March 26, 2021
Global COVID-19 Vaccine Distribution
Background
million), France ($120 million), and Italy ($100 million).
The COVID-19 pandemic has led to severe health and
On February 24, 2021, WHO announced the inaugural
economic consequences across the globe, as governments
shipment of COVID-19 vaccines through COVAX, with the
work to contain spread of the virus and its variants.
delivery of 600,000 doses to Ghana. COVAX plans to send
Officials have instituted a range of physical lockdowns and
600 million doses to Africa by December 2021. As of
quarantine measures. In late 2020, researchers identified
March 17, 2021, COVAX had shipped 30 million COVID-
several new COVID-19 variants, which present challenges
19 vaccines to 50 countries worldwide.
to pandemic control. For example, parts of Brazil, South
Challenges. In 2021, COVAX aims to procure enough
Africa and the United Kingdom are experiencing surges in
COVID-19 doses to cover 20% of the populations in 92
COVID-19 cases, believed to be caused in part by variants
LMICs. Health experts estimate that to reach herd
that have emerged in those countries. Vaccines and other
immunity, 60-80% of a given population should be
countermeasures are playing a growing role in COVID-19
vaccinated, raising questions about how LMICs might
control. Researchers continue to study the safety and
procure additional doses outside of COVAX. Moreover, as
effectiveness of various COVID-19 vaccine candidates.
of March 4, 2021, COVAX had a $2.4 billion funding gap.
Congress has appropriated approximately $15 billion
Availability of COVID-19 vaccines in LMICs might also be
through supplemental appropriations (P.L. 116-123, P.L.
affected by safety questions and resulting vaccine
116-136, P.L. 116-260, and P.L. 117-2) for a range of
hesitancy. Several countries temporarily suspended use of
global COVID-19 responses. Congress authorized the U.S.
the AstraZeneca-produced vaccine after individuals who
Agency for International Development (USAID) to use $4
received the vaccine reportedly developed blood clots. On
billion of those funds in support of multilateral COVID-19
March 18, the European Medicines Agency (EMA)
vaccine efforts. Actions by the Biden Administration to
concluded that the vaccines are not associated with an
deepen U.S. multilateral engagement, such as joining the
overall increase in blood clots and “the benefits of the
COVID-19 Vaccines Global Access Facility (COVAX),
AstraZeneca vaccine outweigh its risks.” After receiving
may lead to additional U.S. government support for global
incomplete trial data from the company, U.S. regulators
COVID-19 control.
also have raised questions over the vaccine’s efficacy.
Global COVID-19 Vaccine Distribution
Though use of the AstraZeneca vaccine has resumed, many
countries are reporting higher rates of vaccine hesitancy in
In April 2020, the World Health Organization (WHO) and
the wake of these developments. COVAX has purchased
partners launched the Access to COVID-19 Tools
170 million doses of the AstraZeneca vaccine.
Accelerator (ACT-A) to accelerate the development,
Global Vaccine Access
production, and distribution of COVID-19 diagnostics,
Insufficient vaccine supply coupled with uneven capacity to
therapeutics, and vaccines. To date, several countries and
pay for the vaccines have led to global vaccine access gaps.
WHO have approved four COVID-19 vaccines for
Whereas manufacturers have produced only a fraction of
emergency use, while vaccines produced in China and
the eight billion doses they have been paid to produce,
Russia that have not been authorized for emergency use are
some countries have purchased enough doses to vaccinate
also in use in many countries. More than 80 other COVID-
their populations several times over. For example, Canada
19 vaccine candidates are in human clinical trials and
pre-ordered an average of 11 doses per citizen, reportedly
numerous COVID-19 therapeutics are in development.
because the country does not have capacity to manufacture
Some observers estimate that COVID-19 vaccines will not
vaccines and must rely on imported doses. Unequal vaccine
be widely available in low- and middle-income countries
distribution has stirred controversy in the international
(LMICs) until at least 2022. COVAX, the vaccine arm of
community.
the ACT-A—co-led by WHO, the Coalition for Epidemic
Preparedness Innovations (CEPI), and Gavi, the Vaccine
Alliance—aims to donate two billion doses of COVID-19
Since December 2020, over 400 million COVID-19
vaccines for use in LMICs by the end of 2021. High-
vaccine doses have been administered worldwide; of
income countries may also purchase COVID-19 vaccines
those doses, less than 10% have gone to LMICs.
through COVAX to access economies of scale and likely
receive more affordable prices.
Some Non-Governmental Organizations, WHO, and several
world leaders, have lamented these inequities. In February
Advances. Nearly 200 countries have joined COVAX. The
2021, French president Emmanuel Macron urged G7
United States is the largest donor to COVAX, having
countries to send 5% of their vaccine doses to Africa.
pledged $2.5 billion in 2021. Other key donors include:
Germany ($110 million), the European Commission ($490
Vaccine Diplomacy
million), Japan and Canada ($200 million each), Saudi
China and Russia appear to be using vaccine sales and
Arabia, ($150 million), the Gates Foundation ($160
donations to bolster their international standing. Many
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Global COVID-19 Vaccine Distribution
LMICs facing manufacturing delays and financial
United States from WHO in July 2020. The Biden
constraints are purchasing vaccine candidates produced by
Administration is working to restore U.S. involvement in
China and Russia. WHO is expected to decide whether to
WHO. Thus far, the Administration has retracted the July
issue an emergency use authorization for two vaccines
2020 decision, resumed regular engagement with WHO,
produced by China (Sinopharm and Sinovac) in April 2021
ended plans to draw down U.S. staff seconded to WHO,
but has reported that there is insufficient data to estimate a
and formally joined COVAX.
decision on Russia’s Sputnik V vaccine candidate.
Outlook and Issues for Congress
China announced in March 2021 that it would donate
Since the beginning of the pandemic, many Members of
300,000 doses of its vaccines to U.N. peacekeepers,
Congress have demonstrated strong interest in COVID-19
particularly in Africa. U.N. officials have not yet indicated
control, including in vaccine development and distribution.
whether they would accept the donations. Chinese officials
Members have also debated how to balance international
have promoted this donation and the international sale of
and domestic responses to the pandemic. During the 117th
COVID-19 vaccines as part of an effort to demonstrate its
Congress, Members may consider a variety of issues related
support for multilateralism. Several LMICs have reportedly
to COVID-19 vaccines including:
ordered more than 400 million doses from China.
U.S. engagement with WHO. Although the Biden
Russia has reportedly reached agreements to supply 1.2
Administration has announced a resumption of
billion doses of Sputnik V across 50 LMICs. India is set to
normalized relations with WHO and joined COVAX,
be one of the biggest producers of the vaccine, with an
some Members of Congress remain concerned about
agreement to manufacture 300 million doses. The vaccine’s
China’s influence in WHO and in related vaccine
lower cost and higher storage temperature make it attractive
efforts. Several bills have been introduced in the 117th
to LMICs despite the lack of WHO approval. Questions
Congress that aim to place conditions on U.S.
remain regarding Russia’s ability to produce enough of the
contributions to WHO. One bill, for example, would
vaccine to fulfill promised orders and domestic needs. Thus
prohibit any U.S. contributions to WHO as long as
far, Russia has not met domestic production quotas.
China remains a member of the organization. No
legislation has been introduced in the 117th Congress in
U.S. Government Role
support of WHO, though several Members of Congress
Bilateral Efforts. U.S. government global COVID-19
rejected plans by the Trump Administration to withdraw
control efforts are led primarily by USAID and the U.S.
from WHO in the 116th Congress.
Centers for Disease Control and Prevention (CDC). Both
agencies are leveraging long-standing disease outbreak
COVID-19 “vaccine passports.” In January 2021,
control programs for global COVID-19 response.
President Biden issued Executive Order 13998 to study
whether the U.S. government should issue “vaccine
passports” or some other document that indicates
Since the pandemic started, USAID and the State
whether one has been vaccinated or recovered from
Department have committed more than $1.6 billion in
COVID-19. The Biden Administration has not
health, humanitarian, economic, and development
determined whether to endorse the idea, but has
assistance for global COVID-19 control.
indicated that the government shall not store associated
CDC has committed at least $800 million for related efforts.
data. In March 2021, the European Commission
The agencies are working jointly to support implementation
published its proposal for a Digital Green Certificate
of National Deployment and Vaccination Plans, required by
that would enable vaccinated certificate holders to move
WHO for countries receiving vaccines through COVAX.
freely in the Eurozone. WHO opposes the idea of
COVAX members are considering whether to allow donors
vaccine passports, stating “there are still critical
to direct donations of COVID-19 vaccines to their country
unknowns regarding the efficacy of vaccination in
of choice. Given the limited supply of vaccines for
reducing transmission.” WHO and other critics also
domestic use, and the inability to earmark vaccine
raised concerns about how inequitable access to the
donations, the United States has opted not to donate large
vaccine might impact underserved populations. No
quantities of vaccines to COVAX to date. In March 2021,
Members of Congress have introduced legislation in
the Biden Administration pledged to jointly manufacture
support of or opposition to the concept, though some
and deliver 1 billion COVID-19 vaccines to Southeast Asia
bills cite key concerns. H.R. 906, for example, would
by the end of 2022, through “the Quad,” the coalition
prohibit the Secretary of Transportation from requiring
between Australia, India, Japan and the United States, and
an individual to test negative for COVID-19 to travel by
announced that it would donate 4 million doses of the
air. Similarly, S. 82 calls for a joint task force,
AstraZeneca vaccine directly to Canada and Mexico, in part
comprising the Secretaries of Transportation, Homeland
to mitigate manufacturing delays of doses those countries
Security, and Health and Human Services, to make
have ordered, and the slow pace of vaccine campaigns.
recommendations for addressing privacy and civil
liberty issues that may arise from such monitoring the
Multilateral Efforts. U.S. diplomatic engagement in
health of air travelers.
multilateral COVID-19 control, particularly with respect to
vaccine deployment, appears to be relatively limited. U.S.
Sara M. Tharakan, Coordinator, Analyst in Global
reticence to participate in such efforts has been driven, in
Health and International Development
part, by a desire to ensure sufficient domestic COVID-19
Tiaji Salaam-Blyther, Specialist in Global Health
vaccine supply, and by the Trump Administration’s
dissatisfaction with WHO’s early response to the COVID-
IF11796
19 pandemic; which resulted in a decision to withdraw the
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Global COVID-19 Vaccine Distribution
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https://crsreports.congress.gov | IF11796 · VERSION 1 · NEW