As of this morning, the CDC reports that we have delivered 222 million doses of the vaccine. Just over half of the adult population has had at least one dose, and 35% have either had two or one dose of the Johnson & Johnson vaccine to get fully vaccinated. Exactly two-thirds of all seniors are now fully protected against COVID-19.

With a glut of doses growing and demand falling, the Associated Press reports that the rest of the world wants the US to start sharing the vaccine wealth:

In the United States, more than one-fourth of the population — nearly 90 million people — has been fully vaccinated and supplies are so robust that some states are turning down planned shipments from the federal government.

This stark access gap is prompting increased calls across the world for the U.S. to start shipping vaccine supplies to poorer countries. That’s creating an early test for President Joe Biden, who has pledged to restore American leadership on the world stage and prove to wary nations that the U.S. is a reliable partner after years of retrenchment during the Trump administration.

Thus far, the White House has been “cautious” in its response, the AP notes:

He has focused the bulk of his administration’s vaccinations efforts at home. He kept in place an agreement struck by the Trump administration requiring drugmakers that got U.S. aid in developing or expanding vaccine manufacturing to sell their first doses produced in the country to the U.S. government. The U.S. has also used the Defense Production Act to secure vital supplies for the production of vaccine, a move that has blocked the export of some supplies outside the country.

White House aides have argued that Biden’s cautious approach to promises around vaccine supply and delivery was validated in the wake of manufacturing issues with the Johnson & Johnson vaccine and the subsequent safety “pause” to investigate a handful of reported blood clots. In addition, officials say they need to maintain reserves in the U.S. to vaccinate teenagers and younger children once safety studies for those age groups are completed and if booster shots should be required later.

“Cautious” might understate the response. India has had a massive spike in COVID-19 cases, so bad that public health officials can’t get an accurate count. The Modi administration in New Delhi has pleaded with the Biden administration to share vaccines, or at least the raw materials for manufacturing them, in order to start blunting the exponential transmission explosion. No dice, the Press Trust of India reported as the White House response, or perhaps more accurately, America first:

When asked when the Biden administration would decide on India’s request to lift a ban on the export of vaccine raw materials, State Department spokesperson Ned Price said: “…the United States first and foremost is engaged in an ambitious and effective and, so far, successful effort to vaccinate the American people. ”

“That campaign is well underway, and we’re doing that for a couple of reasons. Number one, we have a special responsibility to the American people. Number two, the American people, this country has been hit harder than any other country around the world more than 550,000 deaths, tens of millions of infections in this country alone,” he said on Thursday.

“It is not only in the US interest to see Americans vaccinated; but it is in the interests of the rest of the world to see Americans vaccinated,” he said.

“The point the Secretary (of State Antony Blinken) has made repeatedly is that as long as the virus is spreading anywhere, it is a threat to people everywhere. So as long as the virus is spreading uncontrolled in this country, it can mutate and it can travel beyond our borders. That, in turn, poses a threat well beyond the United States,” Mr Price said in responses to questions.

True, but that also applies to India, Brazil, and other larger countries with uncontrolled outbreaks. In fact, it might apply even more to those countries, considering their population densities and lack of health-care support. At some point, and we may already be past it, the threat of new variants becomes much greater to those whose populations have been significantly vaccinated if those variants are different enough to get around the immunity provided by the first-rank vaccines. India especially has a high risk of brewing all sorts of new variants that could make even the mRNA vaccines less effective unless an intervention comes now.

Given Joe Biden’s campaign rhetoric about being global citizens and his criticisms of Donald Trump’s “America First” slogan, this position seems very odd — but explicable. Politically speaking, shipping doses overseas (or even across our northern and southern borders, which our neighbors also desperately want) is a potential disaster while many Americans are impatiently waiting for their turn with the needle. We have begun to see a waning of that enthusiasm, in no small part because of the disastrous FDA/CDC decision to suspend the J&J vaccine and frighten many Americans out of the embrace of the vaccines, but our seven-day average is still 2.7 million doses a day with ~240 million Americans left to fully vaccinate (~180 million adults). That’s a lot of inoculations left to deliver, even if as many as 25% of adults still resist the idea of vaccinations.

At some point, though, we will need to start exporting our vaccines for both epidemiological and diplomatic reasons. China tried getting its vaccine diplomacy rolled out early, but it became clear a month ago that their vaccines were ineffective. Both Chile and Brazil have discovered that the hard way, and it’s one reason why the American and UK vaccines (AstraZeneca) need to get exported as soon as possible. Russia has promised to start exporting its Sputnik vaccine set, but thus far their production has been disappointing. We have an opportunity to lead — perhaps not at this precise moment, but the risk factors are rapidly converging between ensuring we don’t produce variants and making sure we don’t get exposed to those brewing in the COVID-19 hot spots. The windows are closing quickly on both tracks.

Update: Not to mention, of course, that this refusal to share doesn’t look very good to our neighbors and friends. Allahpundit pointed out this separate WaPo report from earlier today:

A long-simmering debate over the glaring gap in vaccine access — largely between rich and poor countries, but among some developed nations, too — is now boiling over, with global figures and national leaders decrying the vaccine plenty in a few nations and the relative drought almost everywhere else.

African nations such as Namibia and Kenya are denouncing a “vaccine apartheid,” while others are calling for policy changes in Washington and a broader rethink of the intellectual property and trademark laws that govern vaccine manufacturing in global pandemics.

“It’s outrageous ethically, morally, scientifically,” said Maria Van Kerkhove, an epidemiologist with the World Health Organization, on global vaccine inequities.

“We have all the kindling to start fires everywhere,” she said in an interview. “We’re sitting on a powder keg.”

Let’s not forget that the wealthy nations put up a ton of cash to develop and produce these vaccines rapidly too. They should benefit from their investment, but at some point the “powder keg” will blow up in our faces as well as those closest to the blast. And it’s tough to defend sitting on tens of millions of doses we’re not even approving for use in the US, too:

🇺🇸 is currently sitting on over 100 million unused vaccine doses. An estimated 35-40m are #AstraZeneca, which 🇺🇸 still hasn't authorised to use on Americans and probably never will.

It is an absurd situation while half of all doses made in 🇪🇺 are exported (chart @jfkirkegaard). pic.twitter.com/kxkRmVtzU0

— Dave Keating (@DaveKeating) April 23, 2021

The CDC and FDA will eventually approve the AstraZeneca vaccine, but we probably won’t need it to hit our targets. It’s a low-hanging-fruit opportunity to show some solidarity, even if it’s on a “loan” basis, as we arranged for the AZ shipments to Canada and Mexico, both of whom are desperate for more doses of any vaccine they can get.