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Student Instructor
health working giving vaccine

Global Vaccine Inequity

This pop-up case is part of the series: The Pandemic and Beyond


With the majority of the world still struggling to get access to COVID-19 vaccines, how should the United States prioritize domestic and global vaccination efforts?

Students will understand that prioritizing its domestic and international response to the pandemic is difficult for the United States because the tradeoffs are many and complicated.

The Situation

The majority of the world is still struggling to get access to COVID-19 vaccines. With worldwide supply limited, many wealthy countries have focused on their own citizens, securing the majority of global doses and leaving low- and middle-income countries without access. As of February 2021, ten countries have distributed 75 percent of the world’s available vaccine supply while over 130 countries have not received a single dose. Concerned by this inequity, the World Health Organization (WHO) has partnered with other international organizations to develop COVID-19 Vaccines Global Access (COVAX), a global initiative that purchases and equitably distributes vaccines to low- and middle-income countries in need. COVAX accepts both donations of doses that wealthy countries have already purchased and donations of money that it uses to purchase doses on the open market. When buying doses, COVAX has to compete with wealthy countries, and purchases often cannot be delivered for months. COVAX has a stated goal to deliver over two billion doses by the end of 2021. However, some global health experts worry that goal is not enough to make a significant impact, and as of February 2021, COVAX does not have the funds to accomplish even that goal.

Some policymakers argue that the United States should prioritize domestic vaccination over global initiatives. The United States has been a hotspot for the virus, suffering over 20 percent of global COVID-19 deaths despite constituting only 4 percent of the global population, with tens of thousands more dying every week, disproportionately in communities of color. A swift vaccination campaign, they say, could save lives, protect against the spread of more dangerous variants, and allow onerous public health measures to be lifted sooner. Many U.S. politicians, who are elected by and responsible to U.S. citizens, argue that the country should do everything to vaccinate Americans as quickly as possible before donating doses to COVAX. Donating funds could also delay a return to a more normal life in the United States by diverting necessary funding at a time when the country faces significant costs fighting COVID-19 and strengthening a battered economy.   

Some health experts counter that without combating the COVID-19 pandemic globally and equitably, the United States could be at risk. They believe that without an equitable global vaccine supply, many low- and middle-income countries could see the spread of more dangerous variants that could be less responsive to vaccines and threaten already-vaccinated countries. Other supporters of a more equitable response believe that the United States and other wealthy countries bear a moral obligation to help low- and middle-income countries. Donating doses or funds could also benefit the United States. Until the pandemic is widely under control, global supply chains will continue to be compromised, hindering economic recovery and possibly costing Americans billions of dollars. Significant support for COVAX could also earn the United States diplomatic capital and global goodwill at a time when U.S. standing in the world has been waning.

Decision Point

The COVAX initiative is still not set to meet its goal of vaccinating two billion people by the end of 2021, in spite of financial commitments from the United States and others. Moreover, the global vaccine rollout is already deeply inequitable and, without additional funding for COVAX, is likely to remain so. A donation of additional doses from the United States could quickly make vaccination more globally equitable, but it could slow U.S. vaccinations, leading to a delay in the return to a more normal life in the United States. Donating funds would have less of an impact on vaccination in the United States, but it risks a less equitable vaccination effort and is not without tradeoffs at home, given the high costs of the domestic fight against the pandemic. Countries with the money to do so are quickly buying up vaccine doses—so if the United States decides to act, time is of the essence. The president has called a meeting of the National Security Council (NSC) to decide if and how the United States should give COVAX the additional help it needs to effectively combat the continued global spread of COVID-19. NSC members should consider whether an increased donation of funds, a commitment to share U.S. doses, or both would advance U.S. interests and values or whether the United States should maintain the status quo.

NSC members should consider any combination of the following policy options:

  • Donate vaccine doses previously reserved by the United States to COVAX and potentially encourage other wealthy countries to do the same. Such a donation would delay the date by which Americans could resume a more normal life, but it could have the most immediate effect on making the global vaccine rollout more equitable by allowing COVAX to deliver vaccines to those who are most at risk in low- and middle-income countries. More equitable distribution also could lower the risk of new variants arriving in the United States and lead to diplomatic and reputational benefits for the country.       

  • Donate additional funds to COVAX and potentially encourage other wealthy countries to do the same. Donating funds avoids disturbing the U.S. vaccination schedule and could help COVAX to supply low- and middle-income countries, but its effects will be more gradual than donating doses.

  • Maintain current commitment to COVAX.

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