Last Week in the US International COVID-19 Response

In the global response to COVID-19, the Biden administration made news last week on several fronts. Here is a quick recap and some ideas for moving forward.

Request for supplemental funding

After weeks of anticipation, the White House finally submitted a formal request to Congress for supplemental funding that includes an ask for COVID-19 response activities. If enacted, the proposed $5 billion in emergency spending for the US international response effort—including $4.25 billion directed to the State Department and USAID—would have vital implications for US-supported work to address the pandemic abroad.

The request arrives none too soon, since the lastest agency reports indicate the US has obligated most of its existing global COVID-19 relief money. New funding will support the US global vaccine delivery initiative, Global VAX ($1.8 billion)—launched by USAID in December—as well as provide countries with crucial medical supplies, including effective therepeutics, and help ensure frontline healthcare workers have personal protective equipment ($1.7 billion). The request also includes funds to shore up important humanitarian accounts ($500 million for USAID’s International Disaster Assistance account, and $250 million for State-managed Migration and Refugee Assistance). In addition, the ask includes $750 million for the Centers for Disease Control and Prevention to “increase global COVID-19 vaccine readiness and technical assistance.” 

While the topline figure came as a disappointment to many in the global health and development communities—falling well below the $17 billion advocates and some lawmakers had pushed—the urgent need for a new injection of resources is undeniable. Vaccination campaigns to reduce transmission and reach high-risk groups in some countries have stalled in the absence of further support to translate doses into shots in arms.

It's frustrating that current political realities also meant the request fell short in a number of key areas, including new support to help countries track the emergence of new COVID pathogens and invest in future pandemic preparedness. Nonetheless, this would be vital money at a critical moment in the pandemic. Lawmakers are reportedly putting the finishing touches on an FY22 spending deal, which could be released as soon as today. Congress should act fast to deliver the requested funding for lifesaving assistance, while recognizing there is still considerable unmet need.

Announcement of plans to share NIH-developed COVID technologies

In another headline announcement, the administration unveiled plans to share some NIH-developed COVID technologies with the WHO’s COVID-19 Technology Access Pool (C-TAP). Through the C-TAP platform, developers can share technological know-how, legal rights, and clinical data to produce and sell COVID-19 therapeutics, diagnostics, and vaccines with external manufacturers. To date, no pharmaceutical companies (and few countries) have shared their expertise and patents openly through C-TAP (besides some use of voluntary licensing through the Medicines Patent Pool [MPP], which partners with but predates C-TAP).

The US government’s decision to share NIH-developed technologies through C-TAP is a welcome step and we hope more countries follow suit. But the impact may be limited without greater incentives for manufacturers to build new (or use existing) capacity for these technologies. Manufacturers need more clarity on who will actually buy the tools after they invest in production. Without more information on demand, commercial uncertainty will continue to be an obstacle.

To turn knowledge sharing into increased, sustainable manufacturing capacity, the US and other global health funders should work to stabilize demand for new manufacturers. Demand-side considerations include which multilateral or national entities will purchase how much of which new products, whether products are included in WHO recommendations or national treatment guidelines, what new data from follow-on studies reveals, and whether buyers agree to advance purchase agreements.  

This holistic strategy must also incorporate purchasing plans for industry-developed technologies as part of the overall COVID-19 innovation landscape. As part of the MPP, pharmaceutical companies developing new COVID treatments have pursued voluntary licensing agreements with generic manufacturers, but the profitability prospects for sub-licensee manufacturers are unclear. As the world faces an uphill economic recovery, evolving variants, and shifting treatment guidelines, we hope policymakers take action to limit financial uncertainty and incentivize expanded manufacturing through all available pathways. For example, the US should consider complementing its C-TAP participation with large, low-interest loans and grants to new facilities so that manufacturers can flexibly switch from producing different products as demand shifts over time while being cost-competitive from the start.

Newly released National COVID-19 Preparedness Plan

In his State of the Union address to Congress last week, President Biden unveiled a new National COVID-19 Preparedness Plan that lays out the administration’s approach to prevent future surges and manage the pandemic in its current phase. Three of its key goals concentrate on domestic priorities, while the fourth and final goal is focused on the international response: “continue to lead the effort to vaccinate the world and save lives.”

As of March 7, the White House estimates the US has delivered over 484 million COVID-19 vaccine doses to 112 countries, a little over one-third of its promised 1.2 billion dose total. The plan describes how a large share of donations (1 billion Pfizer mRNA doses) continue to be distributed through a demand-driven partnership between USAID and COVAX. The approach explained in the plan will allow lower-income countries to reduce the number of doses they are slotted to receive in 2022 as needed while they build national vaccination programs and then set their own delivery schedules for remaining doses.

Beyond vaccines, the White House also intends to secure increased support for treatments, testing, and emergency medical supplies around the world. Of course, realizing these goals is likely to necessitate fast action from lawmakers on the supplemental funding request, even as the pandemic becomes less visible at home. In line with other major donors, the administration also pledged to continue investing in regional and in-country vaccine manufacturing partnerships. As discussed above, we hope this supply-side support is accompanied by demand-side financing measures that allow new manufacturers to survive and thrive in the medium- and long-term, including for future pandemic pathogens (see related CGD work on vaccine manufacturing in Africa and Latin America and the Caribbean.

The plan’s final point is perhaps the most important: COVID-19 will not be the last global pandemic. While the immediate COVID response continues to be a priority in many countries, now is also the moment to deliver ambitious pandemic preparedness funding. In the words of Ngozi Okonjo-Iweala, “We’ve spent $26 trillion in fighting the pandemic… but we are not ready to spend $75 billion for starting prevention now? That is wrong.”

We are encouraged by US commitments to advance global health security in the plan, including working with allies to establish a new health security financial intermediary fund (FIF) at the World Bank this year, but disappointed by the lack of commensurate resources for pandemic preparedness in the supplemental request. Without additional support, preparedness financing may total just $400 million (pledges include $150 million for the Coalition for Epidemic Preparedness and Innovations, announced today by USAID Administrator Samantha Power, and $250 million for the FIF). We are still waiting on the formal White House announcement of its second Global COVID-19 Summit, where we hope to hear President Biden urge renewed global ambition for pandemic preparedness and response—backed with adequate resources from the US. The near-term goals are clear: the world needs to simultaneously accelerate global access to critical COVID-19 technologies and drive large-scale efforts to prepare for future pandemic threats. A global pandemic demands a global response—now and in the future.

Many thanks to Erin Collinson, Amanda Glassman, and Rachel Silverman for helpful comments on earlier drafts.