The U.S. will ‘surge’ over $250 million in vaccine support to 11 African countries

The Biden administration will “surge” more than $250 million in coronavirus vaccine assistance to 11 countries in sub-Saharan Africa, including several where the omicron variant was first identified, as it ramps up efforts to help vaccinate the world, according to a document obtained by The Washington Post and confirmed by global health officials.

The Global VAX initiative, which the administration first outlined in December, represents the latest effort to carry out President Joe Biden’s vows to help end the pandemic and restore U.S. global health leadership. Those goals are driven by national security as well as humanitarian concerns; officials worry that a new variant could emerge in a largely unvaccinated country and quickly circle the globe. The fast-spreading omicron variant, which drove record levels of covid cases and hospitalizations in January, was first detected in southern Africa in November.

According to the “COVID-19 Global VAX Field Guide,” which was shared with diplomatic contacts, the United States will prioritize countries in sub-Saharan Africa - beginning with Angola, Côte d’Ivoire, Eswatini, Ghana, Lesotho, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia - to “receive intensive support” for their vaccination campaigns through in-person staffing, technical assistance and more diplomatic engagement. Those countries have generally vaccinated fewer than 40% of their populations against coronavirus, according to the University of Oxford’s Our World in Data tracking project, but have reported upticks in recent weeks that U.S. officials say show the potential of global aid.

Under the Global VAX initiative, the U.S. plans to spend more than half of the $510 million staked for the program to boost vaccination efforts in the 11 countries, which could include investments in mobile centers to administer shots, freezers for safe vaccine storage and other supplies, U.S. Agency for International Development officials told The Post. The initiative is focused on ensuring “shots in arms,” amid concern that many low-income countries lack the infrastructure to safely store and administer vaccine doses that have been donated by wealthier nations and global aid groups.

Meanwhile, the Biden administration is eying a second group of nations - which includes Burkina Faso, Cameroon, Democratic Republic of Congo, Haiti, Kenya and Malawi - as possible future partners in the vaccine program, but have yet to make significant commitments. “Those are places that we are assessing how best to support, and believe may have high potential in the medium to longer term,” Atul Gawande, USAID’s assistant administrator for global health, said in an interview.

The administration also will continue with an array of smaller investments to support vaccinations, spreading the remaining Global VAX funds across dozens of countries, the officials said.

“We’re really ramping up,” said Jeremy Konyndyk, executive director of USAID’s covid task force. “What we found very consistently in our outreach is that countries do want doses, they do want to vaccinate, and when they have gotten the resources to do that, they’ve made good progress.”

While the United States has already shipped more than 420 million doses abroad, far more than any other country, public health experts have warned that many donated doses are not being promptly administered because of fragile infrastructure, insufficient resources or vaccine hesitancy - problems that U.S. officials say can be largely addressed with targeted investments and diplomatic engagement.

The slow pace of global shots has also jeopardized the White House and the World Health Organization’s goal of vaccinating 70% of the world by mid-year, Secretary of State Antony Blinken acknowledged on Monday. Fewer than 17% of Africans have received at least one shot of vaccine, according to the University of Oxford’s data.

The wide gap in access to vaccines has been a source of anger in the global south, with some public health leaders faulting wealthier countries for stockpiling extra doses and administering booster shots rather than sharing them with the developing world. South African President Cyril Ramaphosa said the gap in vaccine access amounted to “vaccine apartheid.”

USAID officials said in an interview that the 11 countries were prioritized because of the “high potential” that targeted support would lead to rapid gains, citing successful pilots in several of the countries. For instance, more than a quarter of the population in Ghana and Uganda has now received at least one shot of a coronavirus vaccine, after national vaccination rates hovered in the single digits for most of 2021, an uptick that officials said they are hoping to build on and replicate in other countries.

“What that tells us is when there’s the right mix of access to vaccines, access to resources, technical support, and the political will and leadership from the government, countries can make a lot of progress,” Konyndyk said.

Partner countries will be required to share more details and data with the Biden administration on their national vaccination strategies, including quarterly progress reports.

USAID officials are set to travel to Africa to support the vaccination initiative, which is being spearheaded by that agency, with Gawande heading to Nigeria next week. Administrator Samantha Power is planning a trip to sub-Saharan Africa, officials said.

While some public health experts have questioned the need for a new vaccination program, USAID officials said that the effort would build on global health work being done through other agencies like the Centers for Disease Control and Prevention and the President’s Emergency Plan for AIDS Relief, better known as PEPFAR, rather than duplicate them.

“Creating Global VAX is about organizing the whole-of-government effort, not just in the 11 surge countries, but everywhere that we’re doing work,” Gawande said.

“You don’t want to pause the whole PEPFAR program or the whole malaria program to go do vaccinations,” Konyndyk added. “The more that we can spread this mission across a diversity of platforms, the more we also relieve some of the burden on them and enable them to continue their core work.”

USAID officials said they were able to fund the initiative through the last remaining funds made available under the American Rescue Plan Act, a congressional stimulus package passed last year. Administration officials are weighing plans to request additional funding for global vaccinations from Congress, with some Democrats and global health experts calling for at least $17 billion in new money.

On Thursday, global health experts praised the administration for devising a “concrete plan” that resembled strategies used to successfully combat other global health challenges, like HIV/AIDS, but called for expanding the program to more countries and securing additional funding.

“These are primarily the ‘low hanging fruit’ countries where progress is easiest to be made and measured. The last mile - or in this cases - miles, will be even tougher,” Jen Kates, who oversees global health policy at the Kaiser Family Foundation, wrote in an email.

“We need to grow both in terms of breadth as well as depth,” said Krishna Udayakumar, director of Duke University’s Global Health Innovation Center.

Udayakumar noted that USAID has now exhausted billions of dollars in funding from congressional rescue packages. “The second phase of this has to scale up pretty quickly,” he said. “That’s completely at risk now, unless there’s additional funding coming.”