When President Biden announced in June that the United States would buy 500 million Pfizer-BioNTech coronavirus vaccine doses for poorer nations, there was a gaping hole in his plan: To fund it, the administration quietly diverted hundreds of millions of dollars that had already been promised to countries for helping to get shots into people’s arms.
Mr. Biden did not make the same mistake a second time.
His announcement on Wednesday that the United States was donating an additional 500 million Pfizer doses came paired with a promise of an additional $750 million for vaccine distribution, roughly half of it through a nonprofit involved in global vaccinations. That reflected a growing awareness on the part of global leaders that turning vaccines into actual vaccinations represents one of the most significant challenges of this phase of the pandemic.
Even so, the Biden administration’s schedule for shipping the newly announced Pfizer doses frustrated activists: Of the 1.1 billion doses that the United States has committed to donations, only 300 million are expected to be shipped this year. The longer the virus circulates around the world, the more dangerous it can become, even for vaccinated people in wealthy countries, scientists have warned.
“Purchasing doses for donation sometime next year is helpful, but it does not meaningfully expand the global supply, and it is not justice,” said Peter Maybarduk, the director of the Access to Medicines program at Public Citizen, an advocacy organization.
Some experts pleaded for more aggressive action by Mr. Biden to pressure American vaccine makers to share their formulas with nations that desperately need more shots.
“Where is the monthly calendar of what each wealthy country is going to deliver?” said Kate Elder, senior vaccines policy adviser for Doctors Without Borders’ Access Campaign. She added, “Where are the announcements about meeting the calls of regions and middle-income countries that are begging to be self-sufficient?”
It was not immediately clear how the administration was planning to allocate the new money for vaccine distributions. Some countries have been struggling to train and pay vaccinators and to transport doses. Pfizer doses present especially steep challenges: They must be stored at ultralow temperatures, requiring the installation of freezers and, in many cases, backup generators.
Early this year, supply shortages represented the most pressing problem for global vaccinations. Rich nations had raced to secure doses while slow-walking pledges of money and supplies to Covax, the United Nations-backed program to immunize the world.
But as those manufacturing difficulties have eased, different problems emerged. One was blatant inequality: More than 5.9 billion shots have been given globally, but overwhelmingly in wealthier nations. Another was that poorer countries had been left without the money needed to move shots from airport tarmacs into people’s arms.
Although the Biden administration’s pledges have outpaced those of most Western nations, analysts said other wealthy countries were setting an extraordinarily low bar.
Understand Vaccine and Mask Mandates in the U.S.
- Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
- Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.
- Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
- New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.
And even as countries have promised to donate more doses, they have been slow to follow through, with the World Health Organization saying that only 15 percent of promised donations have been delivered. The W.H.O. has set a target of vaccinating 40 percent of every country’s population this year, requiring wealthy nations to share doses significantly more quickly.
There remains considerable excess supply: Wealthy nations will have 1 billion more vaccines than they need by the end of 2021, even if they administer booster shots, according to Airfinity, a science analytics company.
Global health officials have urged wealthy nations to let go of those supplies before they expire. Some countries have donated vaccines so close to their expiration dates, and in such small quantities, that poorer countries have struggled to use them.
Some 11 billion doses are needed globally, and activists said on Wednesday that the wealthy world’s response remained far too piecemeal. The new Pfizer doses purchased by the U.S. will be shipped through Covax starting in January.