In May, Secretary of State Antony Blinken pledged to unite democratic societies against autocratic ones. “What we are trying to do is to uphold the international rules-based order that our countries have invested so much in,” he said during a trip to London to meet with his G7 counterparts. His remarks were largely interpreted as a push back against human rights abuses from Russia and China, with news outlets pointing to treatment of Alexey Navalny and reported atrocities against Uighurs, respectively.
But Blinken’s promise came the same day that the New York Times reported that Russia is using the export of its COVID-19 vaccine – Sputnik V – as a foreign policy tool to wield Russian influence, particularly in Eastern Europe and Latin America. China also moved quickly to supply countries in Africa and South America with its Sinopharm vaccine. If Blinken is hoping to push back against authoritarian governments, he should look no further than vaccine diplomacy, and global health diplomacy writ large. The White House announced recently that it would begin shipping unused vaccines doses abroad, with a commitment of 25 million in the first tranche and a goal to export 80 million by the end of the month. But far more must be done, including dramatically increasing the number of doses shared to push back against aggressive exports from Russia and China.
Russia’s deployment of the Sputnik V vaccine has been unsettling from the beginning. Despite reports questioning the rushed development and unfinished trials needed for approval in Europe, Russia began pushing it out to Eastern European and Latin American countries (including Mexico) late last summer. There are also reports that Russian officials have prioritized exports over vaccinations for Russians domestically. Indeed, a shipment to Hungary was sent before European regulatory approval – shoring up Russian support for the Putin-aligned Viktor Orban. Similarly, the import of the Russian vaccine into Slovakia led to the fracture of the pro-Western ruling coalition, with members breaking off in protest of accepting the Russian vaccine. This in turn led to the near collapse of the ruling coalition and forced the Slovakian prime minister to step down in favor of the finance minister.
European Commission President Ursula von der Leyen has openly questioned why Russia is pushing its vaccine so hard in the export market, to the detriment of the Russian people. But it is not hard to see Russian motivation in its vaccine foreign policy. Russian goals – whether pursued by standing up armed forces on the border with Ukraine or pushing vaccines to Eastern Europe – have long been to pull countries it sees as culturally part of its backyard further into its orbit. Russia is doing what it has done time and again under the Putin regime. It is working to fill the gap left by Western powers and assert its dominance in the region.
The COVID-19 pandemic has been an historic human tragedy, but the effort to bring it to an end is an opportunity to advance U.S. interests and global leadership, and the Biden administration needs to embrace it as such. The United States already contributed more than $5 billion to the Access to COVID-19 Tools (ACT) Accelerator, a coalition of multilateral partnerships addressing the global pandemic, and promised more support if other donor nations step up their funding. Through its diplomacy with other high-income donor countries, the Biden administration must insist that the rest of the world should announce greater contributions immediately.
Additionally, the United States and its European allies would be well-served to ensure that Russia and China are not left to their own devices in exporting their vaccines. Now more than ever, the United States needs to step up its global health diplomacy, and not only regarding vaccines. The gap for vaccine demand and other global health commodities, like personal protective equipment (PPE), diagnostics and medical oxygen, is largely being filled by Russia and China, still this ongoing demand for supplies is an opportunity for the return of U.S. leadership on the global stage. As demand for vaccines tapers domestically, the United States can immediately increase sharing its unused and already-purchased doses, particularly of the AstraZeneca vaccine, which is not yet approved for use in the United States. Dose-sharing agreements, which the United States already has with Mexico and Canada, can be expanded to low- and middle-income countries that are so desperately in need. The recent announcement from the Biden administration to share doses of the Pfizer and Moderna vaccines needs to come with additional detail on where those doses will be sent.
However, American diplomacy must extend far beyond dose sharing. While the international funding included in the American Rescue Plan is a start, the Biden administration should work closely with other ACT Accelerator donor countries to ensure increased contributions to CEPI — the Coalition for Epidemic Preparedness Innovations — and spur innovation. CEPI has a large role to play not only in the development of COVID-19 vaccines, but also in addressing the pandemic’s long-term, knock-on impacts on efforts to address other diseases. The United States can and should use its diplomatic leverage to increase investment and development in new medical technology.
Vaccine diplomacy is only the beginning. This pandemic will not end only through vaccine exports and distribution. To fully grapple with COVID-19, the United States must lead the charge to address all aspects of the pandemic. This means addressing the shortages of tests (both rapid and PCR), treatments, and — crucially — medical oxygen, which are all so desperately needed to stem the tide and the deadly consequences of the pandemic. Increased supply of medical oxygen, the lack of which has been a key factor in the tragic spike in deaths from COVID in India, would additionally work to cement the U.S.-India relationship, as Russia has attempted to increase its engagement on the subcontinent. The Biden administration should work closely with private sector companies and multilateral institutions like the World Health Organization and the Global Fund to scale the purchase and delivery of these commodities to countries forced out of the market by high prices. For example, if the Global Fund’s COVID-19 Response Mechanism is sufficiently funded with the outstanding $6.3 billion it needs from non-U.S. donors, it aims to distribute 500 million COVID-19 tests to low-income countries by the end of 2021.
To ensure contributions from other donors, the Biden administration should increase any and all diplomatic efforts. During the 2020 campaign, then-candidate Joe Biden announced a promise to appoint an assistant secretary of state for global health diplomacy. With COVID-19 deaths rising to record highs in countries like India and Nepal, Biden should follow through on his promise and announce a nominee immediately. The welcome appointment of Gayle Smith, longtime CEO of the ONE Campaign, as a temporary coordinator for Global COVID Response & Health Security is a starting point, but much more action is needed.
A permanent assistant secretary of state for global health diplomacy would work closely with PEPFAR, PMI, USAID and the Department of Health and Human Services to ensure other high-income countries contribute their fair share to the ACT Accelerator and address the pandemic everywhere. And she or he could carry the same approach beyond COVID to other global health challenges to help people around the world survive and thrive, while also benefitting U.S. strategic and human rights goals.
The Biden administration should also swiftly announce a nominee to be Global AIDS coordinator to ensure that PEPFAR, the largest U.S. global health program, is sufficiently weighing in with the expertise and experience that the agency brings to pandemic response to ensure effective and efficient coordination on a multilateral, country, and local level. More permanent PEPFAR and health diplomacy chiefs at the State Department to address the threats of global disease are critical to ensure that the knock-on impacts of COVID on AIDS, tuberculosis, and malaria are also addressed. In a report analyzing programs from April to September 2020 against the same period in 2019, the Global Fund found that HIV testing fell by 41 percent, TB referrals – where patients suspected of having TB are referred to the next step of diagnosis and treatment – declined by 59 percent, and malaria diagnoses fell by 31 percent. Programs like bed net distribution had to be adapted from central point distribution to door to door – requiring more time and more community health workers. If those impacts are not addressed, progress on combating all three diseases, the deadliest infectious diseases before COVID, could be set back by more than a decade.
As COVID-19 shows time and time again, pandemics do not respect borders and COVID-19’s variants will not wait patiently in the wings for the world to develop and manufacture more therapeutics and vaccines. The COVID-19 pandemic will never be fully addressed until it is addressed everywhere. The Biden administration should view combatting the pandemic not just as a moral imperative, which it does, but one that also aligns and assists with U.S. national and foreign policy interests. The global gaps in access to healthcare and political leadership that COVID-19 has illustrated must not be left for exploitation by our competitors, as Russia and China have already begun to do with their vaccine exports. While important steps have been taken so far with recent appointments and the inclusion of international assistance in the American Rescue Plan, much remains to be done to effectively overcome COVID-19. What comes next, including the future of U.S. leadership in global health, is now entirely in the hands of the Biden administration. It cannot let this generation-defining opportunity sail by.