By contrast, the international response to COVID-19 was surprisingly inept, especially compared with

previous campaigns to contain epidemics or eradicate diseases. With smallpox and polio, for
example, governments and international organizations worked together to develop and fund
cohesive strategies, around which response teams were organized worldwide. Not so for COVID-19.
Politics undermined public health in a global crisis to an extent nobody had thought possible. The
president of the United States silenced trusted public health leaders from the U.S. Centers for
Disease Control and Prevention (CDC), the respected disease-prevention agency that the world
expected to take the lead in that very moment, and he withdrew the United States from the World
Health Organization (WHO) just as global collaboration was needed most. Emboldened by Trump,
self-interested leaders elsewhere followed suit, pursuing disease-denying policies that further
amplified the death toll and suffering.

Vaccine development has been one of the few bright spots in this pandemic. Pharmaceutical and
biotechnology companies worked hand in hand with governments to make powerful new vaccines in
record time. The two vaccines based on messenger RNA, or mRNA—the Moderna and Pfizer-
BioNTech ones—moved lightning fast. Just two months after the genetic sequence of SARS-CoV-2
was published, the Moderna vaccine was being tested in a Phase 1 clinical trial, and not long after, it
moved on to Phase 2. At the same time, a number of actors—the Coalition for Epidemic
Preparedness Innovations; Gavi, the Vaccine Alliance; the WHO; and many governments, companies,
and philanthropies—were investing massively in manufacturing capacity. As a result, the companies
behind the two vaccines were able to rapidly scale up production and conduct Phase 3 trials over the
summer. The trials demonstrated that the Moderna and Pfizer-BioNTech vaccines were not just safe
but also far more effective than many had thought, and by the end of 2020, regulatory agencies
around the world had authorized them for emergency use. Vaccines based on a modified adenovirus
also moved quickly. The United Kingdom authorized the Oxford-AstraZeneca vaccine in December
2020, and the United States did the same for the single-dose Johnson & Johnson vaccine in February
2021.

Cremating COVID-19 victims in Srinagar, India

Cremating COVID-19 victims in Srinagar, India, May 2021

Danish Ismail / Reuters

Although the creation of the vaccines was a triumph of international cooperation, their distribution
has been anything but. Hedging their bets, the United States and other rich countries bought many
times the number of doses they needed from several manufacturers, essentially cornering the
vaccine market as if the product were a commodity. Making matters worse, some countries imposed
restrictive export regulations that have prevented the wider manufacture and distribution of the
vaccines. In May, pointing out that 75 percent of the vaccine doses had so far gone to just ten
countries, the WHO’s director general, Tedros Adhanom Ghebreyesus, rightly called the distribution
a “scandalous inequity that is perpetuating the pandemic.”

In the absence of global coordination for the purchase and distribution of vaccines, governments
struck bilateral deals, leaving some unlucky countries with less effective or untested vaccines. For
instance, China has exported more than 200 million doses of four homegrown vaccines—more than
any other country—and yet there is disturbingly little transparent data on the Chinese vaccines’
safety. Anecdotal reports from Brazil, Chile, and the Seychelles have raised doubts about their
efficacy. Meanwhile, India’s devastating surge in COVID-19 cases has reduced exports of its locally
produced vaccines, leaving the countries that were depending on them, such as Bhutan, Kenya,
Nepal, and Rwanda, with inadequate supplies. The United States made a lot of promises, but as of
late May, the only vaccine it had exported was the Oxford-AstraZeneca one—which the U.S. Food
and Drug Administration had not yet authorized—sending four million doses to its neighbors, Canada
and Mexico.

To provide at least a cushion of vaccines for less well-off countries, and to help the WHO manage the
challenge of global vaccine distribution, a coalition of organizations created a unique consortium
called COVAX. The body went on to develop an “advance market commitment” mechanism, through
which governments have agreed to buy large numbers of doses at predetermined prices. The goal is
to raise enough money to provide nearly one billion doses to 92 countries that are not able to pay for
vaccines themselves, allowing each to meet 20 percent of its vaccine needs. As of May, however,
reaching this target anytime in 2021 seemed a long shot.

In fact, the barriers to access have been so profound that many low- and middle-income countries
won’t have enough vaccines to inoculate even just their at-risk populations until 2023. This disparity
has led to a jarring split-screen image. At the same time that Americans were taking off their masks
and preparing for summer vacations, India, with only three percent of its 1.4 billion