MD, MPH, Associate Professor UCLA Dept of Medicine
Shahin Lockman, Associate Professor, Harvard Medical School
Kathleen Powis, MD, Massachusetts General Hospital
Scott Dryden-Peterson, MD, MSc, Assistant Professor, Harvard Medical School
David Barr, The Fremont Center
Andrew Goldstein, MD, MPH, Moderator, Progressive Doctors
Udom Likhitwonnawut, Thailand National CAB
Erick Okioma, COP, Nelson Mandela TB HIV Community Information and Resource Center CBO
Ingrid Katz, MD, MHS, Associate Faculty Director, Harvard Global Health Institute
Sara Schwanke Khilji, MD, MPH, Associate Professor, Oregon Health & Science University
Roger Shapiro, Associate Professor, Harvard TH Chan School of Public Health
Jennifer Jao, MD, MPH, Northwestern University Feinberg School of Medicine
Lisa Bebell, MD, Assistant Professor, Harvard Medical School
Amanda Lugg, Interim Co-Executive Director, African Services Committee
Catherine Hankins, MD, PhD, FRCPC, CM, Canada’s COVID-19 Immunity Task Force
Zoltán Kis, PhD, Lecturer at the Department of Chemical and Biological Engineering, The University of Sheffield
Lisa Rosenbaum, MBA, Data Scientist, Ford Motor Company
Gregory Whitman, MBBS, LLM, MPH, CEO, Blended Value Health
Nader Hijazi, MD
Suhaib Siddiqi, Ph.D., Principal, Consultant
Mitchell Warren, Executive Director, AVAC
Alexander Lankowski, MD, Infectious Diseases Physician, Fred Hutchinson Cancer Research Center / University of Washington
Carl Sciortino, MPA, Executive Vice President of External Relations, Fenway Health
Ulysses W. Burley III, MD, MPH, Founder, UBtheCURE LLC
Peter Maybarduk, Access to Medicines Director, Public Citizen
Partners In Health
Resolve to Save Lives
Blended Health Value
Women’s Probono Initiative
Thailand National CAB
Nelson Mandela TB HIV Community Information and Resource Center
African Friends Service Committee
Sen. Robert Menendez
Sen. James Risch
Sen. Chris Van Hollen
Sen. Mike Rounds
Rep. Gregory Meeks
Rep. Michael McCaul
Rep. Karen Bass
Rep. Christopher Smith
Sen. Patrick Leahy
Sen. Richard Shelby
Sen. Christopher Coons
Sen. Lindsey Graham
Rep. Rosa DeLauro
Rep. Kay Granger
Rep. Barbara Lee
Rep. Hal Rogers
Rep. Raja Krishnamoorthi
Sen. Jeff Merkley
Sen. Elizabeth Warren
Sen. Edward J. Markey
Rep. Pramila Jayapal
Rep. Tom Malinowski