Should the U.S. donate COVID vaccine doses to less-wealthy countries? Some want to wait until all willing Americans can be vaccinated


As the U.S. faces calls to share excess COVID-19 vaccine doses with less-wealthy countries, a new study suggests Americans have differing views on the appropriate levels and timing of so-called vaccine diplomacy.

Older people in a survey of 788 U.S. adults were less likely to support higher levels of COVID-19 vaccine donation by the U.S. to low- and middle-income countries, and more likely to say they wanted to wait until everyone in the U.S. who wanted their shots had been vaccinated, according to the study led by Virginia Commonwealth University researchers in the peer-reviewed journal Vaccine.

“This may be because older adults are a higher-risk group themselves and, as a result, might be more concerned about their own health or that of their peers,” the authors suggested.

Similarly, uninsured respondents were more likely to say they wanted to wait to donate until all willing U.S. recipients had been vaccinated, and more likely to back waiting until all high-risk Americans had been vaccinated. This could point to economically vulnerable Americans’ vaccine-access concerns, the authors wrote, “and speaks to the importance of developing and communicating a strong plan for equitable vaccine access within the U.S.”

Meanwhile, self-identified Democrats in the study were more likely than Republicans to support higher donation levels — consistent, the study said, with Democratic support for universal health care and more lenient immigration policies.

Respondents who scored higher on the Social Dominance Orientation (a tendency to believe that “one’s own group should dominate and be superior to other groups,” as the study put it) were also more likely to back waiting until all Americans who wanted coronavirus vaccines had been inoculated, and less likely to want higher donation levels. This characteristic, the authors said, was “by far the largest predictor.”

About eight in 10 respondents overall said they backed donating at least 10% of future U.S. COVID-19 vaccine doses to poorer countries, though nearly six in 10 said doses shouldn’t be donated until “at least some threshold of domestic vaccination has taken place.”

“Despite some hesitancy among a minority of the sample, many we surveyed recognized the importance of closing the gap,” study co-author Bernard Fuemmeler, a professor at VCU’s School of Medicine, said in a statement. “Policymakers should be encouraged that proposals to donate the vaccine will be met with acceptance.”

With that said, the authors warned that their sample’s quotas for race and ethnicity — which enabled them to compare demographic subgroups — may have also skewed toward a higher willingness to donate doses. They warned that the percentages given were not representative of the U.S. population.

But the findings still have implications for how U.S. policymakers and health professionals can build public support among different groups for donating vaccine doses abroad, the authors said — and how messaging should vary.

“Specifically, those with high [Social Dominance Orientation] beliefs will likely be more effectively persuaded by messages tapping into American exceptionalism and the need to provide aid to those less advanced, whereas those affiliated with the Democratic party may be more persuaded by collectivist messages emphasizing that we are all in this together,” they wrote.

What the U.S. has done so far

President Biden projected in early March that the U.S. would have enough doses by the end of May to vaccinate every adult. “We want to be oversupplied and over-prepared,” White House press secretary Jen Psaki said ahead of Biden’s announcement days later that the U.S. would buy an additional 100 million doses of the Johnson & Johnson

vaccine by the year’s end to allow for “maximum flexibility.”

In the meantime, Biden faces pressure from multiple corners to donate extra doses to other nations, as countries such as China and India have done as a form of diplomacy.

“We’re going to have excess supply,” Zeke Emanuel, a University of Pennsylvania oncologist and bioethicist who helped craft the Affordable Care Act and advised Biden’s transition team, told Axios in March. “It would be unethical, and it would be a diplomatic and strategic mistake, to say we need to build up a buffer of 100 million doses while China and Russia are selling to people and saying, you know, ‘You guys count.’”

Biden’s administration, which recommitted the U.S. to the World Health Organization once the president took office, has so far said it would loan 4 million total AstraZeneca

doses to Mexico and Canada, where regulators have authorized that vaccine, and contribute $4 billion to Covax, the global vaccine-sharing effort to ensure fairer distribution between lower- and higher-income nations.

Biden and the leaders of Japan, India and Australia (collectively known as the “Quad” alliance) have also pledged to help Indo-Pacific countries with vaccination, including through U.S. financial support of Indian manufacturer Biological E’s production of at least 1 billion vaccine doses by the close of 2022.

Asked about additional steps the Biden administration is planning — particularly in the way of donating vaccine doses — and at what point the administration would feel it had enough vaccine to start donating doses abroad, a White House spokesperson directed MarketWatch to Psaki’s comments during a separate March 22 briefing.

In response to a question about sharing vaccine doses, Psaki noted that the U.S. had been one of the countries hit hardest by the virus and said there were “still a number of factors that are unpredictable that we need to plan for to the best of our ability,” such as the impact of variants and the best course of action for children, who are not yet eligible to receive the currently authorized Pfizer

and Johnson & Johnson vaccines.

As the administration gains confidence that its vaccine supply is sufficient, she added, it will explore options to share doses more widely.

“We recognize fully that in order to defeat the pandemic globally … the global community needs to be vaccinated. But there’s a shortage of supply, at this point, around the world, but also including around the country still,” she said. “We are not sitting on a secret dose of supplies. We are focused on getting these out the door as quickly as possible at this point.”

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