WASHINGTON (NYTIMES) - President Joe Biden, who has pledged to fight the coronavirus pandemic by making the United States the "arsenal of vaccines" for the world, is under increasing criticism from public health experts, global health advocates and even Democrats in Congress who say he is nowhere near fulfilling his promise.
Mr Biden has either donated or pledged about 600 million vaccine doses to other countries - a small fraction of the 11 billion that experts say are needed to slow the spread of the virus worldwide.
His administration has also taken steps to expand Covid-19 vaccine manufacturing in the US and India, and is supporting production in South Africa and Senegal to expand access to locally produced vaccines in Africa.
But with the administration now recommending booster doses for vaccinated Americans starting next month, outraged public health experts and many Democrats on Capitol Hill are calling on the President to move more aggressively to scale up global manufacturing.
In an analysis to be published on Thursday (Aug 26), Aids advocacy group PrEP4All found that the administration had spent less than 1 per cent of the money that Congress devoted for ramping up Covid-19 counter-measures on expanding vaccine manufacturing.
Congress put a total of US$16.05 billion (S$21.70 billion) in the American Rescue Plan this year, in two separate tranches, that could be used to procure and manufacture treatments, vaccines and tools for ending the pandemic.
But PrEP4All found that all told, the administration had spent US$145 million - just US$12 million of it from the American Rescue Plan - to expand vaccine manufacturing. The bulk of that went to retrofitting production lines at pharmaceutical giant Merck, which is teaming up with Johnson & Johnson to produce one billion vaccine doses starting in early 2022.
White House officials say all the money has been allocated as intended, including US$10 billion for "vaccine raw materials, vaccine and other manufacturing capacity, and industrial base expansion".
But they did not respond to repeated questions about whether or how the money has actually been spent.
Democratic senator Patty Murray and the chairman of the Senate health committee has also asked for a more detailed accounting, her office said.
On Capitol Hill, 116 Democrats, including Senator Elizabeth Warren, have called for putting US$34 billion to increase vaccine manufacturing capacity in the upcoming budget reconciliation act. This month, they wrote to Mr Biden asking him to endorse the idea but have not received a response, said Democratic representative Raja Krishnamoorthi, who is leading the effort in the House.
"This lack of attention to executing a robust vaccination strategy abroad is arguably one of their biggest missteps with regard to Covid," Mr Krishnamoorthi, who said he lost three members of his extended family in India to Covid-19.
Mr James Krellenstein, a founder of PrEP4All and the author of its report, was more pointed. "If they don't change course pretty soon, the Biden administration is going to be remembered in terms that the Reagan administration is remembered today in not dealing with the Aids crisis," he said.
Addressing the world's coronavirus vaccine needs is a complicated endeavour, with many layers of challenges. Vaccine makers around the world, including those in Russia, China and India, have predicted a total of 12 billion doses by the end of 2021, according to Duke University's Global Health Innovation Centre, which tracks vaccine manufacturing and publishes the Launch and Scale Speedometer website. Eight months into the year, an estimated five billion have been delivered.
Several other countries as well as the United States are already recommending booster shots, which will cut into the supply. And the virus changes shape so rapidly - the highly infectious Delta variant is now dominant around the globe - that the vaccines developed last year may soon be outdated, said Dr. Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations, which helps lead the international vaccine effort known as Covax.
Mr Biden took his first steps to address the vaccine shortage in March, when the White House announced the Merck deal as well as a partnership with Japan, India and Australia aimed at expanding manufacturing capacity. That included a pledge to help Biological E, an Indian manufacturer, produce one billion doses by the end of 2022.
A White House official said the US International Development Finance Corporation, which is making the investment, "expects to begin disbursing funds within the next several weeks". The official did not offer specifics, or an amount.
White House officials say that it is not possible for them to scale up production quickly, in part because of a scarcity of raw materials, and that doing so would take three to five years - an assertion that Dr Tom Frieden, who directed the Centres for Disease Control and Prevention during the Obama-Biden administration, dismissed as "nonsense".
Dr Frieden, now the president of Resolve to Save Lives, a health non-profit, pointed to Lonza, a Swiss biotechnology firm, which entered into an agreement with vaccine maker Moderna in May 2020, retrofitted its facility in Portsmouth, New Hampshire, and was producing vaccine six months later.
"People say, 'Oh, it's going to take months'. Well, Covid is with us for years. The best time to plant a tree is 20 years ago. The second best time is today," said Dr Frieden.
He and others also want the Biden administration to lean more heavily on Pfizer and Moderna to transfer their technology to manufacturers around the globe. The Financial Times reported this week that South Korean vaccine makers are poised to expand but are struggling to secure intellectual property licensing deals with the two firms.
Mr Biden is likely to make some kind of announcement about addressing the pandemic when the United Nations General Assembly convenes in New York for its annual meeting in September.
The administration is considering creating a government-owned manufacturing plant that would be run by a private contractor - a plan endorsed by PrEP4All. But a person familiar with the proposal said it was only a possibility at this point.
There are challenges with such an approach, particularly if experienced vaccine makers do not participate, as the situation with Emergent BioSolutions demonstrated.