U.S. Covid-19 Vaccine Donations to Poor Countries Fall Short of Target

President Biden made the pledge last September at a virtual summit with other world leaders. At the time, many poor nations had been waiting for months to get Covid-19 shots to their most vulnerable citizens after limited early supplies were bought up by the U.S. and Europe, and India had blocked exports of doses produced by the Serum Institute of India, the world’s largest vaccine maker. Hundreds of thousands of people died as the Alpha, Gamma and Delta variants swept across Africa, Asia and Latin America.

At the summit, Mr. Biden also endorsed an international effort to vaccinate at least 70% of people in low- and middle-income countries against the coronavirus, calling the global fight against the pandemic “an all-hands-on-deck crisis.”

The U.S. has shipped around 614 million doses, most of them made by

Pfizer Inc.

and

BioNTech SE,

to developing countries in Asia, Africa and Latin America. Some 10 million doses went to high-income countries, including Canada and South Korea.

European Union countries have donated around 500 million doses so far, out of a goal of 700 million by mid-2022, a spokeswoman for the European Commission said.

The donations, along with shots purchased by governments themselves and the World Health Organization-backed Covax program, contributed to significant advances in the international vaccination drive, with about 63% of the global population now fully vaccinated against Covid-19, according to Our World in Data, a project based at the University of Oxford. Some regions, including South America, where about 77% of the population is fully vaccinated, have surpassed the 68% vaccination rate in the U.S.

But many countries in Africa and low-income nations elsewhere have struggled to keep up. Only around 23% of Africans and 19% of people in low-income countries have received an initial full course of Covid-19 vaccines.

Vaccination rates are lowest in countries with conflicts and very poor infrastructure that made it difficult to get vaccines like the Pfizer shot, which needs to be stored at ultralow temperatures, into communities. In Yemen and the Democratic Republic of Congo, for instance, just 2.2% and 5.1% of people, respectively, have received at least one dose.

A senior Biden administration official said the donations have helped save an estimated 20,000 lives, but that vaccine hesitancy and barriers to access in many developing countries have complicated the U.S. effort. Some countries, the official said, are also dealing with other public-health priorities, such as ramping up childhood vaccinations that lagged during the height of the pandemic.

Due to these challenges, the administration has amended its contract with Pfizer, which was for up to 1 billion doses, to 600 million doses, with the option to buy the rest of the contract’s doses in the future, the official said.

Discussions are under way about how to use the savings from the amended contract, the official said. The White House declined to say what those savings amount to.

The official said that the administration had spent more than $1.7 billion on the global effort to get shots into arms, but that more funding was needed to address vaccine hesitancy.

The White House had asked Congress for $4 billion to support that effort, but Republicans have opposed granting more money, saying there hasn’t been a full enough accounting of funds spent so far. Some also say there are other unspent Covid-19 funds that should be used up first.

The smaller number of donations globally is concerning because it means a greater burden on healthcare systems in countries that have fewer resources, the official said.

Most of the U.S. donations were funneled through Covax, which was set up in 2020 to provide free Covid-19 vaccines to 92 of the world’s poorest countries. After spending much of 2021 pleading with vaccine makers and rich countries to make doses available, Covax is now working with donors and manufacturers to adapt shipments to limited demand for shots in recipient countries, a spokeswoman for the program said.

Public-health experts say there are multiple reasons for the low demand for Covid-19 shots in many African and low-income countries. Limited testing made it difficult to capture the real burden of the pandemic in most African countries, where for many people the economic impact of lockdowns weighed heavier than the disease itself.

By the time large numbers of vaccines arrived toward the end of 2021, around two thirds of Africans already had recovered from Covid-19, according to an analysis from the WHO. That, along with the emergence of the milder Omicron variant, helped limit hospitalizations and deaths from Covid-19 in 2022.

“Whenever there is delay [in accessing a vaccine or medicine], the focus and the urgency within members of the public shifts,” said Ahmed Ogwell, acting director of the Africa Centres for Disease Control and Prevention.

But medicines-access activists and people working on Covid-19 vaccinations in Africa also said governments and international donors did too little to communicate the need for vaccinations and counter misinformation. Civil-society groups that work with local communities on health education often struggled to get funding for outreach campaigns.

“You cannot just be shipping vaccines,” said Tian Johnson, co-chair of the African Union’s African Vaccine Delivery Alliance. “There needs to be a corresponding demand-creation strategy, because vaccines are not going to jump out of the fridge and jump into people’s arms by magic.”

Ritu Sharma, vice president at CARE USA, which has been supporting the Covid-19 response in around 60 developing countries, said after the early shortages there was too much focus on buying doses and not enough on helping countries roll out the vaccines.

“Because the doses were not going to be delivered with wraparound support, without helping front-line healthcare workers, without the transportation, without the cold chain, without all of the things that are needed, countries did not want to accept the vaccines,” she said.

Lumka Joni, a nurse in a public hospital in Queenstown, South Africa, where just 33% of the population is fully vaccinated, said the number of people coming in for Covid-19 shots has dwindled to almost nothing. “Sometimes we have to turn people away because you can’t open a vial for just one person,” she said, adding that those people are directed to other clinics that may already have an open vial.

In South Africa’s economic capital, Johannesburg, Sibusiso Vilakazi, who ekes out a living washing cars, said he didn’t see how getting a Covid-19 vaccine would better his circumstances. “I’m not sick,” he said, “and even those who got [the vaccine] thinking it will improve their chances of getting jobs, they are where they were before getting those vaccine certificates: jobless.”

—Thandi Ntobela in Johannesburg contributed to this article.

Write to Gabriele Steinhauser at [email protected] and Stephanie Armour at [email protected]