The Trump administration said it will not join a global effort to develop, manufacture and equitably distribute a coronavirus vaccine, in part because the World Health Organization is involved.
More than 170 countries are in talks to participate in the Covid-19 Vaccines Global Access [Covax] Facility, which aims to speed vaccine development and secure doses for all countries and distribute them to the most high-risk segment of each population.
The plan, which is co-led by the WHO, the Coalition for Epidemic Preparedness Innovations and Gavi, the vaccine alliance, was of interest to some members of the Trump administration and is backed by traditional U.S. allies, including Japan, Germany and the European Commission, the executive arm of the European Union.
But the United States will not participate, in part because the White House does not want to work with the WHO, which President Donald Trump has criticized over what he characterized as its "China-centric" response to the pandemic.
"The United States will continue to engage our international partners to ensure we defeat this virus, but we will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China," said Judd Deere, a spokesman for the White House.
Already, a handful of the dozens of experimental covid-19 vaccines in human testing have reached the last and biggest hurdle in the U.S. -- looking for the needed proof that they really work. A U.S. advisory panel suggested Tuesday a way to ration the first limited doses once a vaccine wins approval.
"America is taking a huge gamble by taking a go-it-alone strategy," said Lawrence Gostin, a professor of global health law at Georgetown University.
Kendall Hoyt, an assistant professor at Dartmouth's Geisel School of Medicine, said it was akin to opting out of an insurance policy.
The United States could be pursuing bilateral deals with drug companies and simultaneously participating in the coalition effort, she said, increasing its odds of getting some doses of the first safe vaccine. "Just from a simple risk management perspective, this [decision] is shortsighted, she said.
The U.S. move also will shape what happens elsewhere. The idea behind the vaccine coalition is to discourage hoarding and focus on vaccinating high-risk people in every country first, a strategy that could lead to better health outcomes and lower costs, experts said.
Some members of the Trump administration were interested in a more cooperative approach but were ultimately overruled.
Health and Human Services Secretary Alex Azar and Deputy Secretary of State Stephen Biegun had interest in exploring some type of role in the global effort, a senior administration official said, speaking on the condition of anonymity because they were not authorized to discuss the decision-making.
But there was resistance in some corners of the government and a belief that the United States has enough coronavirus vaccine candidates in advanced clinical trials that it can go it alone, according to the official and a former senior administration official who learned about it in private discussions.
An unlikely worst-case scenario, experts said, is that none of the U.S. vaccine candidates are viable, leaving the United States with no option since it has rejected the cooperative effort.
Another possibility is that a U.S. vaccine does pan out, but the country hoards doses, vaccinating a large number of Americans, including those at low risk, while leaving other countries without.
Experts in health security see at least two problems with this strategy: The first is that a new vaccine is unlikely to offer complete protection to all people, meaning that a portion of the U.S. population will still be vulnerable to imported cases -- especially as tourism and trade resume.
The second, related problem is that a U.S. recovery depends on economic recovery elsewhere. If large parts of the world are still in lockdown, the global economy is smarting and supply chains are disrupted, the United States will not be able to bounce back.
Proponents of a multilateral approach to global public health would like to see all countries coordinate through the Covax effort. Perhaps unsurprisingly, interest is strongest from poor countries, while some larger economies are cutting deals directly with drugmakers.
WHO officials have argued that countries need not choose -- they can pursue both strategies by signing bilateral deals and also joining the cooperative effort.
"By joining the facility at the same time that you do bilateral deals, you're actually betting on a larger number of vaccine candidates," Mariangela Simao, a WHO assistant director for drug and vaccine access, said at an Aug. 17 briefing.
If nothing else, the United States could pledge surplus doses to the Vaccines Global Access Facility to ensure they are distributed in a rational and equitable way, experts said.
The decision to steer clear of the cooperative effort comes at a time of tremendous change for health diplomacy.
The United States has long been the biggest donor to the WHO and a major funder of vaccine initiatives.
In the early days of the coronavirus pandemic, Trump praised both China and the WHO for their handling of the outbreak. But as the crisis intensified in the United States, he turned on the U.N. health agency.
In April, he announced a freeze on new U.S. funding. Not long after, the State Department started stripping references to the WHO from fact sheets and rerouting funds to other programs.
By July, the administration had sent a letter signaling its intent to withdraw from the WHO.
But untangling the United States from the agency it helped found and shape is not simple -- and the terms of the separation are still being assessed.
It is not yet clear, for instance, whether a U.S. withdrawal means the United States will just stop its contributions to the WHO or whether it will stop funding any initiative linked to the agency in any way.
For instance, the White House no longer wants to work with the WHO, but the United States is a major supporter of Gavi, which co-leads the Covax project.
Asked to comment on the Covax decision, a State Department spokeswoman pointed to U.S. funding for Gavi, as well as money for such programs as UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, said the White House could still reverse course and join Covax, or at least let the Senate fund through Gavi -- a political workaround.
AstraZeneca announced Monday that its vaccine candidate has entered the final testing stage in the U.S. The Cambridge, England, company said the study will involve up to 30,000 adults from various racial, ethnic and geographic groups.
Two other vaccine candidates began final testing this summer in tens of thousands of people in the U.S. One was created by the National Institutes of Health and manufactured by Moderna Inc., and the other developed by Pfizer Inc. and Germany's BioNTech.
"To have just one vaccine enter the final stage of trials eight months after discovering a virus would be a remarkable achievement; to have three at that point with more on the way is extraordinary," Azar said in a statement.
National Institutes of Health Director Francis Collins tweeted that his agency "is supporting several vaccine trials since more than one may be needed. We have all hands on deck."
AstraZeneca said development of the vaccine, known as AZD1222, is moving ahead globally with late-stage trials in the U.K., Brazil and South Africa. Further trials are planned in Japan and Russia. The potential vaccine was invented by the University of Oxford and an associated company, Vaccitech.
Meanwhile, a U.S. advisory panel released a draft plan Tuesday for how to ration the first doses of vaccine. The National Academies of Sciences, Engineering and Medicine proposed giving the first vaccine doses -- initial supplies are expected to be limited to up to 15 million people -- to high-risk health care workers and first responders.
Next, older residents of nursing homes and other crowded facilities and people of all ages with health conditions that put them at significant danger would be given priority. In following waves of vaccination, teachers, other school staff members, workers in essential industries, and people living in homeless shelters, group homes, prisons and other facilities would get the shots.
Healthy children, young adults and everyone else would not get the first vaccinations, but would be able to get them once supplies increase.
The panel of experts described "a moral imperative" to lessen the heavy disease burden of covid-19 on Black Americans, Hispanics, American Indians and Alaska Natives, and suggested state and local authorities could target vulnerable neighborhoods using data from the Centers for Disease Control and Prevention.
The National Academies will solicit public comments on the plan through Friday.
Information for this article was contributed by Emily Rauhala and Yasmeen Abutaleb of The Washington Post; and by Lauran Neergaard, Carla K. Johnson and Danica Kirka of The Associated Press.