Decisions by top officials responding to President Donald Trump’s edict to protect “America first” contributed to a global delay in Covid-19 vaccine donations and a lack of effort to assist low- and middle-income countries, according to five current and former U.S. officials who worked under Trump on the federal pandemic response.
The failure to view the Covid threat in global terms left some nations — including those where the Omicron variant emerged in recent weeks — lacking inoculation and much more vulnerable to mutations, the officials said.
They described a White House and its health agencies fixated on one goal: obtaining enough drugs and protective gear to shield the American people from Covid-19. But that strategy, pushed directly by Trump and his senior aides, neglected to seriously consider the threat of variants and spread of infections if lower-income countries were left unprotected, the officials said.
Despite a series of high-level internal conversations and discussions with the World Health Organization in 2020 about the danger of limiting lower-income countries’ access to the shot, including the emergence of new, more dangerous variants, the Trump administration did not develop a strategy for helping the rest of the world access the vaccine or develop the infrastructure needed to administer vaccines. Instead, it raced to secure as many of the world’s components needed to manufacture a vaccine as possible, cutting other countries out of the supply chain, and quickly scaled up manufacturing of a Covid-19 vaccine to deliver to the American people — not to the global population.
“In 2020 there was no discussion at all about global donations,” said one former official with direct knowledge of the administration’s conversations about protecting Americans from Covid-19. “We didn’t know if we had a vaccine. It was always, ‘Let’s just wait until we have a vaccine, and then we will decide what to do with that.’”
Another former senior Trump official who worked on the virus response said the president “did not see helping other countries as a priority.”
“If anything, the message inside the White House was to disengage from the world community and deflect blame,” the second official said.
With the election of Joe Biden and changing of the guard in January of this year, longtime global public health officials hoped the new administration would usher in an era of international cooperation. But in the spring of 2021, the Biden team failed to heed calls from within Operation Warp Speed, the group that worked to fast-track a vaccine, to ship surplus doses overseas before they expired. White House officials pushed back, claiming the U.S. needed to hold onto its extra vaccine in case of another surge. The Biden administration didn’t begin delivering international doses until the summer of 2021.
A White House official disputed the idea that the Biden administration held on to its surplus, saying the U.S. did not have enough doses to make overseas donations until it started planning in April.
Trump’s office did not respond to a request for comment.
Paul Mango, who served on Operation Warp Speed and as deputy chief of staff at the Department of Health and Human Services, told POLITICO that the Trump administration wanted to vaccinate Americans first before giving doses overseas. But, he said, the Department of Health and Human Services developed an initial plan for international distribution in the summer of 2020, well before the vaccines were available.
“We knew the whole world was going to be beating down our door once we finally had the vaccine,” Mango said.
Still, the failure to move more quickly and to develop a more comprehensive plan for helping poor countries across the world access and administer doses has raised new frustrations among international health advocacy groups who say the Omicron variant is partly the result of that inaction. The variant first appeared in seven African countries, none of whom had a sizable percentage of their population vaccinated. Despite efforts to contain the variant through travel bans, dozens of Omicron cases have been reported across Europe, Asia and Africa. The U.S. has stopped travel from seven countries in southern Africa while scientists study whether the strain causes severe disease and can evade the vaccine.
“We’ve been warning about this the whole time,” Lily Caprani, head of advocacy for health and pandemic response at UNICEF, said of the emergence of the Omicron variant. “It means we need to pick up the pace of getting these vaccines distributed more equally across the world.”
Although the Biden administration has donated close to 275 million doses worldwide, the U.S. has moved slowly to roll out doses to low- and middle-income countries, and it has sent only a fraction of its total donations to Africa, where less than 10 percent of the population is vaccinated.
In response to increasing calls for the U.S. and other Western countries to do more, Biden, in his first statement on Omicron Nov. 26, said the U.S. has donated more doses internationally than all other countries combined.
“It is time for other countries to match America’s speed and generosity,” he said.
Two other current Biden health officials pushed back on recent scrutiny of the Biden administration’s global Covid efforts, saying even if the U.S. had billions of doses available to send to countries overseas, many would not be able to administer the doses because of their failing health systems.
“Some of these countries just don’t have the capacity to store the doses and then give them out,” one of those senior health officials said, adding that countries and Europe and Africa were also struggling with decreasing demand for the shot.
Racing to develop a vaccine first
The delay in establishing a global strategy to combat Covid-19 extends back to early 2020, when the U.S. first determined that cases of the virus, which originated in China, would soon begin rising in the U.S. Rather than rely on existing structures within the Department of Homeland Security and Federal Emergency Management Agency, the Trump White House took control of the Covid-19 response itself.
The president and his confidants implemented the same “America First” strategy it had fostered in the national security apparatus — isolating America and downplaying the importance of international cooperation, according to four former officials directly involved with discussions within the administration, several of whom worked inside the administration’s health agencies.
By March of 2020, the White House had closed the borders to Canada and restricted travel from other countries experiencing surges. It blamed China for the outbreak and hoarded life-saving medical supplies for domestic use. Trump also pulled out of the World Health Organization — the international group now responsible for helping aid the Covid-19 fight across the globe.
“China has total control over the World Health Organization despite only paying $40 million per year compared to what the United States has been paying, which is approximately $450 million a year,” Trump said during a news conference May 29, 2020.
Trump personally enlisted his son-in-law Jared Kushner and White House trade adviser Peter Navarro to help find ways to ensure the U.S. gained access to personal protective equipment and medical supplies before other countries, particularly those in Europe.
“We need these items immediately for domestic use, we have to have them,” Trump said of Covid-19 personal protective gear during a press conference on April 3, 2020 in which he invoked the Defense Production Act to stop companies from exporting the equipment overseas.
Kushner created a small office within the White House — a team that called in favors with businesses and manufacturers to procure the necessary equipment. Navarro drafted and pitched an executive order that would have blocked the import of foreign goods and spurred the increased production of American medicines, raw materials and vaccines. The “Buy American” executive order was never implemented — but the ideology lived on within the Trump Covid-19 pandemic response, the officials said.
In March, the WHO declared Covid-19 a pandemic. But the Trump White House focused solely on keeping case numbers down in the U.S. and worked to keep information about the spread in the country within the administration, four former officials said.
“That early on we were just trying to figure out the science. We still did not know how it spread or what we should be doing to keep transmission down,” one of the former senior Trump health officials told POLITICO.
But the Trump administration moved quickly to develop a vaccine. By the spring of 2021, Trump officials were brokering conversations with pharmaceutical companies about how quickly they could manufacture a Covid-19 vaccine.
In May, HHS formed Operation Warp Speed, a group to fast-track the development of a vaccine for the American people. Three of the former senior Trump officials, all of whom worked with the team, said the directive from the White House was clear: find a way to manufacture a Covid-19 vaccine with a high-degree of protection against infection and severe disease and bring it to the market in record time.
To do that, the White House pushed Operation Warp Speed and other agencies such as HHS and the Pentagon to procure supplies and components American companies needed to make the vaccine before other countries.
“There was clearly competition between Europe, India, China and the US on the materials and the components,” one of the former senior Trump officials working with Operation Warp Speed said. “That was the big debate — how we get the materials. We were competing with Europe more than anything else.”
The Trump White House enacted the Defense Production Act “several times to take priority deliveries of the components,” that official said.
“It essentially made it more difficult for Europe to access what they needed to make the shot for their people,” a current senior Biden health official told POLITICO, adding that the act of pushing out others from the market unnecessarily delayed the manufacturing of vaccines in places outside the U.S.
That delay ultimately limited the ability of other, poorer countries across the world to quickly receive both direct donations and purchase the shot from pharmaceutical companies. Those countries would not receive doses until both the U.S. and Europe secured enough vaccine for their respective populations.
The rest of the world had little option but to wait until the U.S. and Europe — as well as Russia and China — had enough doses in their stockpiles to donate or until pharmaceutical companies were able to develop enough manufacturing capacity to ramp up production of new doses to sell.
But even then, low- and middle-income countries would have difficulty garnering the vaccine needed to inoculate their populations. Major U.S. vaccine makers such as Moderna and Pfizer refused to share their vaccine technology so other countries could try and manufacture doses on their own. And the Trump administration signed a contract with Moderna, a company that had reaped more than $1 billion in federal funding to develop a shot, for hundreds of millions of doses for the American people that prevented the U.S. government from shipping any of those doses overseas. The provision allowed the company to negotiate its own prices with other countries.
Throughout 2020, COVAX, the international group formed at the beginning of the pandemic to help distribute vaccine products across the globe, worked to gain commitments from wealthy countries, including the U.S., to donate doses and cash to its vaccine campaign.
“The only countries that were going to get vaccinated and get out of the pandemic were those with the buying power,” Caprani said of the thinking behind the formulation of COVAX.
The Trump administration refused to sign on. It had officially pulled out of the WHO, one of the main organizations leading the global vaccination effort.
“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,” White House spokesperson Judd Deere told reporters in a statement in September of 2020.
But there would be little attention to the global aspects of the fight against Covid-19 for the remainder of the Trump administration. In November, after the election, the administration announced that it believed it would be able to vaccinate 20 million people by the end of the year and the majority of the U.S. population by April.
Weeks later, on Dec. 8, Trump signed an executive order that solidified his America First strategy. The order was designed to ensure that Americans were given first priority in receiving the Covid-19 shot before federal agencies such as the State Department and USAID helped inoculate other people across the world.
Biden’s own America First moment?
When President Biden stepped into office in January, 2021, he promised that the U.S. would become a world leader in delivering Covid-19 doses to the rest of the world.
In February, Biden pledged $2 billion to COVAX to help finance the shipment of Covid-19 vaccine to countries in need.
“As the virus continues to spread throughout the world, and with new variants emerging, the facts are clear that it is critical that we vaccinate as many people as possible, as quickly as possible,” a White House press statement said about the pledge.
But despite the promises made by Biden and his team, White House and Covid-19 task force officials pushed back on calls from within Operation Warp Speed to begin laying out a strategy for shipping U.S. doses to the rest of the world.
In a series of meetings in February and March, Operation Warp Speed advocated to David Kessler, the chief science officer of Biden’s Covid-19 task force, and Jeff Zients, the head of the task force, that the administration begin to donate doses internationally, according to two of the former Trump officials who were directly involved in the conversations. Those officials said the U.S. was quickly building up its supply and that the country would soon have more than enough doses for the American population.
“We kept saying these doses are going to expire on the shelves, we are going to have more doses than the U.S. can absorb,” one of those officials said. “They refused to have in February a discussion about what to do with the doses when the supply would exceed the demand. The administration didn’t want to face the governors and curtail shipments because the message was ‘there are vaccines available to everyone.’”
Those same two officials said there were several weeks in February and March where states were ordering more doses than they were administering.
“General [Gustave] Perna was very well aware of the problem,” the other official said, referring to the former chief operating officer of Operation Warp Speed.
Finally, in March, the Biden administration announced that it was developing plans to send doses of the AstraZeneca vaccine — which was not yet authorized for use in the U.S. — to Mexico and Canada. The total anticipated shipment: 4 million doses, a tiny fraction of the populations of those countries. In April, the administration announced that it would bump up its worldwide AstraZeneca donations to 60 million and would deliver the shot as they became available.
Those deliveries did not start rolling out en masse until May — the same time the administration laid out its strategy for delivering 80 million more doses to the world — still a fraction of what was needed to help quicken the pace of vaccinations in poor countries. The Biden team promised those doses by the end of June. Weeks later, though, after sending 20 percent of what it had promised, the White House revised its pledge, saying it would only allocate those doses to countries across the world by that time, not ship them.
The shipment of those 80 million doses — and additional Pfizer doses pledged by Biden — moved slowly. Throughout August and September, vaccine deliveries trickled out to various countries in Southeast Asia, the Caribbean and Latin America. Only 15 million were allocated for countries in Africa, home to some of the world’s most populous nations.
In October, the Biden administration significantly ramped up its donations. It’s now delivered close to 275 million doses internationally.
Still, international health advocacy groups continue to call on the Biden administration — and wealthy countries in Europe — to do more to help prevent more variants like Omicron from emerging.
Those calls for action have grown louder in recent days and top Biden officials have become increasingly frustrated with international criticism. Fearing international blame for low vaccination rates in Africa, U.S. officials have begun to push back, saying the U.S. shouldn’t be held responsible for vaccinating the world without significant help from other wealthy countries in Europe and Asia.
“We’ve done more than our share,” said one senior Biden official working on the federal Covid-19 response.
“And some of the doses we want to give … countries don’t want them. They are sending them back,” the official said, referring to South Africa recently delaying a shipment of Johnson & Johnson vaccine, claiming the country had too many doses in stock and not enough demand.
But international health advocates say there is significant demand, including in Africa, for Covid-19 vaccine but that more work is needed in helping countries receive and distribute the doses locally.
“This isn’t about supply anymore,” another senior Biden official said. “It’s about making sure these countries have the infrastructure they need to actually administer the doses. That’s where the real hold up is.”