Why did European countries, with their vaunted national health insurance systems, and Asian countries, with their vaunted public health systems, fall behind the U.S. on vaccination?

For Europe, one big obstacle was that the EU decided to bargain for vaccines as a group, which made the process of securing shots very cumbersome. As a result, the region got cheaper vaccine prices but delayed delivery. The EU regulatory state has also reportedly gotten in the way of rapid approval. And the EU member states seem to have spent some time fighting over who gets how many vaccines — not the first time that dissension within the multinational federation has caused problems at a moment of crisis.

As for Asian countries, their success in suppressing the virus with public health measures has reportedly made them more cautious about mass vaccination, and more focused on getting vaccines cheaply. Japan wasn’t as good at suppression as many of its neighbors, but its approval process has been slow; the government also hasn’t shown as much urgency as others. And in some Asian countries, reluctance to get vaccinated may also be a factor.

U.S. manufacturers have also been better at rolling out large numbers of vaccine doses.