The US is under increasing pressure to share Covid-19 vaccine doses with less wealthy nations, as advocates call for prevention of an emerging “vaccine apartheid” and point to the strategic and diplomatic importance of sharing essential medicines.

Calls to share vaccine doses grew louder this week after the Biden administration announced an additional purchase of 100 million vaccine doses from Johnson & Johnson. The American government has now bought enough doses of vaccines from Moderna, Pfizer and Johnson & Johnson to vaccinate 500 million people – nearly the entire eligible population twice over.

The administration also holds the rights to 100 million AstraZeneca vaccine doses. The vaccine has not been authorized in the US, but is authorized for use elsewhere in the world. AstraZeneca asked the US to give “thoughtful consideration” to donating the vaccines elsewhere, a spokesperson for the company said.

“I’m doing this because, in this wartime effort, we need maximum flexibility,” Biden said at a White House briefing announcing the purchase this week. “There is always a chance that we’ll encounter unexpected challenges.”

On Friday, Biden and the leaders of Japan, Australia and India – an informal working group known as the Quad announced they would work to increase manufacturing capacity, with the aim of sending 1bn doses of Covid-19 vaccines to Asian and Pacific island countries by 2022.

But Biden administration officials have continued to resist sending stockpiled vaccine doses abroad, saying it is part of a plan to be “over-prepared and over-supplied” in the event emerging Covid-19 variants or waning immunity require booster shots.

“We want to be a part of the effort around the world to vaccinate people around the world in a range of countries,” said the White House press secretary, Jen Psaki, citing the US’s $2bn commitment to Covax, the global effort to share Covid-19 vaccines.

However, she said the president’s “first priority and focus is on ensuring that the American people are vaccinated. And once we are at that point, we will have a discussion about what’s next”.

The administration’s strategy is also a hedge against any potential manufacturing disruptions, and could provide a supply of vaccines for children, if and when clinical trials show they are safe for use in children younger than 16.

The Biden administration intends to lift all vaccine eligibility requirements by 1 May, and hopes to vaccinate all eligible 267 million Americans by the Fourth of July holiday. More than 530,000 Americans have died after contracting the virus, a number the the administration often cites when defending its reliance on the vaccine rollout.

“As I’ve told you before, I carry a card in my pocket with the number of Americans who have died from Covid to date,” said Biden in a primetime speech on Thursday. “It’s on the back of my schedule. As of now, the total deaths in America: 527,726. That’s more deaths than in world war I, world war II, the Vietnam war and 9/11 combined.”

However, countries such as China and Russia have agreed to share vaccines to gain a strategic advantage. China’s vaccine manufacturers have pledged half a billion doses to 45 countries, according to an Associated Press tally.

“We may be outcompeted by others who are more willing to share, even if they’re doing it for cynical reasons,” said Ivo H Daalder, a former Nato ambassador and the president of the Chicago Council on Global Affairs, to the New York Times. “I think countries are going to remember who was there for us when we needed them.”

A recent analysis by the World Bank found 82% of high-income countries have begun vaccinations, compared to 3% of low-income countries. A January forecast by the Economist Intelligence Unit found middle-income countries will likely mass vaccinate their populations by the end of 2022, but 84 of the world’s poorest nations will not likely complete mass vaccination campaigns until at least 2024, and may never reach herd immunity.

“It’s going to define the global economy, the global political landscape, travel, pretty much everything,” said Agathe Demarais, forecasting director for the unit, at the time the report was released.

Advocates have described the gulf in vaccine access between rich and poor countries as a potential “vaccine apartheid”. Many have also said failure to share vaccines threatens to repeat the failures of the HIV/AIDS epidemic.

“A me-first approach might serve short-term political interests, but it is self-defeating and will lead to a protracted recovery, with trade and travel continuing to suffer,” wrote Dr Tedros Adhanom Ghebreyesus in the Guardian.

“The threat is clear: as long as the virus is spreading anywhere, it has more opportunities to mutate and potentially undermine the efficacy of vaccines everywhere. We could end up back at square one,” he said.

Ghebreyesus is among advocates who have called for pharmaceutical companies to waive intellectual property rights granted by the World Trade Organization. The hope is that temporarily waiving patents would allow for broad-based manufacturing of vaccines.

The petition would waive certain rights guaranteed by what is called the TRIPS agreement. The issue is before the WTO, which is expected to debate the petition twice in upcoming meetings in April. The petition is supported largely by lower income countries, and opposed by high-income nations.

“We must make sure that in the end we deliver,” said Ngozi Okonjo-Iweala, the WTO director-general. That way, she said, “the millions of people who are waiting for us with bated breath know that we are working on concrete solutions.”

This content first appear on the guardian

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