September 30, 2021
Dear President Biden,
We commend you for having initiated the Global COVID-19 Summit and for catalyzing global COVID-19 targets, and for your recent additional Pfizer vaccine donations. At the Summit, you urged the world to “go big,” as that is what the world needs from the United States, and from you. We hope that this Summit marks the beginning of a new era of U.S., and your own, leadership on COVID-19 globally. Such leadership, accompanied by far more ambitious action, is critical to meet – and as we believe is necessary, exceed – those targets, including on vaccinating the world, 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 unprecedented action – from the world, and from the United States.
Even as you have taken 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 you have 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 every 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 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 as quickly as possible and vaccinating and re-vaccinating the world – equitably.
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 lower-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 sufficient numbers of trained vaccinators, cold storage and supply chains, and data systems to extensive education to reduce vaccine hesitancy. The United States should provide robust funding, working with international partners and ensuring that between U.S. and partner resources, the needed funds are provided within two months.
Finally, your administration’s own global vaccination plan remains unclear. We urge you to make public a fully detailed plan, consistent with the elements of this letter, within two weeks.
Specifically, we call upon your administration to:
- Inform Congress of the additional funding your administration requires to ensure a minimum mRNA dose production capacity of at least 8 billion doses per year and significant capacity increases of other safe and highly vaccines, to robustly support technology transfer and any related support needed to increase global production, in all regions, and to sufficiently fund 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. We urge you to call upon Congress to provide emergency additional funds through the first possible legislative vehicle, including an emergency supplemental if required. Congressional lawmakers have made initial progress towards this goal, as the House Energy and Commerce Committee included $2 billion dedicated to global and domestic vaccine manufacturing in the Build Back Better Act it has advanced. Your administration should support this – but insist upon far higher sums.
- Promptly donate the hundreds of millions surplus doses of vaccine 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.
- Produce a public global vaccination 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 and includes 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 us if they are behind the United States in a manufacturer’s queue;
- 5) donate excess U.S. vaccine doses, where most urgently needed, and;
- 6) working with COVAX, WHO, and other partners to 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 equally, and that all countries have the necessary support for vaccine end-to-end delivery and administration.
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 in our national interest, and 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 – everywhere.
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
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
Keith Martin MD, PC, Executive Director, Consortium of Universities for Global Health
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
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 Katz, MD, MHS, Associate Faculty Director, Harvard Global Health Institute
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
Steven Shea, MD, MS, Professor, Columbia University Mailman School of Public 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
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