Gayle E. Smith, State Department Coordinator for Global COVID-19 Response and Jeremy Konyndyk, USAID COVID-19 Task Force Executive Director

Moderator: Thank you. I’d like to welcome participants to today’s telephonic press briefing. We’re very pleased to be joined by State Department Coordinator for Global COVID-19 Response Gayle E. Smith and USAID COVID-19 Task Force Executive Director Jeremy Konyndyk. Today’s officials will discuss the United States commitment to global vaccine distribution and the milestone of the U.S. donating 200 million vaccine doses.

We’ll begin today’s call with opening remarks from both speakers and then turn to your questions. We’ll do our best to get to as many as possible in the time we have, which is approximately 30 minutes.

As a reminder, today’s call is on the record. And with that, I’ll turn it over to Coordinator Gayle Smith for opening remarks. Please go ahead.

Ms. Smith: Sure. Thank you, and thank you, everybody, for joining us. As you just heard, we’re very pleased to be hitting the milestone of having shared and delivered 200 million doses of vaccine to more than 100 countries around the world as of today. This has been an arduous effort initially announced by the President in June, and across the U.S. Government we’ve been able to build a team that works with our international partners – COVAX, UNICEF, WHO, the African Union, and others – to make sure this is a smooth process. It’s not a simple one. It’s very complex. But we’ve had deliveries – many deliveries any given day, deliveries leaving the United States on a very regular basis and a wide [inaudible].

I’ll just say a couple of things about what this has meant. When we started, I think as most of you know, global vaccine coverage was very, very, very poor. It is still not where it needs to be, but I think we are doing a great job of building those layers of vaccines and increasing that supply in tandem with others to get those numbers up.

The second point is that vaccines aren’t the only thing. We’ve got to get shots in arms, so that’s still a focus.

And the last point I would make, as the President said and as we made clear at the summit that he convened in September, our intention is to keep sharing doses. We announced at the summit that we have bought and are donating to COVAX an additional 500 million Pfizer doses, bringing us to a billion just on that source alone. But we will continue also to share from our surplus. We are also encouraging other countries with surplus doses to share as quickly as possible and help make it possible for more of the world to be vaccinated as we move towards the 70 percent target that was raised at the summit, but also so that we build the system architecture, rhythm, and planning that is needed to run a smooth global operation in partnership with institutions and governments all over the world.

Let me leave it there and turn to my colleague, Jeremy, to add more. And he’s been quite a leader in this whole effort. Jeremy?

Mr. Konyndyk: Thanks so much, Gayle. Yeah, and we are – we are really, incredibly proud of this milestone, which has been a tremendous team effort from across the U.S. Government. USAID’s role in this includes managing the distribution and the targeting of the Pfizer doses that are routed through COVAX, so we are working very closely with COVAX on – and Pfizer on getting those doses shipped as COVAX identifies the countries where they’re going to go. We are also – and I think this is very important – working closely with countries to help them scale up their absorptive capacity, so their ability to receive these vaccines and to distribute them through their national vaccination systems, and that has been an enormous effort along with a lot of partners like UNICEF and the World Health Organization to do things like install the specialized cold-chain capacity, make sure that countries have the syringes that they need, and support national distribution systems to roll out these vaccines as they arrive. And so it is a large and complex machine, but it is now scaling up and we’re seeing a larger flow of doses to low- and middle-income countries than we’ve seen so far, and we’re continuing to – we’re continuing to increase that.

So I think we’re in – we’re really pleased to see this going forward. We’re also cognizant that there are other things we need to do while we’re doing vaccines. So in addition to vaccines, we’re supporting things like oxygen provision, PPE provision, and testing so that countries can continue to mount a really comprehensive response to COVID-19. Thanks.

Moderator: Great, thank you very much for those remarks. We will now begin the question and answer portion of today’s call.

Operator: One moment for our first question.

Moderator: All right, our first question comes from Hyekun Seo of Radio Free Asia.

Question: Hi, can you hear me?

Ms. Smith: Yes.

Question: Hi, thank you so much for doing this. My question actually focuses on North Korea. They have rejected the COVAX that was offered before, but is the U.S. planning to provide vaccine assistance for North Korea, and if so, how will the vaccines be able to get to North Korea when the border closure is so tight? Thank you.

Ms. Smith: Sure. I will take that. Jeremy, you may want to add on this. We think that the best mechanism for delivering these vaccines is COVAX. It allows us to coordinate globally. It gives us a single system. There’s one exception given the terrific work of the African Union where they’re running their own system, but we’re making sure that we are coordinating with both of them in that case.

So COVAX, as you rightly say, has looked into this, I think is willing and able to provide vaccines. What’s necessary in any case is for governments to accept vaccines. So I think it would be our hope for the people of North Korea that there would be an acceptance of vaccines, and we would leave that in the hands of COVAX for the time being.

Moderator: Okay. Our next question comes from Pearl Matibe of Power FM 98.7 in South Africa.

Question: Good morning, Gayle and Jeremy. Good to talk to you again. So my understanding is for us to – for the world to get to this new tone, the 70 percent, that about 10.8 billion doses are going to be required. Can you help explain what portion of that would go to sub-Saharan Africa? And I separate that out as opposed to the whole of Africa, maybe if you can give us some understanding of the variances there. And where are we at now? I know in July Africa only had had about 2.6 percent vaccinated, vaccination rate. So where is that vaccination rate at now?

And my second part of my question is: What specific diplomatic efforts have you been doing in terms of even the G20 or which are those countries where you might be facing some challenges? Also, perhaps speak to the countries – for example, like Zimbabwe and Tanzania – who I know Tanzania only just recently just started accepting vaccines. Why is that? Help us understand which of those countries on the continent have not yet been accepting vaccines. Thanks.

Mr. Konyndyk: Thanks. I can maybe take that.

Ms. Smith: Jeremy, first one?

Mr. Konyndyk: Gayle, so I’ll take the dosing numbers and do you want to take the G20 piece?

Ms. Smith: Sure.

Mr. Konyndyk: Okay. So the population of sub-Saharan Africa is about 1.14 billion. If you assume a two-dose regimen, which I think most are – Johnson & Johnson is still formally one dose, although some of the recent research holds the potential, I think, to alter that, but I won’t get ahead of the research there. But so just assume in general a two-dose regimen for most vaccines. That would be about 1.6 billion doses that would be needed to – would need to be administered in sub-Saharan Africa to hit 70 percent. That’s 70 percent of population times two doses apiece.

So that’s obviously a pretty significant volume, but then again, the volumes that are now coming into the COVAX portfolio through both our support via a billion doses of Pfizer and the – and some of the other doses that COVAX has secured, and then, really importantly, the African Union has its African vaccine access initiative, AVATT, which has secured 400 million doses of J&J and working to secure additional – we are providing much of the surplus that we are sharing in Africa, we are coordinating it very closely with AVATT. All of it, in fact, is being coordinated closely with AVATT. And so I think that there is a path here to beginning to catch up on the supply side, and then it’s going to be a matter of working very closely with countries across sub-Saharan Africa to ensure that they have the capacity to manage and administer those doses very rapidly, and so we’re scaling up our support on that front as well.

Ms. Smith: And I’d just add – hello, Pearl. Nice to hear from you. On the diplomatic front, in answer to your questions, two quick things. I think with many of the countries we work with, primarily, say, in the G7, we are strongly encouraging and we’ve got strong commitment, but one of the things we all need to do is be able to project when we’re going to be able to provide these vaccines, give the countries fair notice, and accelerate the pace. Because as Jeremy says, we’re seeing some improvements on the supply side, but it doesn’t mean we’re there.

Because part of what we need internationally is to be able to look out three months, six months, know what the supply is going to be and plan accordingly. Because countries need to prepare to deliver these vaccines on the ground, and that’s been a very difficult thing to do because the supply, particularly with COVAX, has not been at all predictable. So that’s a big focus: How do we get predictability of and increased volume of supply?

On your other question, I mean, Tanzania, we are pleased to have delivered over a million doses there. I think that country is embarking on an effective vaccination campaign, and we think it’s great. There are a couple of other countries that have – and they’re tiny numbers – may have declined to receive doses from us or COVAX. I think what needs to happen there and what is happening there is continued, often quiet conversations to encourage governments to accept and utilize vaccines from whatever the source. It doesn’t have to be from us. But I think as we all know, the virus doesn’t care whether you live on one side or the other of the border, and we want to make sure that people everywhere are protected. So we just keep trying to work those issues until we get the acceptance that’s needed to enable them to care for their citizens but also help end the global pandemic.

Moderator: Great. Our next question comes from Joel Gehrke of The Washington Examiner.

Operator: We’re going to the next caller. Please go ahead.

Question: Hi, thank you. Thanks for doing this. I have a question sort of apropos of some comments that Secretary Blinken made yesterday while he was traveling in Ecuador and there was a migration-related question, and of course he mentioned that one of the drivers of migration right now is the pandemic. And I wondered, either with respect to that particular issue or more broadly, as you survey the landscape, do you see places where the pandemic and perhaps the pandemic response is contributing to some kind of crisis like migration or something analogous, and do you have the ability to target vaccines towards different situations and ameliorate that or mitigate that problem? Is that the kind of approach you’re able to take and do you think it’s effective?

Ms. Smith: Yeah, let me say a couple of things on that and Jeremy may want to add. Look, our approach on the vaccines is driven largely by epidemiology, right? We really need to shut this virus down, which means in the main getting coverage up in a lot of countries. There is also a need to focus on populations where there may be a challenge and ensure that internally displaced people, for example, are covered. So we are supporting UNHCR and other organizations to make sure that indeed we’ve got a global response.

I think we have provided a significant number of vaccines within the Western Hemisphere, if that’s the focus of your migration. I think the other thing I would add there, though, is that yes, the pandemic is one of the triggers and one of the factors, but I think if you look at the biggest consequences of the pandemic, they are far-reaching economically across the board in almost every country in the world. We’re seeing huge losses in growth, a huge spike in poverty. We are seeing some decline in other health indicators. Which is why even as we’re doing the vaccine response, we are supporting through the international financial institutions, USAID and others, responding to the economic impact, because we think you’ve got to do both of those things if you want to mitigate some of the potential fallout.

Mr. Konyndyk: Yeah, and I think the vaccination progress in Central America has been improving, as it has been in most middle-income countries, and they’re – most of Central America now is pretty far ahead of sub-Saharan Africa in terms of their coverage rates and continue to improve. As Gayle said, we have been targeting some of our shared domestic surplus in Central America, and a number of those countries are also eligible for some of our Pfizer doses through COVAX. We are providing that kind of support.

It is hard to – it is hard to parse out in terms of the drivers of migration how much is – how much is pandemic-related and will be ameliorated, or would theoretically be ameliorated, potentially, by vaccine availability. But I think Gayle’s point is the right one, which is that it’s really – to the extent that the pandemic is driving wider – the wider economic disruption, and that tends to be a pretty significant factor in migration flows. That’s certainly an element of it there.

Moderator: Okay. We’ll go to a pre-submitted question from Dusabemungu Ange de la Victoire at TopAfricaNews.com in Rwanda, who asks: “Ethiopia is currently experiencing conflict. Do you have confidence that the Ethiopian population in conflict zones will be able to get vaccines? What do you say about similar situations around the African continent?”

Ms. Smith: Yeah. I’ll take that question, and thanks – it’s a really good question. We have shared a substantial number of vaccines with Ethiopia that also has other sources. They’ve obviously got a big population. It is certainly our hope that those vaccines will be made available equitably to everyone who needs them. But your question points to an obvious challenge on that front. That is, where there is conflict, how do we approach it? What do we do? What’s our confidence level?

Look, where there’s conflict, there’s a challenge. Our effort is overwhelmingly to make sure – or where there are political tensions – that these vaccines are shared on the basis of national vaccination programs which countries share with COVAX in advance, and that they’re based on – just as our global sharing is – the epidemiology. Right? They’re not based on politics; they’re not based on any other thing.

All of that said, it’s one of the challenges we face and that we and other international partners are working on not just in Africa, but in various parts of the world where we have active conflict, and therefore there is some risk that vaccination coverage won’t be as high as it needs to be. So that’s our focus and it’s a really good, really good question.

Mr. Konyndyk: I would just add that the – USAID and the U.S. Government and many international health partners have worked in conflict zones for many, many years and run vaccination programs in conflict zones all over the world. It’s not a coincidence, for example, that we still have active polio eradication programs in places like northern Nigeria and other conflict zones.

So I think what we know from those kind of experiences is that this is something that can be done. It’s hard to do this work in conflict zones, but it’s also possible to do it. But it does depend in part on access, and so it will be important in Ethiopia and anywhere else where there is conflict underway that warring parties allow access for vaccination teams to carry these sort of activities forward. It’s really going to depend on that.

Moderator: Okay. Our next question is from Alexander Tin of CBS.

Question: Thanks for taking the question. Can you give us an update on the kind of timeline and challenges you foresee for scaling up production for more donations, both of the currently authorized vaccines from Johnson & Johnson and then [inaudible] shots like Novavax? Thanks.

Mr. Konyndyk: Yeah. I mean, I think the U.S. is doing everything that we can with those companies to support them and to help them to scale up. Both Novavax and Johnson & Johnson are also vaccines that are part of the domestic portfolio. Novavax obviously hasn’t been approved yet, but it was part of the – one of the candidates that the U.S. Government was supporting.

So I think we’re continuing to push hard and do everything we can to support the scale-up in those – of those companies, but ultimately we also have to ensure as a government that that’s being done in a way that is safe and will pass muster with regulators. And so we can’t and wouldn’t try to get out ahead of that. I think we are providing whatever support we can, and we’re also – something like what we’re doing with our purchases of Pfizer is also a way of ensuring that there are multiple options available to COVAX and to developing countries in terms of the vaccines that they can draw on. So what we’ve seen throughout the past year is some of the vaccines in the COVAX portfolio have come through hugely and some are – some have been slower to arrive than we’d hoped, and we are both supporting and leaning on the companies to support them and push them to deliver to COVAX, but also working with COVAX to find alternate options so that they can meet some of their near-term supply needs if the original plans are not panning out.

Ms. Smith: And I would just add one thing to that, is that the other way that we’ve been able to help increase production is our Development Finance Corporation, which was previously known as OPIC – it’s now a new organization with a lot more capabilities – has made investments, for example, in South Africa, where the Aspen manufacturer plant does J&J; another investment through the Quad in India. Our head of – acting head of DFC is now on the road exploring other opportunities for investment where we can with the injection of capital help pretty swiftly increase the production of vaccines in existing facilities.

Moderator: Lovely. And with that, we have time for one more question.

Operator: And are we ready to move on to the next caller?

Ms. Smith: Yeah, I believe he said —

Moderator: Yes, sorry. Next —

Ms. Smith: — the next question.

Operator: Pardon me, I apologize. Pearl Matibe, your line is open.

Question: [Inaudible] further on the manufacturing question. Now, since we’re heading to the end of the year, do we know, for example, how much in the facility there in South Africa, Aspen Pharmacare, how much have we actually done up to now or do we expect to have produced by the end of the year? And how are you, like, comparing with the China and Russia vaccines being produced, for example, in Morocco and Egypt, and do you have any new countries that you maybe can share with us that you might be looking to be working with to begin that? Are you doing anything in Senegal, in Nigeria, or any of that?

Ms. Smith: Sure.

Question: Or any of that? And maybe give us where might we be by mid-2022? Because I think the expected target for mid-2022, to get to that 70 percent, like I said, we’ll probably be requiring about 10.8 billion vaccines. So I’m trying to understand, okay, how much have we produced, might we produce by the end of the year, and where would we be by mid-2022? Thanks.

Ms. Smith: Let me say something quickly on Aspen and where else we might be looking for production, and then I’ll turn it over to Jeremy about looking at mid-2022, which I think is important to do.

But just very quickly, I don’t have the numbers on Aspen’s production with me right at the moment. They have certainly increased. But taking a step back, here’s our theory of the case. That is that the global vaccine architecture has proven to be too small and not sufficiently available geographically to help the world out in a global pandemic, right? So we need to reimagine what that global architecture looks like, and it’s not just vaccines; it’s the supply chains for vaccines, it’s a whole host of things, PPE, other things that have been necessary.

But if we’re focusing on vaccines, what we are looking at is countries so that we can see increased production over time in multiple regions where there are facilities that may exist that with an injection of capital might be able to expand production immediately, but also companies that may be small and new that may not be the ones that change the game in the next two quarters but which over time and into the future, as we prepare and prevent, will have some of the capacity that’s needed. That’s a very active line of effort on the part of the U.S. Government and will remain one, I’m confident, throughout the administration. Because this is a short-term imperative. Right? Aspen was an important short-term imperative. But this is also a medium- and long-term imperative, because unless we’ve got more places with greater production, we could be at risk of facing the same challenge should we face another virus like this one.

Let me turn to Jeremy for the question about thinking about mid-2022.

Mr. Konyndyk: Yeah. I mean, so I think the figure of around 11 billion as the number that needs to be administered to get to 70 percent globally is right. And I think from a production point of view, certainly by mid-2022, that volume of doses will have been produced and then some. I think that part of the challenge here is making sure that they are then being allocated in a strategic way, and in particular that more – a larger and larger share of the doses that are being produced each month are going to low-income countries where they’re most needed at this point.

And so the – where we will be by mid-2022, I think it is – it’s hard to project. A lot depends on what happens with production of Johnson & Johnson. I think Aspen does have a really important role in that and it’s been – and we’ve been really thrilled they’re a partner of the Development Finance Corporation. As Gayle said earlier, we’ve been really thrilled to see the progress that they’ve been making and the really important role they’ve been playing in enabling supply of finished doses on the African continent. Novavax is another big, big variable at this point, and I think if Novavax comes through fairly soon, that will be wonderful and that will be a big help because they’re a major part of the COVAX portfolio. If Johnson & Johnson can continue to scale up their manufacturing, and there are a couple of facilities here in the United States that they’re bringing back online over the coming months, that could play a really important role. And I think those things like that will help to be in a really – to us to be in a better place by mid-2022.

I think Gayle’s point on the longer term is also really important. I think what we’ve seen in this pandemic is that what the world needs is more decentralized, regionalized vaccine production capacity so that we have more options to depend on when we need to produce this kind of vaccine push. Thanks.

Moderator: Thank you. That was the last question we have time for. I’d like to thank both our speakers for joining us and turn to them to see if they have any closing remarks.

Ms. Smith: No, I would just say thank you for your continued interest, and I hope you will keep covering it. As we said at the top, we’ll continue to share vaccines. We’ll check in with you later as this moves forward. And thank you again for your interest.

Mr. Konyndyk: Yeah, and thank you all for your focus on this. We are really proud to have shared 200 million vaccine doses to date. We’ve got a billion and counting to go, and there’s a lot of work to be done. But we think we’re gaining good momentum.

Moderator: Great. Once again, thank you for joining us and thank you to all the reporters on the line for your participation and your questions. This concludes today’s call.