MUNICH – A storm is raging over the European Union’s failure to have ordered more of the approved COVID-19 vaccines ahead of time. Stéphane Bancel, the CEO of the US pharmaceutical company Moderna, which gained approval for its vaccine shortly after Pfizer/BioNTech, claims that the EU has relied too much on “vaccines from its own laboratories.”

Did the European Commission prioritize supporting its own pharmaceutical industry over protecting human lives? In fact, matters are not as simple as that. Contrary to what Bancel wants us to believe, the EU has actually ordered too little of its own vaccine. After all, the vaccine that is being administered most widely across the West was developed by a German company, BioNTech, and thus comes from the EU (though it was tested and partly produced in partnership with Pfizer in the United States and with Fosun Pharma in China).

Far from having ordered too little of the “American” vaccine, the EU sat back while the US and other countries stocked up on doses of a vaccine that was created and produced in a German lab. The EU is guilty not of protectionism, but of institutional inflexibility. The slow vaccine rollout in many European countries is the result of the EU’s failure to coordinate the interests of the various member states. Whereas some countries balked at the price of BioNTech’s mRNA vaccine, others were skeptical about its new gene-based technological underpinnings, and still others simply did not recognize the urgency of the situation, having assumed that the worst of the pandemic had already passed.

To be sure, an inter-European rivalry between national vaccine producers may have contributed to the EU’s unwillingness to preorder more of the German vaccine last summer, as America and other countries did. As a small start-up from Mainz, BioNTech had little chance of being heard above the din of lobbying at the European Commission by established European pharmaceutical giants.

Whatever the reason, the severe delay in the supply of vaccines in Europe is now a fact. While the US, the United Kingdom, Japan, and Canada jostled last July and August to secure huge batches of the BioNTech vaccine, the EU initially placed its orders only with Sanofi and AstraZeneca, both of which subsequently admitted difficulties in clinical trials. Not until November – when journalists started asking pointed questions – did the EU strike its first deal for a batch of the BioNTech vaccine. This was followed in December and early January by further purchases, including from Moderna.

Due to the delay in ordering, the deliveries are coming late. After all, producers are operating on a first-come, first-served basis and need time to build up new production sites. As a result, European news media are filled with forlorn images of empty vaccination centers that have run out of supply, alongside footage of overstretched intensive care units. A sense of imminent horror has seized a frightened European public. At this rate, the EU will have no chance of catching up with the US, the UK, Israel, and other leading vaccinators until this summer.

The EU contends that it diversified its orders early on because it couldn’t know which vaccine candidates would succeed. But that is a cheap excuse, considering that it still didn’t order nearly enough from any producer to be able to vaccinate its people in the event that only one vaccine candidate reached the approval stage – a distinct possibility at the time.

If the EU had taken the risk of purchasing enough doses to cover two-thirds of its population from each of the six producers it dealt with, it would have needed to spend just €29 billion ($35 billion). For comparison, that is how much income the EU economy has been losing over the course of just ten days of the COVID-19 crisis. And given that not one but two vaccines have now turned out to be highly effective, the EU would have ended up with a surplus of high-quality doses, which it could have donated to some 300 million people across the developing world.

No single decision-maker bears the blame for Europe’s vaccination debacle. But this episode should make clear that EU member states were wrong to entrust the European Commission with the purchase of vaccines last summer. Article 5 of the Treaty on European Union subjects the EU to the Subsidiarity Principle, which leaves political actions up to member states, except in cases where supranational action can be proven to be more efficient. When it came to securing an ample supply of vaccines, this principle was willfully ignored. There is neither the legal necessity nor a convincing economic justification for central planning in the procurement of vaccines. Had member-state governments been able to buy vaccines independently and in direct competition with other countries worldwide, they might have had to pay a slightly higher price, but they would have placed their orders much earlier to avoid missing the boat. And if orders had been placed earlier, vaccine producers would have been able to invest more in expanding their production capacities.

In the end, central planning and lobbying by established producers created Europe’s vaccine debacle. Europeans will now have to live with the consequences of an avoidable tragedy.

STANFORD – Strange as it may sound, vaccines are now the key to reviving the transatlantic relationship. Former President Donald Trump’s “America First” administration had left ties between the United States and its European allies badly frayed. So, in his address to the Munich Secutiry Conference in February, President Joe Biden thought it best to reaffirm America’s support for Article 5 of the North Atlantic Treaty: an attack on one NATO member would be considered an attack on all.

That is all to the good. Yet a speech is still a speech, and some wonder what Article 5 and the Alliance is worth when Europe’s shortage of COVID-19 vaccine supplies is putting European lives and livelihoods in danger while the US is swimming in doses. The Biden administration has not even pressed for Food and Drug Administration approval of the United Kingdom’s Oxford-AstraZeneca vaccine, despite having an estimated 60 million doses on hand.

There is no doubt about Biden’s desire to revitalize ties with Europe, which is why his administration must address this egregious vaccine imbalance and help the Europeans in their moment of need. The fastest way to do this – and to strengthen the transatlantic relationship – is US-European joint production of vaccines in Europe. Here, the Biden team should follow the model of the highly successful deal it brokered in the US, where Merck is manufacturing millions of doses of Johnson & Johnson’s (J&J) vaccine under license.

Cooperation in production and distribution across borders, and even oceans, is a more effective way to promote diplomatic objectives than simply selling vaccine supplies to the Europeans (though that is better than nothing at a time when Europe lags far behind the US in terms of vaccine delivery). Russia, not famous for sharing anything, understands this, and has just signed a deal to produce its Sputnik V vaccine in Italy, with similar arrangements reportedly in the works in France, Germany, and Spain.

By cutting such deals, the Kremlin has succeeded in leveraging a critical area, public health, while seeking to divide and hollow out the European Union. Given this, the obvious question is, why hasn’t the US government done more to push US pharmaceutical firms to agree to joint production agreements with European pharmaceutical firms?

True, Pfizer/BioNTech (which is a German firm) have a deal with Novartis to produce their vaccines in Marburg – 60 million doses per month at full capacity. And J&J’s vaccine is being produced in Leiden, with the company having signed in February a deal with Sanofi to produce 12 million doses per month in Marcy-l’Étoile, France. Moderna has now contracted with the Lonza Group to manufacture its vaccine in Switzerland.

But all of these moves came late (thanks to Trump), after it became clear that the EU was far behind in delivering vaccines to its citizens. And that inability to deliver vaccines gave both Russia and China a window of opportunity to position themselves as Europe’s health saviors, which they are now seeking to exploit.

By pushing joint vaccine ventures, US national security would be enhanced without an additional dime of defense spending. Just as the US cemented its ties with Europe after World War II with Marshall Plan aid, it should encourage as many cooperative vaccine production agreements as the Europeans need to meet their needs. The Marshall Plan helped to keep the Soviets out of Western Europe; joint production of vaccines in Europe would limit the malign (and costly) influence that Russia and China seek to exercise. Hungary, for example, is paying many times more for its Chinese vaccines than it would for the UK or US versions.

But jabs are only part of the story. The Biden administration has already made solid progress in mending US relations with Europe, particularly by ending a long-standing, and poisonous, dispute over aircraft production subsidies. Biden and Ursula von der Leyen, President of the European Commission, agreed in early March to suspend all tariffs imposed in the subsidies dispute for an initial period of four months.

This agreement’s commercial significance is matched by its symbolic importance as a signal of a revitalized transatlantic partnership. The aircraft dispute had started almost two decades ago, and the EU had imposed tariffs on US products worth roughly $4 billion, while the US levied tariffs on $7.5 billion of European goods. “Finally, we are emerging from the trade war between the US and the EU, which created only losers,” Bruno Le Maire, the French finance minister, said on Twitter.

But aircraft subsidies were not the only trade issue separating Europe from America. The tariffs Trump imposed on steel and aluminum from Europe on national security grounds remain in place. Gina Raimondo, the US commerce secretary, recently called the steel and aluminum tariffs “effective,” an indication the Biden administration will not soon repeal all of Trump’s protectionist measures. And there also remains the thorny dispute over US sanctions on German and other EU firms building the Nord Stream 2 gas pipeline to deliver Russian natural gas directly to Germany, bypassing Ukraine and Poland.

How can Europeans not be skeptical of Biden’s promise that “America is Back” when he refuses to stand up to the steel protectionists? For Biden, there is a fear that tariffs are popular with the working-class white voters the Democrats want to win back. Moreover, Republicans, and the steel industry and its unions remain behind them.

Biden’s preservation of steel tariffs represents a victory of domestic politics over sound foreign policy. But Biden also recognizes that an America estranged from its allies is a weaker America. By helping Europe produce vaccines within the Union, he will demonstrate not only that America is back, but that it is the far-sighted America of the Marshall Plan, not the sneering “America First” of Trump, that has returned.

OXFORD – In a recent letter to her G20 colleagues, US Secretary of the Treasury Janet Yellen argued that a truly global COVID-19 vaccination program “is the strongest stimulus we can provide to the global economy.” With rich countries vaccinating their populations while low-income countries have yet to receive even paid-for vaccine doses, the world seems a long way from that goal. But the first shoots of solidarity are beginning to appear, and leaders must strengthen cooperation to nurture them.

Such an approach is essential, because reopening the global economy requires containing the coronavirus everywhere. One recent study estimates that, even if advanced economies reach optimal vaccination levels by mid-2021, they could nonetheless suffer economic losses of up to $4.5 trillion this year if developing countries’ vaccine rollouts continue to lag far behind. Open economies such as European Union member states, Switzerland, the United Kingdom, and the United States would be most at risk, and output losses in sectors such as construction, textiles, retail, and automobiles could exceed 5%.

Uncoordinated vaccine distribution also poses grave health risks. Leaving poorer and needier countries out of the supply chain has resulted in the deaths of numerous desperately needed African frontline nurses and health workers. When Guinea declared an Ebola outbreak in February, the world relied on the country’s own health-care workers to roll out a containment and vaccination campaign. Without such workers, the world is more vulnerable to future pandemics: in 2014, for example, a single case of Ebola in the US caused nationwide panic when it spread to the nurses treating the patient.

But ensuring a speedy global vaccine rollout is proving difficult. The COVID-19 Vaccine Global Access (COVAX) Facility, established by three international health agencies to speed up vaccine production and distribution, needs more money. Otherwise, poorer countries will be forced to divert scarce budget resources or slow down vaccination programs against other diseases such as polio, measles, and meningitis.

More funding is also needed for the Access to COVID-19 Tools (ACT) Accelerator, which the World Health Organization and other partners created to develop tests, treatments, and vaccines to fight the disease. According to one estimate, a $10 billion US contribution to this initiative would safeguard up to $1.34 trillion in domestic output, giving America a more than hundred-fold return on its investment. Yellen’s letter to the G20 recognizes this logic, and the group agreed on February 26 that granting equitable access to safe COVID-19 vaccines, diagnostics, and therapeutics for all countries “is a top priority.”

But money is not the most immediate obstacle. African countries that have borrowed to purchase vaccines have discovered that there are no doses for them to buy. Although COVAX has concluded some deals for developing countries, by March 1 it had delivered only a few hundred thousand doses to Ghana and Côte d’Ivoire. A first shipment reached Nigeria on March 2. And Guinea has administered a total of 55 doses to date.

Some blame intellectual-property (IP) protections for developing countries’ lack of vaccine access. In late 2020, India and South Africa, as well as some NGOs, urged the World Trade Organization to waive current IP rules related to COVID-19, but the US, EU, and UK opposed the idea. Governments will debate the issue at the World Trade Organization in early March.

But patents are not (yet) the problem. The US pharmaceutical firm Moderna, which has developed an approved COVID-19 vaccine, has said that, while the pandemic continues, it will not enforce its coronavirus-related patents against those making vaccines intended to combat it. And AstraZeneca says that “for the duration of the coronavirus pandemic,” it will proceed “with only the costs of production and distribution being covered.”

Yet, these short-term arrangements will soon need attention. The voluntary licensing regime preferred by the UK and other rich countries may well be inadequate. At the least, policymakers should be considering non-exclusive licenses and technology transfer, as John-Arne Røttingen, who chairs the WHO Solidarity Trial of COVID-19 treatments, has proposed.

This still leaves two more immediate obstacles. First, there are manufacturing challenges related to increasing production speed. Each vaccine is different and relies on biological and chemical processes of variable efficacy that are sometimes difficult to scale up. And vaccine production requires intensive supervision and quality control. But these problems will ease as manufacturing improves and more vaccines – including a newly approved one from Johnson & Johnson – come on stream.

The other big problem is vaccine nationalism. Wealthy countries have stockpiled more COVID-19 vaccine doses than they need, and other governments also are competing to prove that they are procuring adequate supplies for their own citizens.

Two Brazilian research institutes had planned to produce millions of doses of the AstraZeneca-Oxford and Chinese Sinovac vaccines, but have been hampered by unexplained delays in shipments of vital ingredients from China. And the Serum Institute of India, the world’s largest vaccine manufacturer, was aiming to make more than 300 million doses available to 145 countries through COVAX in the first half of 2021, before the Indian government recently ordered it to meet domestic needs first.

Still, some encouraging signs of vaccine solidarity are emerging. Forty-seven countries, as well as the African Union, which has 55 member states, have made or been offered COVID-19 vaccine deals with China, India, or Russia. India has shipped nearly 6.8 million free doses around the world, China has pledged around 3.9 million, and Israel is offering 100,000.

UK Prime Minister Boris Johnson has pledged to donate most of his country’s surplus doses to poorer countries. Some other G7 leaders – including French President Emmanuel Macron – are making similar commitments, although the US government has declined to do so for now.

Rich-country governments must deliver on their solidarity promises. They need to donate vaccine doses immediately to protect frontline health-care workers in vulnerable countries. They need to contribute more to the ACT and COVAX initiatives to ensure a genuinely global rollout. And they need to work with their own countries’ pharmaceutical firms to deliver more transparent, non-exclusive licensing deals. Only this level of solidarity can restore global growth.

LONDON – The first vaccine deliveries by the COVID-19 Vaccine Global Access (COVAX) facility to Ghana, Nigeria, and Ivory Coast brought a glimmer of hope to African countries keen to start immunizing their populations against the disease. But while COVAX is ramping up deliveries, its mission to provide rapid, fair, and equitable access to COVID-19 vaccines to people everywhere is being threatened by rich countries ordering more than they need. This worrying global imbalance in vaccine distribution could hold back Africa’s recovery and prolong the pandemic worldwide.

COVAX is the world’s best opportunity to avoid this scenario. Never before has the entire global population simultaneously needed a vaccine against the same disease, and COVAX is enabling remarkable collaboration to meet the challenge, bringing together governments, global health organizations, the private sector, scientists, and many other partners to develop, manufacture, and deliver vaccines.

We will ultimately measure the success of this unprecedented undertaking over several years, if not decades. But COVAX is already on track to deliver two billion COVID-19 vaccine doses to countries of all income levels in 2021, and has the world’s most diverse and actively managed vaccine research-and-development portfolio. The goal is to ensure that the most vulnerable populations receive COVID-19 vaccines by the end of this year.

And yet developing countries must compete with wealthy countries, some of which have ordered sufficient vaccine supplies to vaccinate their populations several times over. The African Union (AU), by contrast, has ordered vaccines for only 38% of the continent’s population, and even if countries want more, supplies are not immediately available. Some even fear that vaccine manufacturers may be focusing on fulfilling bilateral agreements with wealthy countries, instead of delivering doses to COVAX.

Fears about lagging vaccine supplies may be contributing to African authorities’ efforts to source vaccines elsewhere. The AU has set up the African Vaccine Acquisition Task Team (AVATT), a platform for African countries to preorder and purchase vaccines. Russia has offered 300 million doses of its Sputnik V vaccine for purchase through AVATT, but it is unclear when such doses might be delivered, or at what price. Meanwhile, some governments are pursuing bilateral arrangements. South Africa has paid $5.25 per dose of the Oxford-AstraZeneca vaccine, more than double the price that European countries are paying. Zimbabwe is using the Chinese Sinopharm vaccine, and Nigeria’s health authorities have announced that they are in discussions with Russia and India to procure vaccines.

Although the costs of many of these bilateral deals are unclear, they are happening outside of COVAX, which is committed to negotiating the most affordable price for the vaccines it procures.

COVAX can succeed as a central mechanism for ensuring equitable vaccine access, but not if countries pursue their own interests or are forced to procure doses in other ways. Some countries appear to be using their vaccines to advance political ends. While the AU has shown leadership by establishing AVATT, it should continue to coordinate with COVAX to avoid duplicating or undermining collective efforts.

At the same time, COVAX itself should focus on supplying higher volumes to low- and middle-income countries (LMICs), including African countries. Currently, the scheme aims to provide vaccine doses to at least 20% of these countries’ populations by the end of 2021, which is lower than many African governments would like. The Africa Centers for Disease Control and Prevention has set a target of vaccinating 35% of Africa’s population this year, and eventually at least 60%, which is consistent with the goals of higher-income countries.

COVAX ultimately aims to supply LMICs with as many as 1.8 billion doses in 2021, contingent on funding and supplies. African governments should therefore align their efforts with COVAX to ensure that these goals are met. This would offer the best prospect of ending the pandemic as quickly as possible, while ensuring transparency and rigor regarding vaccine safety.

Ultimately, COVAX’s purpose is to enable equitable access to COVID-19 vaccines. Making Africa wait is unfair and unwise. Although overall case numbers are much higher in Europe and the US, Africa’s need to protect frontline workers and other vulnerable groups is no less urgent. The longer it takes to vaccinate the region’s population, the greater the risk that new coronavirus variants will emerge that can again threaten the world.

Many countries understandably regard their own citizens’ health and economic welfare as the top priority. But no one will be safe from COVID-19 until we all are. COVAX remains our best tool for expanding vaccine protection, and rich- and poor-country governments alike must support it.

The views expressed in this commentary are the author’s own.

NEW DELHI – As countries scramble to secure COVID-19 vaccines, ugly expressions like “vaccine race” and “vaccine nationalism” have entered the global lexicon. But, at a time when global cooperation in sharing vaccines is minimal, and the World Health Organization’s vaccine-distribution plans are yet to get off the ground, India has taken a different tack, quietly pursuing “vaccine diplomacy.” Its “Vaccine Maitri” (Vaccine Friendship) campaign has shipped hundreds of thousands of Indian-made Covishield vaccines, manufactured under license from Oxford-AstraZeneca, to some 60 countries.

India is a global pharmaceutical powerhouse, manufacturing some 20% of all generic medicines and accounting for as much as 62% of global vaccine production, so it was quick off the mark when the pandemic struck. Before COVID-19 vaccines were developed, India supplied some 100 countries with hydroxychloroquine and paracetamol, and sent pharmaceuticals, test kits, and other equipment to around 90 countries. Later, even before the Oxford-AstraZeneca vaccine was approved, Adar Poonawalla, the 40-year-old head of the privately-owned Serum Institute of India, audaciously decided to manufacture it – a billion-dollar gamble. When approvals came, SII was able to churn out millions of doses, making them available to the government both for domestic use and export.

Indian vaccines have been flown to most of the country’s neighbors, including Afghanistan, Bangladesh, Bhutan, Sri Lanka, the Maldives, Myanmar, and Nepal, and also farther afield, to the Seychelles, Cambodia, Mongolia, and Pacific Island, Caribbean, and African countries. Vaccines have helped mend strained relations with Bangladesh and cement friendly ties with the Maldives.

To be sure, China and Russia are promoting their own vaccines, and Western drug companies are raking in a publicity bonanza (along with a share-price windfall). But in developing vaccines for its own use, the Global North overlooked the prohibitive cost of the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines for poorer countries. Indian-made vaccines, on the other hand, are reportedly safe, cost-effective, and – unlike some others – do not require storage and transport at very low temperatures.

India’s vaccine diplomacy is, of course, not purely altruistic. When the country’s first prime minister, Jawaharlal Nehru, laid the foundations of India’s science and technology infrastructure, his intentions were expressed in noble, humanist, and universalist terms. But his successors have long recognized how India can leverage its scientific and medical skills to enhance its geopolitical standing. At a time when most richer countries are criticized for hoarding vaccine doses, India stands out for having sent 33 million to poorer countries, with millions more in the pipeline.

There is also an unspoken subtext: rivalry with China, with which tensions have intensified following clashes along the Himalayan frontier. Not only has India overshadowed China as a provider of cheap and accessible vaccines to the Global South; it has been quicker and more effective. For example, China has announced 300,000 doses for Myanmar but is yet to deliver any, while India quickly supplied 1.7 million. Similarly, Indian vaccines beat China’s into Cambodia and Afghanistan.

When a credibility crisis consumed China’s vaccines in pandemic-ravaged Brazil, with polls showing 50% of Brazilians surveyed unwilling to take the Sinovac vaccine, President Jair Bolsonaro turned to India, which came through promptly. Tweeting his thanks, Bolsonaro illustrated his gratitude with an image from India’s Ramayana epic, depicting Lord Hanuman carrying an entire mountain to deliver the life-saving herb Sanjeevani booti to Lanka.

Indian vaccines are arriving even in richer countries. The United Kingdom has ordered ten million doses from SII. Canada, whose prime minister, Justin Trudeau, has riled his Indian counterpart, Narendra Modi, more than once, telephoned Modi to ask for two million vaccines; the first half-million were delivered within days. Trudeau effusively declared that the world’s victory over COVID-19 would be “because of India’s tremendous pharmaceutical capacity, and Prime Minister Modi’s leadership in sharing this capacity with the world.”

India is using the country’s capacity in this sector subtly to advertise an alternative to China’s economic and geopolitical dominance. While China has been secretive in releasing data about its vaccines, leading to controversies over the efficacy of them, India organized trips for foreign ambassadors to visit pharmaceutical factories in Pune and Hyderabad.

The contrast with the behavior of wealthier countries is no less striking. According to Duke University’s Global Health Institute, developed countries with 16% of the world’s population – including Canada, the United States, and the UK, each of whom have guaranteed enough supplies to vaccinate their populations several times over – have secured 60% of global vaccine supplies for themselves. Other countries commandeering supplies exceeding their domestic needs include Australia, Chile, and several European Union members.

The world is paying attention to India as it shares its available vaccine supplies, instead of choosing the nationalist course of blocking exports. India has also offered 1.1 billion vaccine doses to the WHO’s COVAX program to distribute COVID-19 vaccines to poorer countries. As Modi has tweeted, “We are all together in the fight against this pandemic. India is committed to sharing resources, experiences, and knowledge for global good.”

If there is a concern, it is that India has exported three times as many doses as it has administered to its own people. The country is lagging behind its own target of immunizing 300 million people by August, after vaccinating some three million health-care workers in a campaign that began on January 16. And mounting concern about rising case numbers, the emergence of COVID-19 variants that may not respond to existing vaccines, and an economy that has not yet fully recovered, will intensify the challenge India confronts in fulfilling its obligations to developing countries while also meeting domestic demand.

Meeting that challenge is a vital national interest. India’s vaccine diplomacy has been a boon to the country’s aspirations to be recognized as a global power. In combating the pandemic, it has gone well beyond the routine provision of health care or the supply of generics. To be sure, it is uncertain whether promoting soft power through health-care exports significantly boosts a country’s position in the global order. But if and when the permanent seats at the United Nations Security Council are ever rearranged, grateful governments will know who has done the most to save a world reeling from the onslaught of a deadly pathogen.

BEIJING – Evolutionary pressures accompanying the spread of the coronavirus have driven the COVID-19 pandemic into a phase in which new variants are starting to pop up everywhere. In response, governments around the world are racing to vaccinate enough people to achieve herd immunity before the virus acquires a mutation that nullifies existing vaccines’ effectiveness. Sadly, in many emerging and developing economies, this race is being lost, leaving everyone vulnerable to new strains. But it doesn’t have to be this way.

The global deployment of COVID-19 vaccines has so far been an ugly free-for-all, with rich and large countries winning out. At this point, many emerging and developing economies probably will not achieve meaningful levels of vaccination until the end of this year, at the earliest. And many of these countries may never get vaccines that have already been pre-purchased, because manufacturers have massively overpromised what they can deliver. Worse, there is now a distinct possibility that the vaccines, even if they do arrive, will no longer be effective, owing to the proliferation of new variants.

But these delays and global-governance failures could yet be made into an opportunity. Because the situation calls for mass-vaccination drives on a global scale, such efforts could serve as a platform for ambitious international initiatives to improve health-system resilience, prepare for future pandemics, and work toward universal health coverage. The recent start of deliveries under the COVID-19 Vaccine Global Access (COVAX) mechanism for vaccine finance and deployment is very encouraging.

The stars are aligned for precisely such a global strategy. For once, health is atop the global agenda, with world leaders and finance ministers eager to listen. US President Joe Biden’s administration has brought hope of global leadership and proper funding for efforts to reach poorer countries. Biden’s reversal of Donald Trump’s decision to withdraw the United States from the World Health Organization will provide much-needed authority and resources to that indispensable body. We must not squander this opportunity.

Vaccine deployment, with an emphasis on primary care for delivery, requires mobilizing a broad range of capacities, including transportation, storage, and logistics infrastructure. Moreover, most immunization systems are currently focused on delivering childhood vaccines and will need to be adapted to reach adult populations.

Governments are already drawing up national plans to deal with difficult questions such as which vaccine recipients to prioritize. Health officials are updating information and monitoring systems, identifying vaccination sites, targeting hard-to-reach populations, and preparing communication tools to address vaccine hesitancy and other challenges.

As a first step in establishing a more robust framework, the COVID-19 vaccination infrastructure should be retained to deliver vaccines against other diseases. Many vaccination programs and health interventions have been postponed or put on hold as a result of the pandemic. We should now be looking for opportunities to reactivate them. At a minimum, it is critical that health workers around the world be vaccinated against other illnesses such as hepatitis B and influenza.

Administering COVID-19 vaccines calls for upgrades to, or the creation of, delivery infrastructure, particularly for the vaccines that require cold storage chains. But to retain this infrastructure after the pandemic, it will have to be made sustainable. Introducing solar power into vaccine logistics chains and basic health units in remote areas could provide huge long-term benefits in poor countries with unstable power supplies or unreliable electricity grids.

Expanding immunization to adult populations also will require extra training. Here, we should be considering how digital platforms and artificial intelligence might be used to train health workers, volunteers, and non-medical personnel around the world. The same technologies could also be used to disseminate critical public health messaging against non-communicable diseases such as diabetes, or to expand smoking-cessation programs.

In the months ahead, governments and health-care providers will need to collect an extraordinary amount of information about who was vaccinated with what vaccine at what time. Vaccine registries will have to be upgraded or built from scratch, and modern digital infrastructure will need to be developed and expanded widely. Fortunately, these data banks can be enriched or synced with additional health information – possibly using blockchain technology to protect privacy – and then used to improve delivery of care, or to enhance disease surveillance and other preventive measures.

Finally, and perhaps most crucially, the COVID-19 vaccination effort could lead to more pharmaceutical production and even research in the emerging and developing world. India is already an important drug and vaccine producer, but the world will need even more regional production and logistics hubs, particularly if the COVID-19 virus becomes endemic, as many epidemiologists fear. Existing governance structures to prevent counterfeits and black-market activity will need to be reinforced. Though this implies some up-front costs, it will yield long-term benefits for health infrastructure in these countries.

Making the most of the COVID-19 vaccination effort will require leadership at the highest level. As the current occupant of the G20’s rotating presidency, Italy – now with Prime Minister Mario Draghi’s experienced hand on the tiller – could work with the United Kingdom, the current G7 chair, and the newly empowered WHO to seize the opportunities on offer. Now is the time to leverage the skills and financing capacities of multilateral development banks, non-governmental organizations, and the private sector.

The unprecedented speed with which COVID-19 vaccines were developed represents a signal achievement for humanity. With just a little foresight, we can leverage that success into equally impressive improvement in global health, longevity, and life satisfaction.

BOSTON – Although mass vaccination campaigns are picking up speed in the West, the end of the COVID-19 pandemic still is not even in sight. For that, the United States and other rich countries have only themselves to blame.

It has been clear at least since the early summer of 2020 that even with effective vaccines in hand, COVID-19 will not be stopped until populations everywhere have achieved herd immunity – when the share of people still susceptible to infection is so small that the disease can no longer spread. It isn’t enough for any individual country to reach this point. As long as the virus is still circulating in other parts of the world, random mutations will continue to occur. Some will be disadvantageous to the virus, but some will render it even more contagious or deadly.

Again, we already know this. Just since December, three highly infectious strains of the SARS-CoV-2 virus have been identified. With a significantly higher transmission rate (and potentially a greater fatality rate), the British variant, B.1.1.7, is already spreading rapidly within the US and Europe. The South African variant, B.1.351, may be even more contagious. And the Brazilian strain, P.1, may be the most dangerous of all.

The emergence of new variants means that even when the United Kingdom reaches herd immunity (as seems likely at the current vaccination rate), Britons still will not be out of the woods. Unless the UK seals itself off completely from the rest of the world (which is essentially impossible), those who travel outside the country will bring back new variants, and some of these could be capable of bypassing the protections afforded by the current vaccines.

P.1 is especially worrying. It emerged in Manaus, which by last October recorded an infection rate of almost 80%, above the 60-70% threshold that scientists estimate to be sufficient for herd immunity against COVID-19. But because more infections allow for more mutations, being above the herd-immunity threshold may not be enough. Indeed, the emergence of P.1, which pummeled the city with another wave of infections, implies that immunity against the initial virus did not provide immunity against the new variant.

True, scientists should be able to reprogram the vaccines to be effective against the new variants once they have been identified; that is one of the advantages of the mRNA technology underpinning the Moderna and Pfizer-BioNTech vaccines. But this flexibility is small consolation after a variant enters a country and forces economic and social life back into a state of lockdown. Once this happens, the entire population must queue up again for booster shots.

This whack-a-mole scenario can be avoided if the rest of the world gets vaccinated quickly, halting the virus’s spread and thus its opportunities to acquire new mutations. But worldwide vaccination seems impossible at the moment, because not enough doses are being made available in the developing world. Had we managed to provide the two billion doses sought by the World Health Organization’s COVAX program, it would still have been exceedingly difficult to achieve widespread vaccination in remote parts of Africa, Asia, and the Middle East, owing to a lack of basic health infrastructure and transport networks.

With Johnson & Johnson’s new one-shot vaccine, which doesn’t need the cold-supply-chain logistics required by the mRNA vaccines, there should be a fighting chance. Tragically, though, vaccine nationalism is still standing in the way. With the rollout of Chinese and Russian vaccines, we may be able to produce enough vaccines to supply the entire world. What we lack, however, is international cooperation.

Coordinating the global delivery of vaccines is crucial for ending the pandemic. For example, it stands to reason that the most effective vaccines should be administered in areas where the virus is spreading the fastest. An additional complication is that there is currently limited reliable data on the Chinese vaccines. We may need to allow for the possibility that they are less effective than others and that the virus could have a better chance of continuing to spread and mutate in populations that have received these vaccines.

Despite the precariousness of the situation, Western governments and business lobbies are busy coming up with bad ideas instead of attempting to provide more vaccines to the developing world. The worst of these, now under consideration in both the US and the European Union, is a proposed “vaccine passport” that would allow those who have been vaccinated to travel internationally.

Now, there is good argument for granting vaccinated people credentials to access crowded indoor spaces, thus encouraging vaccine uptake. But with its singular focus on opening up global travel, a vaccine passport is a terrible idea for a world in which the virus is still spreading and mutating as a result of our failure to vaccinate everyone. Vaccine passports do not provide protection against new variants such as P.1. All it would take is one rich businessperson or tourist with a vaccine passport and a new variant to trigger an epidemic in a country that thought it had achieved herd immunity.

These problems will multiply until we start treating the pandemic as the global crisis that it is. In a world without international cooperation, a country that succeeds in vaccinating most of its population has only one defense: to abandon the most basic tenets of globalization. At a minimum, all international travelers should be required to quarantine for two weeks in carefully monitored sites, regardless of whether they are nationals or foreigners, and regardless of whether they have been vaccinated against the known variants.

Even this basic measure would represent a huge step back from globalization. But if Western countries continue to focus solely on vaccinating their own populations while ignoring the need for global coordination, they should prepare for a future without unencumbered international travel.