How the 2020 Election Could Affect Americans’ Access to a COVID-19 Vaccine

Voters face a choice on vaccine development: go it alone, or benefit from international cooperation.

At the beginning of this month, the Trump administration announced that it will not join an initiative for global cooperation in rapidly developing a COVID-19 vaccine partially led by the World Health Organization. The initiative will be known as the “Covid-19 Vaccines Global Access Facility,” or Covax for short. A spokesman for the White House told the Washington Post “the United States will continue to engage our international partners to ensure we defeat this virus, but we will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China.”

This latest stubborn refusal to accept international help in fighting COVID-19 comes after the administration began the process of withdrawing from the WHO this summer. That move would have devastating impacts on global health efforts — the WHO depends on millions in annual funding from the U.S. — but could also pose a barrier to American access to COVID-19 vaccines. This latest announcement doubles down on the administration’s reckless “go-it-alone” strategy, as the pandemic continues to ravage the country.

As Dean Michelle Williams and 14 other health and legal experts argue in the Lancet, this unlawful and reckless action would have dire consequences for Americans, including barring the U.S. from the global system to design annual influenza vaccines and limiting U.S. access to other scarce vaccine supplies — at the very moment when we are in desperate need of a COVID-19 vaccine.

Implications for 2020 and Beyond

The consequences of the Trump administration’s WHO withdrawal are worth keeping in mind for voters as we head into the 2020 Presidential election. Democratic Presidential nominee Joe Biden has firmly committed to remaining in (or rejoining) the WHO should he be elected, stating that “Americans are safer when America is engaged in strengthening global health.” This is, of course, just one of many contrasts between the two candidates, but perhaps one of the most critical. Global cooperation has been and will continue to be a key part of the response to the COVID-19 pandemic, especially when a viable vaccine reaches the market.

President Trump’s critics have warned that this move could hamper America’s own COVID-19 response by creating barriers to cooperation and communication with our global partners. Even some fellow Republicans have criticized his decision, including Sen. Lamar Alexander (R-TN), the chair of the Senate Health, Education, Labor, and Pensions Committee, who said evaluating the WHO’s missteps in its COVID-19 response may be necessary, but “the time to do that is after the crisis has been dealt with, not in the middle of it.”

There are currently 9 vaccines for COVID-19 that have reached Phase 3 trials, the final phase of testing before they can be released for limited use and then broader release. Of these vaccines, only one is being produced by an American company — Moderna, which launched Phase 3 trials in late June, has received billions in funding from the NIH to accelerate its research. Four of the other vaccines are being tested by private and state-owned companies in China, one is the product of an Australian company, one is British, one German, and one Russian.

There is reason to believe the vaccines being developed in China may have a better shot at being the first to reach full approval for widespread use. Michael Kinch, director of the Centers for Research Innovation in Biotechnology and Drug Discovery at Washington University in St. Louis, has said China “has a more balanced portfolio” of potential vaccines — meaning their vaccines use a broader array of mechanisms to induce immunity to the virus relative to the American projects’ more narrowly focused approach. He argued the U.S. essentially putting all our eggs in one basket.

China has seen success in developing novel vaccines in recent years, according to a 2018 study of the country’s vaccine landscape. The authors noted that China “has a large domestic manufacturing base capable of producing [a] large quantity of vaccines at low prices,” including an oral rotavirus vaccine and both live-attenuated and inactivated Hepatitis A vaccines.

Should China or any other country beat America to the finish line in vaccine development, membership in the WHO would likely put us on the fast-track to sharing in those benefits. The WHO has urged its member states to share any vaccines when they’re developed “as a public good,” which is undeniably the right approach — in our interconnected global society, no country can fully eradicate the pandemic while others still battle it. In keeping with that philosophy, the WHO recently launched the “Covax” initiative for cooperative vaccine development, production, and distribution, which the Trump administration promptly declined to join.

In light of these developments, Biden’s and Trump’s respective attitudes will clearly have serious impacts on the health and safety of all Americans. Refusing global cooperation poses a real danger to our citizens. And even beyond the domestic impacts, the Trump administration’s decision to withdraw from the WHO is sure to have devastating global impacts when it goes into full effect.

Global Impacts of Withdrawal

The United States is the single largest donor to the WHO. According to the organization’s most recent budget reports, the U.S. contributed almost $900 million in 2018–2019 biennium, the majority of which consisted of voluntary contributions above the required assessed contribution threshold for member countries. The WHO reports that its total budget for 2018–2019 was just over $6 billion, much of it coming from the 20 top donors displayed in the graphic below.

An American ‘WHEXIT’ will therefore have major implications for healthcare and public health efforts globally and domestically. The largest regional beneficiaries of U.S. contributions are the Middle East and Africa, as well as the WHO headquarters itself. U.S. funding supports many of the WHO’s top programmatic priorities: from 2018–2019, $244 million from the U.S. went toward eradicating polio, $155 million to providing access to essential health services, and almost $29 million toward vaccination efforts. The WHO’s budget priorities for 2020–2021 include continuing polio eradication work and ensuring access to Universal Health Coverage and protection from health emergencies for one billion more people — all efforts that will likely suffer without America’s substantial financial support. This global work improves the quality of life for millions of people every year; for example, the WHO spent nearly $250 million in 2016–2017 combating non-communicable diseases, which “cause untold suffering, reduce productivity…and have a staggering economic impact.”

Worryingly, the U.S. withdrawal will further reduce America’s soft power in the global community. Historically, the U.S. itself has been able to reap the benefits of global cooperation on healthcare, even when its role is more as a donor than a recipient of aid. For example, America’s contributions to the WHO and other humanitarian aid organizations help build trade capacity in developing countries and forge new trade partnerships globally. As the COVID-19 pandemic has illuminated in brutal detail, healthcare efforts such as vaccination and access to essential health services benefit all players in the international sphere in our modern, interconnected global society. Aiding in developing countries’ pandemic prevention and control is a global public good. Improving health, longevity, productivity, and stability in developing countries through the WHO’s work brings massive benefits to the U.S. in the long run. Withdrawing funding might mean fracturing the mutually beneficial relationships America has built with numerous countries across the globe, not just health partnerships but economic and global security partnerships too.

Damaging those partnerships will have economic consequences in addition to the geopolitical consequences. As we at the Health Finance Institute have frequently highlighted through our work, chronic diseases are a huge economic burden globally, contributing to millions of premature deaths and losses in productivity. By our calculations, these costs could near $50 trillion over the next 20 years without much-needed interventions from the WHO and others. The WHO itself has published extensive research supporting the economic benefits of their work as well.

What’s Next?

According to a Congressional resolution dating back to 1948, the U.S. must give a year’s notice and pay all outstanding payments before leaving the WHO, so President Trump’s decision will not take effect immediately. Pending the results of the November presidential election, the withdrawal may never take practical effect — presumptive Democratic nominee Joe Biden has said he would reverse the decision and rejoin the WHO on his first day in office, if elected. But regardless of whether the decision eventually goes into effect or not, the administration has sent a strong signal to the global health community that America’s official position, for now, is non-cooperation with the international health experts whose help we desperately need in this catastrophic public health emergency.

As UN Foundation President Elizabeth Cousens put it, “WHO is the only body capable of leading and coordinating the global response to COVID-19.” Case rates and mortality continue to rise in many parts of the U.S., even as many other countries around the world have successfully flattened the curve and returned to some semblance of normal life — this is the worst possible time for America to shun the assistance of its global allies.

Written by Thomas Roades, Jenna Patterson, and Andrea Feigl-Ding

Heart of a non-profit. Engine of an investment bank. We use economic data to facilitate investments to prevent diseases.

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