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Opinion | How to End the Covid Pandemic

Even with boosters, though, the United States, Britain, European nations and others could satisfy their own needs and still have an estimated 1.2 billion excess doses by the end of the year. The United States, for its part, has either donated or pledged about 600 million doses to other countries, which the Biden administration is quick to point out exceeds any other country’s commitment. But only 115 million of those doses have actually been donated, or about 1 percent of the 11 billion doses the world needs.

“We’re patting ourselves on the back for doing the bare minimum and doing more than any other country, but that’s not a great mark,” Matthew Rose, the head of U.S. policy at the Health Global Access Project, told The Washington Post. “If everyone’s failing, then we’re all failing together. We’re just the head of the people failing.”

Covax has also suffered from administrative and logistical problems. In Chad, for example, the program delivered 100,000 doses of the Pfizer-BioNTech vaccine in June, but five weeks later only 6,000 of them had been administered. Like many countries, Chad cannot move Pfizer doses outside major cities because of demanding storage requirements.

“The vaccine pileup illustrates one of the most serious but largely unrecognized problems facing the immunization program as it tries to recover from months of missteps and disappointments: difficulty getting doses from airport tarmacs into people’s arms,” Mueller and Rebecca Robbins reported for The Times last month.

It hasn’t helped that bureaucratic barriers imposed by Covax’s leadership have held up the disbursement of $220 million for countries to buy freezers. Nor has it helped that the Biden administration is funding its donation of doses by diverting hundreds of millions of dollars promised for vaccination drives in poorer nations. That has left countries with even fewer resources to transport doses to clinics, train people to administer shots and persuade people to get them.

To vaccinate the global population quickly, Biden and other leaders of rich countries will have to take these four key steps, argues Seth Berkley, the chief executive of the nonprofit organization that leads Covax:

  • Honor promises to donate doses now: Of the 600 million doses pledged to Covax so far, only 100 million have been delivered. More is needed, he says, and soon.

  • Enforce transparency: Covax has agreements with vaccine manufacturers for more than four billion doses, but it has often faced delays in getting them — potentially because manufacturers are giving preferential treatment to countries that have signed their own deals.

  • Make global vaccine access the first priority: Countries with pending orders for doses that they do not need should allow Covax to take their place in line.

  • Provide financial and technical support: Strengthening national health systems in lower-income countries to get shots into arms will not only help end the pandemic sooner but also leave in place systems that can be used to guard against future global health threats.

As the global supply of vaccines swells to meet demand over the coming months, Udayakumar, the Duke doctor, believes the fourth step may prove the toughest. “We’re nowhere near having the capacity in most low- and middle-income countries to be able to ramp up vaccinations at scale,” he said. “That’s not an excuse to keep supply away, but it should be a sign that we need to do more in terms of building capacity, so that every country is ready to ramp up vaccination as the supply is available.”

Do you have a point of view we missed? Email us at debatable@nytimes.com. Please note your name, age and location in your response, which may be included in the next newsletter.

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