While the domestic US vaccine rollout lost momentum, global vaccine inequity continued apace. Hopefully, this legacy sparks a reckoning in global health to ensure the unjust and inequitable distribution of life-saving vaccines never occurs again.

The US summer was not the optimistic comeback many had hoped it would be. Back in the spring, with domestic vaccination rates climbing and infection rates coming down, it looked as though the worst was behind and Americans were planning their vacations and reunions. Instead, as vaccination rates plateaued by the summer, the US fell into a staggering third wave largely affecting the unvaccinated.

But while vaccines remain readily available to all Americans, and as President Biden receives his booster shot, billions globally still lack the opportunity to even receive their first shot. Although a chasm between the vaccine haves and have-nots was foreseen from the get-go (fears of “vaccine hoarding” date back to April last year), the fact that too little was done to prevent it will remain one of the enduring legacies of the pandemic. It’s a painful reminder that, as was true thousands of years ago when first exclaimed by Thucydides, some still believe it’s acceptable that “the strong do what they can while the weak suffer.”

Vaccine nationalism, export controls, and structural inequities, including around international trading rules, have all prevented lower-income countries from accessing the medical tools they need to protect themselves and help finally slow the spread of COVID-19 globally — to everyone’s benefit. The only way to end the pandemic is to confront this inequity and injustice and ensure everyone, everywhere — 7.7 billion people — get access to COVID-19 vaccines.

During last month’s UN General Assembly, the Biden administration sought to fill the void in global leadership when it comes addressing this tragic reality. I was fortunate to participate in President Joe Biden’s pandemic summit, which, unlike the UK-chaired G7 summit back in June, has to be commended for finally pulling together key leaders behind a plan to achieve 70 percent vaccine coverage worldwide, with measurable targets and goals, by this time next year. Of course, as I pointed out in my message for the summit, the world could achieve this milestone even sooner, perhaps as early as April or May next year, based on the global supply trajectory — if leaders have the will.

President Biden, to his credit, has led on dose sharing amongst the G7 industrialised countries, and America’s latest pledge during the UNGA will lead them to donate 1.1 billion doses in total through next year. According to science analytics firm Airfinity, the G7 and EU could collectively have over 1.7 billion excess doses this year alone — if 80 percent of their populations ages 12 and over get two doses (more than the average national demand) and only high-risk individuals, like those with weakened immune systems, get a booster. That’s why Global Citizen has been calling on these countries to share at least one billion doses immediately with those most in need, and eventually increase pledges to two billion by the end of the year. To date, they have only actually shared just over 200 million doses with low- and middle-income countries, mostly, to its credit, by the US. By delivering on vaccine donations, the US has kept pressure on its G7 counterparts to share more, and the last few weeks has seen significant new commitments from Europe.

Ultimately though, access through donation is not a long-term solution. Donations are a stopgap. They’re inefficient, often earmarked politically, and can result in higher wastage as many donations have occurred near vaccine expiry dates. The very concept of dose sharing recognises that as soon as a vaccine was discovered, vaccine manufacturing nations started to take control of their production assets, essentially going into business with big pharmaceutical companies, then instituting export limits and hoarding supply.

According to Airfinity once again, 12 billion doses are expected to be produced this year alone, but the vast majority of these are spoken for by the US, EU, India, and China. Of the 6.1 billion doses administered so far globally, according to Our World in Data, around 75 percent have been in upper-income countries, compared to just 0.4 percent in all low-income countries. Most frustratingly, that number hasn’t really moved in months.

As Prince Harry, the Duke of Sussex, told the audience at Global Citizen Live on 25 September, ending the pandemic “cannot just be a charity operation.” Indeed, we must empower countries and COVAX to be able to buy, produce, and, critically, allocate vaccines for themselves.

Once again here, the US led over its European counterparts by coming out early in support of a proposal to waive intellectual property around the production of COVID-19 vaccines. But by not following this up with a concerted diplomatic push, it did little to change Europe’s stance, leaving many of these governments thinking, as I heard directly from one senior official, it was nothing more than a gimmick to earn early applause from the Global South. Now with renewed US energy into achieving global vaccine coverage once again, the WTO ministerial meeting occurring at the end of November would mark a timely milestone for the US to reassert itself on this issue with countries that remain opposed, like the UK, Switzerland, and Germany.

Waiving IP would open up doors for expanded global production, but sharing technology and know-how non-exclusively in combination would get the world cooperating like we’ve sorely lacked throughout this pandemic. One key pathway is the new WHO-backed mRNA technology transfer hub based in South Africa, a collective of public health authorities, researchers, scientists, and local manufacturers. Together they aim to strengthen African regional health security and develop the first mRNA vaccine production facility in Africa. Were the hub to receive the support and necessary technology from companies such as Pfizer, Moderna, and BioNtech, their efforts would be dramatically accelerated. The US government has leverage over Moderna, which developed its vaccine with significant taxpayer money, and the US owns a key patent underpinning their technology. Pressure on them to collaborate could make an immediate impact and would be an important display of support the Biden administration could show to the African continent.

President Biden said last month that in three months he will follow up with a second summit to rally specific commitments against achieving the goal of 70 percent global vaccine coverage. We’ve heard from government insiders that participation in the summit will be on a “pay to play” basis, and the pressure is on countries to deliver. If the US can stay disciplined and focused (something it has struggled to do after declaring it will be the global “arsenal of vaccines” early in the year), and if it invites civil society partners to help inform and drive tangible policy outcomes, the US may yet play a critical role in ending the pandemic for everyone, and would deserve credit for such. Many are watching, and many are depending on this outcome.

Michael Sheldrick is a co-founder and Chief Policy, Impact, and Government Relations Officer at Global Citizen.

This article is published under a Creative Commons License and may be republished with attribution.