When President Joe Biden entered office, he promised the U.S. would become a leader in the effort to vaccinate the world, carrying out a campaign divorced from politics to ship millions of doses to countries in need to help end the pandemic.
His aides have pledged from the podium and in front of lawmakers that the administration would not use the vaccine to curry diplomatic favors the way Russia and China have. But a recent trip by Bill Richardson, the former Democratic governor from New Mexico, to Myanmar is raising concerns among global health advocates and even senior Biden officials about the extent to which the U.S. is mixing politics with public health needs in deciding where to send its vaccine doses, according to two senior officials working on the effort to distribute the vaccine globally and three people familiar with the matter. All spoke on the condition of anonymity in fear of offending the White House and to discuss internal administration deliberations freely.
Richardson, a former ambassador to the United Nations with previous experience working in Myanmar, traveled to the Southeast Asian nation’s capital last month on a private mission to meet with the country’s military junta to discuss the possible shipment of U.S. vaccine doses to the country and to help secure the freedom of imprisoned American journalist Danny Fenster. Richardson was the first major western figure to meet with the military leaders since they carried out a violent coup in February — an event widely condemned by the international community.
The former governor traveled to Myanmar after receiving a green light from the State Department, according to two individuals with direct knowledge of the meetings. Richardson spoke with military leaders about the logistics behind getting U.S. doses into the country and the importance of freeing Fenster despite his sentence of 11 years in prison, those people said, adding that Richardson was in constant communication with the State Department during the visits. Fenster flew home to the U.S. with Richardson Nov. 16. And a deal to send U.S. doses to Myanmar is currently under consideration by the Biden administration and COVAX, the global vaccine equity effort, according to those people and a senior Biden official.
Despite repeated requests, Richardson declined to speak to POLITICO. One of the individuals with direct knowledge of Richardson’s meetings said he did not discuss the vaccine and Fenster’s freedom “in the same meeting” and that the military junta did not make a formal request for doses. A State Department official told POLITICO that Richardson had “no authority to act as a representative of the U.S. government” and was not authorized to make promises of vaccine deliveries.
“The idea that he was in any position to make a promise or to suggest there could be some reciprocity is totally false,” that official said.
However, the U.S. discussed with Myanmar officials the possibility of sending vaccine doses for months and representatives from both countries have met to talk about the vaccine in Washington and at the U.S. embassy in Yangon, Myanmar, the State Department official said. Representatives of COVAX have also been involved in those discussions, another senior Biden official said, and have been working to get the vaccine to Myanmar and ensure shots get into arms equitably.
The discussions around vaccine delivery to Myanmar, including those that took place during Richardson’s trip, raise questions about how the U.S. is making decisions about its donations, whether officials are factoring in political considerations in that process and why the U.S. is earmarking doses for specific countries rather than relying strictly on COVAX — an organization that uses its own algorithm and factors in a country’s ability to distribute doses locally.
Richardson’s trip is not the first to draw attention internally within the Biden administration among officials tapped to work on the international distribution effort. In June, a group of senators flew to Taiwan for a congressional member trip and announced, to the surprise of officials, that the U.S. would send Taipei more than 700,000 doses.
The Taiwan announcement fueled concerns that the administration was holding out the possibility of help in fighting Covid-19 in order to obtain diplomatic favors such as reassuring Taipei about the level of U.S. commitment in protecting it against a possible Chinese invasion.
The administration denied any quid pro quo in either case, but critics — including some of its own officials, speaking on the condition of anonymity — noted that they came at a time when the interagency process originally established to facilitate the U.S. shipment of vaccine overseas has broken down. When the Biden administration first began donating doses to the rest of the world in the spring, the administration had formed a working group composed of officials from the State Department, USAID and the National Security Council to facilitate the shipments.
But over the past several months, officials from the various agencies have disagreed on where and when to send doses. Two of the senior Biden officials said the White House has centralized the process, making decisions about allocations with little transparency or involvement of other agencies.
“The White House is making all the decisions,” the official told POLITICO. “It’s a sore spot for a lot of people.”
The notion that politics or diplomacy could play a role in determining which countries receive vaccine donations sparks broader concerns than fairness. Such donations have the potential to upend the global fight against Covid-19 by diverting doses to countries that are not ready to receive doses or are not in need of supply, health advocates have warned, potentially preventing vaccine products from reaching areas that are considered the most fertile ground for the emergence of dangerous new variants.
The working group established to help facilitate shipments was supposed to develop a concrete rubric for making allocations based on objective public-health considerations similar to those in the algorithm used by COVAX. But those guidelines were never formalized, officials said.
To date, the U.S. has shipped more than 275 million vaccine doses overseas — more than all other countries combined. But that only covers a small percentage of the billions of people in low- and moderate-income nations who lack inoculation. And the U.S. practice of earmarking donations to specific countries — a practice also carried out by Europe and other wealthy countries — has complicated COVAX’s operations on the ground, according to global health advocates and U.S. officials working on the global effort to vaccinate the world.
“There are a lot of things that both the donor countries … could do to speed things up that we are pushing really hard for. Some of the things that could speed it up are if countries could just let us allocate freely instead of earmarking,” said Lily Caprani, head of advocacy for health and pandemic response at UNICEF, of the rush to give more low- and middle-income countries vaccine. “We just need to be able to deliver them where they're needed.”
Seth Berkley, the CEO of Gavi, the group helping finance COVAX, added, “If somebody says ‘Gee, we want this to go to Africa,’ it's pretty easy for us. But if somebody comes in and says, ‘We want these doses — and they’re short shelf life doses — to go to this country,’ you don't know at that moment [if it’s even feasible]. Because once we talk to the country, they say, ‘Oh, well, we're just getting this dose or that dose,’ or ‘We still haven't rolled out these other doses we have.’ That's the problem.”
In response to criticism over earmarking, a senior USAID official told POLITICO that the administration has practiced the earmarking of doses “very little.”
“There were some of the doses from our domestic surplus … we did initially designate for specific countries,” the official said. “But we did that in consultation with COVAX and with the EU,” the official said.
Internal dissensions hamper vaccine push
A lack of guidelines for international vaccine donations has plagued the Biden administration from its earliest days. Under the Trump administration, the Department of Health and Human Services had concocted a strategy to do so — but it never saw the light of day, according to two Trump officials who worked on it. It took months for the new administration to put in place plans to eventually ship doses overseas.
In April, once the administration believed it had obtained enough shots to inoculate all Americans, it pulled together a working group to develop a strategy for distributing doses internationally and prioritizing countries in need.
The group was composed of officials from the White House, State Department, National Security Council and the U.S. Agency for International Development (USAID). The National Security Council worked as the coordinating body. The State Department brought on Gayle Smith, a former USAID administrator with a proven track record of helping some of the world’s poorest countries to combat the spread of preventable diseases. And USAID tapped Jeremy Konyndyk as executive director of its Covid-19 task force to work closely with Smith on developing a plan to send doses overseas.
The initial, two-pronged mandate was to figure out how to facilitate the shipment of U.S. vaccine doses overseas and to take charge in doling out cash for other global Covid-19 aid efforts, such as the procurement of oxygen and personal protective equipment. The group was supposed to look at several factors in considering shipments, including case rates in the country, vulnerability of the population and the countries’ ability to administer doses, Smith and others have said. But officials who worked on the international distribution effort told POLITICO those considerations often shifted, depending on the advice of various agencies.
Senior officials including Smith also stated publicly that the administration would remove politics from the equation when considering donations.
“Both China and Russia are actively encouraging countries to buy their vaccines,” Smith told reporters in a briefing April 30. “I can tell you that from the United States point of view, our intent is not to market or encourage vaccines based on any political policy, but because they’re the best means of ending a pandemic.”
Since then, the administration has shared few details of how it makes decisions regarding dose allocations except for broad statements about its strategy to help as many countries as possible. Lawmakers on Capitol Hill have pressed officials at State and USAID for more information on donations.
At a hearing in May, when the Biden administration was just beginning to gear up its shipments, Sens. Tim Kaine (D-Va.) and Mitt Romney (R-Utah) asked Smith and Konyndyk to provide exact details of how the administration was prioritizing doses and whether it was setting up a strategy to counter Russia and China.
“We’re looking at need. We’re looking at how we can get maximum coverage, because … the demand exists everywhere. So those are the number of factors we’re taking into account,” Smith said at the Senate hearing on May 12, adding that the administration works closely with COVAX to determine which countries receive U.S. doses donated to the group.
“I think the really important point here is that vaccines are tools for public health,” Smith testified. “We do not see them and do not intend to use them as means for influence or pressure.”
Smith did not answer questions at the hearing about where the U.S. was considering sending doses, only to say that the administration was looking closely at helping countries in the northern hemisphere — a region that could significantly impact the case rates in the U.S. She also said the State Department had created “documentation” that “goes into great detail” about a framework for shipping doses.
But some of the most senior officials working on the U.S. effort to distribute vaccine doses globally told POLITICO that they have not seen the document. Instead, most officials working on the team, as diplomats, had access to a vaccine donation tracker that details which country had received shipments and which country was administering the doses the fastest.
Despite Smith’s assertions, officials struggled throughout the summer to develop formula for deciding where to send doses, according to two of the senior Biden officials who worked on donations.
Each agency in the working group — State, USAID and the NSC — came to the table with different ideas of how the U.S. should prioritize doses, the officials said. On top of that, the State Department was receiving requests from countries and created a spreadsheet diplomats overseas could update Washington about a country’s specific needs. The White House, too, received pleas for help, including from Mexico and India, those same two senior Biden officials said.
In June, the Biden administration announced it would allocate 80 million doses for shipment by the end of the month. The White House announced it would send the majority of doses through COVAX, and the rest would go directly to countries hand picked by the administration. Those included countries in the Caribbean, Southeast Asia, the Middle East and Eastern Europe.
Many of those doses donated to COVAX were earmarked for specific countries as well, including some in Latin America and Southeast Asia. The U.S. has since pulled back on its demands that COVAX earmark U.S. shipments, but the first several months of America’s international campaign created problems for the global vaccine effort, multiple global health advocates told POLITICO.
Several of the countries the U.S. wanted to earmark doses for were either not ready to absorb the doses, meaning their governments did not have the capacity to distribute and administer the vaccine efficiently, or they needed more time to consider indemnification language attached to the contracts.
The earmarking process is still creating difficulties on the ground.
“In an ideal world, and this is why COVAX started, you should have one mechanism … and the reason is that then you can coordinate the timing of all the deliveries, who's ready for what vaccine and which vaccine is best for each country. We're not in that ideal world now,” Gavi’s Berkley said. “What we have to do is take into account other people donating vaccines, bilateral deals they've already done and earmarking. ”
When asked about details regarding how the administration makes decisions about donations, or if a strategy was ever formalized, the White House declined to answer.
Politics or need?
Concerns about the U.S. playing politics on donations arose early on in the administration’s initial rollout of donations.
In June, Sens. Tammy Duckworth (D-Ill.), Chris Coons (D-Del.) and Dan Sullivan (R-Alaska) traveled to Taipei to show U.S. support for Taiwan in the face of threats from China and announced a donation of 750,000 U.S. vaccine doses. The announcement caught senior State Department and USAID officials working on the donation task force off guard, sparking conversations about why the White House had bypassed them in deciding to donate the tranche to Taiwan.
A statement by Duckworth after the trip raised even more concerns, particularly because the senator noted that conversations about the potential allocation had been ongoing for weeks.
“After several weeks of conversations between each of us and White House officials, I’m pleased to help announce that Taiwan will be receiving 750,000 doses of the vaccine as part of the first tranche of doses,” Duckworth said in a statement at the time. “This contribution from the United States also reflects our gratitude for Taiwan’s efforts to send [personal protective equipment] and other supplies to America in the early days of the pandemic.”
To those in the State Department and USAID, it looked as though the White House had sealed a deal with Taiwan with input from lawmakers on the Hill — not the experts working on the international vaccine efforts with direct knowledge of Taiwan’s health situation and public health abilities.
“It was this really off-the-cuff announcement on the tarmac in Taipei,” one of the senior Biden officials said. “There were clearly discussions happening outside of the group’s inner circle.”
That senior administration official, along with two others who worked on the global vaccination drive, said although each agency advocated for sending doses to specific regions and for different reasons, the White House made the ultimate decisions on allocations.
One of those senior officials, who has since left government, said as time went on, the White House established a “parallel structure” that operated independently and made decisions about international donations without involving other agencies.
“There has been little transparency,” that former official said.
The official said the White House often “makes decisions at the last minute” and directs USAID to execute operations — and contracts — on the ground. Another senior Biden official involved in the campaign pushed back on the assertion the White House was unilaterally deciding where to send vaccine doses, saying it works closely with the various agencies in considering allocations.
Several high-level officials involved in the interagency effort to distribute the vaccine have left the government. Meanwhile, the U.S. is gearing up to begin a new phase of vaccine shipments. Pfizer has pledged to deliver one billion doses to low- and middle-income countries by the end of 2022. Moderna has also pledged more than 50 million doses to the world. China has also pledged one billion doses to Africa.
In the next several months, the U.S. plans to work with COVAX and world partners to help low- and middle-income countries set up the necessary infrastructure on the ground to absorb doses, streamlining both the distribution and allocation of doses.
This week, USAID announced a new initiative — Global VAX — to accelerate global efforts to get Covid-19 shots into arms.
“The emergence of COVID-19 hotspots and variants including Delta and Omicron further underscore the importance of our global fight,” USAID said in a statement. “As more vaccine supply flows to low and middle income countries, the United States and other donors must redouble efforts to help countries efficiently and effectively receive, distribute, and administer doses.”
Carmen Paun contributed to this report.