Putting U.S. Global COVID-19 Vaccine Donations in Context

On May 17, 2021 President Biden announced that by the end of June, the U.S. would donate 80 million doses of COVID-19 vaccine for use internationally. Sixty million of these doses are expected to be U.S.-owned doses of the Oxford/AstraZeneca vaccine (enough to vaccinate 30 million people), which has yet to be authorized in the U.S. but is authorized in multiple countries. An additional 20 million U.S.-owned doses will be from a mix of Pfizer, Moderna, and Johnson and Johnson vaccines (while the exact combination of doses for each was not announced, this could amount to enough vaccines for an additional 10-20 million people).

Prior to this point, the U.S. had provided 4 million doses of AstraZeneca to Canada and Mexico (via a “loan”), so 80 million doses would represent a significant increase in U.S. vaccine donations and make the U.S. the largest single country donor of in-kind vaccine doses worldwide (see Figure). In addition, the U.S. has also appropriated $4 billion to COVAX, the international partnership for COVID-19 vaccine procurement and distribution overseen by the Gavi Alliance, CEPI, and the World Health Organization, making the U.S. the largest donor to this effort as well.* In addition, vaccine production and manufacturing continue to lag and a key supplier of global vaccines has announced it will not be exporting any additional doses until the end of this year, underscoring the importance of countries donating doses in the near term.

While some have praised the most recent U.S. donation announcement as an important development, others have said the U.S. could do much more, pointing to the large supply of doses the U.S. is building up and the slowing demand for vaccinations in the country.  We sought to put the U.S. pledge of 80 million doses in further context, looking at what it represents relative to the current landscape:

• Almost 3 times the number of doses pledged by the next largest donor, France;**
• 56% of donated doses from all other governments combined;
• 115% of the total number of doses already delivered by COVAX through May 20;
• Less than 2% of the number of doses needed to vaccinate all people in low- and middle-income countries (LMICs);
• 8-16% of the number of doses sufficient to vaccinate the highest risk groups in LMICs – health care workers and adults over 65;
• 29% of the total cumulative vaccine doses administered in the U.S. (as of May 18).
• Figure: US pledge of 80 million doses vs. pledges from other donor governments

The world is still very unequal in terms of access to vaccines across regions and income groups, with estimates that some lower-income countries may not be able to vaccinate a majority of their adult populations for a year or more, even as many high-income countries approach or have already exceeded this milestone. Therefore, donated doses can help speed global vaccinations, provided the doses are distributed efficiently and administered effectively in the countries that need them. The U.S. has so far pledged to donate more doses than any other country and has provided the largest contribution to COVAX to date. Still, the U.S. effort represents only a fraction of what would be needed to vaccinate everyone, raising challenging questions about how access to COVID-19 vaccines will be scaled up and on what timeline, and what the role should of high income countries like the U.S. will be going forward.