So Far, So Good on the US at the WHO and at the COVAX Facility

The good news of the “day after”, above and beyond the happy sensation of savoring the smooth flow of democracy in action, was the carry-through on seeing the adults back in the room on multilateralism in global health and the pandemic. What do I mean? Well, the day that I am referring to is 20 January 2021, the day that was filled with pomp and ceremony (but no crowds) for the inauguration of President Joe Biden and Vice President Kamala Harris to lead the United States government. On the day itself,  President Biden signed over a dozen executive orders to put things back in place, as it were. And on the “day after”, we witnessed the follow-through on a new national strategy on the COVID-19 response and pandemic preparedness. Here are some preliminary reflections on the good news, with the caveat that the journey is not yet over.

I had been looking for clues about the promise to return to the WHO and had been worried that it did not seem to be on the advance list of planned executive orders for that first day. Relief set in when we verified that the return to the World Health Organization (WHO) merely involved a letter (available here) and not an executive order. And there it was, nestled in among the more formal announcements of President Biden’s first day at work. So far, so good! But it did take another day to verify the additional promise of joining the global response to the pandemic in the COVAX Facility. So now, and with that, we can all breathe a sigh of relief that the nightmare is over.

Again, this commentary provides some preliminary reflections on the good news, with the caveat that the journey has been long and is not yet over. (For more details on the journey with WHO, ACT-A and COVAX, see my prior commentaries, including the most recent one posted here on 16 December 2020 on “Looking to US Action in Support of the Global Pandemic Response”.) As the awesome new national youth poet laureate, Amanda Gorman, reminded us at the inaugural, we still have a hill to climb.  The vaccines may give us more than a sigh of relief eventually, but the hill ahead is still steep with caseloads still out of control, hospitalizations reaching capacity and more losses of life yet to grieve. The national action plan announced by the President on his second day at work gives us inspiration that Americans will band together, even as it gives us hope where we are in other parts of the world that it will indeed be part of a global strategy. So here are my reflections.

First, returning to active membership at the World Health Organization was part of President Biden’s actions on Day One, but it was gracefully reinforced by announcing the appointment of Dr. Anthony Fauci to head the US delegation and his appearance before the WHO Executive Board currently in session on the very next day. How heart-warming it was to see this lone figure of reason and science in the previous administration’s flawed team to be freed at last! In his appearance the following morning, 21 January 2021, he very movingly said that he was honored to announce that the United States will remain in the WHO. (See his statement here.) As he explained, the President had sent a letter to the UN Secretary-General with a copy to the Director-General of the WHO, duly transmitted to both of them on 20 January 2021.

The letter was all that was needed to retract an earlier letter sent by the President’s predecessor (whose name we will not mention here) on 6 July 2020 that had announced this predecessor’s intent to withdraw the US from the WHO. Since withdrawal was “in process” but not yet verified as completed, this did not require any further action than a letter. But it still required the affirmations by Dr. Fauci in his 21 January statement that the drawdown of US staff seconded to the WHO would cease and that all financial obligations and technical collaborations would be reinstated. The US, said Dr. Fauci, will assume its full obligations as a member-state of the WHO and will work with other member-states to strengthen and reform the WHO.

Second, Dr. Fauci further affirmed that the US will also help with strengthening the COVID-19 global response and its impacts. He announced that President Biden would be issuing a directive later in the day to confirm the intent of the US to join the COVAX Facility and the ACT-Accelerator initiative. And in mid-afternoon on this second day, President Biden did appear before the media to announce a comprehensive seven-point national COVID-19 pandemic and pandemic preparedness strategy that included carrying through on this announcement.

Understandably, the emphasis is on the domestic challenges facing the Biden Administration on restoring trust, escalating domestic vaccine distribution, improving testing and other prevention strategies, scaling up production, dealing with racial and ethnic inequalities, and opening up schools and child care. But one of the seven goals of the detailed strategy is to “restore US leadership globally and build better preparedness for future threats”. The strategy document specifically mentions joining the COVAX Facility and the ACT-A initiative, and a commitment to “make recommendations on a framework for donating future U.S. vaccine surplus”. Oops! Surplus? Well, this is bothersome.

This reference to a surplus was further clarified in the directive signed today (21 January 2021) by President Biden. Sadly, the directive instructs his advisors to prepare “a framework for donating surplus vaccines, once there is sufficient supply in the United States, to countries in need, including through the COVAX Facility.”  (See the National Strategy here and the new directive here. The italics are mine.) Only after there is a “sufficient supply” in the US? I have to say that I am disappointed that this is the extent of the US commitment to the COVAX Facility. But I am not surprised. As I have observed in previous commentaries, the Biden campaign had committed to the importance of free vaccines for every American, and clearly the political environment in the US requires this priority for national distribution. I can still be disappointed about this.

At the WHO Executive Board this week, the WHO Director General Dr. Tedros spoke of the looming catastrophe in the unevenness of vaccine distribution already underway between rich and poor countries. And the global response requires more than an American “surplus”. What is more, the Chinese and the Russians are showing more readiness to distribute their vaccines to these countries in need than the EU or US are apparently willing to do.

Some of that has to do with the fact that there is no demand for Chinese and Russian vaccines in the US or Europe, but there does seem to be a major flaw in the way this is unfolding. European countries (and the other rich countries like Japan or Australia) may be guilty of hoarding the limited vaccine supply for their own citizens but perhaps less guilty than the US since the bulk of vaccine development has been in the US or is controlled by the US. And the readiness of President Biden to invoke the Defense Productions Act to ramp up domestic vaccine production without making it a global pool is very disappointing. Perhaps a Biden administration earlier in the pandemic would have made a difference. In any case, it is important that American funds are at least being added to the pool to underwrite the purchase and distribution of vaccines for and from the Facility.

A third initial observation about the US announcement(s) on the pandemic is that the US clearly sees its global leadership role as one to promote a comprehensive global health and global health security agenda. This is more than the promotion of global health; it is the articulation of the defense of global health for the sake of global security.  In fact, the Biden Administration has included among its announcements that the formally titled “Global Health Security Agenda” that had been launched in 2016 by the Obama Administration (and that had been disbanded in 2017) is being reinstated. I can’t disagree with this framework, given the shocking nature of how the COVID-19 pandemic swept across the world.

We know that more pandemics are possible and that biological threats are growing in number through the interplay of human health with animal health and the environment. So yes, a Global Health Security Agenda is appropriate. The bulk of this section of the National Strategy addresses the various steps to implement this reinstated agenda, including multilateral and humanitarian actions on COVID-19 but with a much broader focus on the unknown prospects of a future pandemic and the urgency of overall pandemic and biodefense preparedness.

Much more is happening on the US return to active participation in global health (and global health security), and future commentaries will tie them to my continuing interest in global multi-stakeholder collaboration.  But this commentary is only a preliminary reaction to the actions taken on global health in the first days of the Biden Administration. The COVAX Facility and the ACT-Accelerator are where multi-stakeholder collaboration has blossomed in the global response to the COVID-19 pandemic. It is good news that the US is back in the WHO and will be joining these initiatives, even if the commitment isn’t as globally fulfilling as I might have hoped. I sincerely hope that the US will support the multi-stakeholder framework of this model for global collaboration going forward. It would be especially welcome to apply the model to the efforts directed to being better prepared for future pandemics. Welcome back, America! So far, so good.

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