The new estimates, included in the paper alongside recommendations, come as the Biden administration faces mounting pressure to facilitate equitable vaccine distribution around the world.
On Wednesday, Oxfam released an open letter signed by more than 100 former heads of state and Nobel laureates calling on President Biden to waive intellectual property rules for coronavirus vaccines and “put the collective right to safety for all ahead of the commercial monopolies of the few.”
“Leadership from the US on safe, effective, and equitable global access to Covid-19 vaccines is imperative,” the Duke paper argues, pushing for Washington to increase funding for vaccine-sharing programs, but beyond that to also donate excess doses and use its clout to open up vaccine manufacturing.
Another proposal, put forward in a letter backed by the Center for Strategic and International Studies (CSIS), calls for the United States to donate 10 percent of its excess doses over the summer, moving to 50 percent by the end of the year, and argues that Biden should deliver a speech this spring to make the case to the American people.
The proposals come amid new evidence that the U.S. vaccination drive is seeing success, even as the virus spreads uncontrolled in much of the world and more-virulent variants continue to take hold.
Under Biden, the United States has reengaged with Covax, a United Nations-backed initiative to help lower-income nations acquire vaccine doses, and Secretary of State Antony Blinken is hosting an event in support of the effort Thursday.
But many experts argue that current measures are not enough.
The United States will probably have “at least 300 million excess doses or more” by the end of July, the Duke paper’s authors estimate, even as vaccination programs are extended to the vast majority of U.S. children.
The estimate is based on the assumption that the vaccine developed by AstraZeneca receives emergency-use authorization and the Johnson & Johnson vaccine is used widely, despite rare side effects.
The oversupply in the United States forms a stark contrast with the situation in many poorer parts of the world, where vaccination programs have been slow to begin amid problems with supply and distribution, and could ultimately prolong the pandemic and hamper a U.S. recovery.
The administration has pledged to donate doses. “If we have a surplus, we’re going to share it with the rest of the world,” Biden said last month, when pressed on the issue. “We’re going to start off making sure Americans are taken care of first, but we’re then going to try to help the rest of the world.” And Blinken has made the case that protecting Americans requires international action. “This pandemic won’t end at home until it ends worldwide,” he said at a news conference April 5. But no global plan to donate doses has been specified.
The world’s poorest 92 countries will not be able to reach a vaccination rate of 60 percent of their population until 2023 “or beyond” if current distribution trends continue, the Duke paper estimates.
The authors include former U.S. officials such as Mark McClellan, ex-commissioner of the United States Food and Drug Administration under President George W. Bush, as well as Krishna Udayakumar, founding director of the Duke Global Health Innovation Center.
Their recommendations echo the concerns from other public health experts around the world, including World Health Organization Director General Tedros Adhanom Ghebreyesus, who called vaccine-distribution plans that focus only on domestic issues a “self-defeating strategy [that] will cost lives and livelihoods.”
French President Emmanuel Macron in February pushed for the United States and Europe to donate up to 5 percent of secured vaccine doses, though the idea has not gained significant momentum.
Though the Trump administration spurned calls for vaccine diplomacy and refused to back Covax, Biden reversed course and pledged $4 billion in backing to the scheme in February.
Even if Covax were fully funded this year, it would be able to vaccinate only a quarter of the population in the world’s 92 poorest nations, according to the Duke paper.
Though many experts believe the United States needs to do more to ensure that the developing world can vaccine faster, they differ over approach.
While the letter spearheaded by Oxfam called on the United States to back a temporary waiver of World Trade Organization intellectual property rules, breaking vaccine monopolies, the Duke experts argued such a measure is unnecessary and could prove chaotic.
Instead, they propose that the United States should back the use of cooperative licensing arrangements to increase manufacturing capacity, so that production can be scaled up quickly but safely.
The Duke authors also state that while U.S. contracts with drug manufacturers may restrict donations of excess doses, the Biden administration could modify its contracts and could provide “loans” of currently available vaccine doses (as it has already done with Mexico and Canada). It could also shift the timing of vaccine deliveries so more-needy countries receive their doses first.
Both the Duke and CSIS proposals noted that while the AstraZeneca vaccine does not yet have emergency-use approval in the United States, it could be used in other countries. The United States has purchased 300 million doses of the AstraZeneca vaccine alone.