The Biden administration’s plans to distribute surplus vaccines to countries in need are greeted with skepticism by public health and human rights activists who argue that the United States must do more to increase the supply worldwide in vaccines.

Health officials said Thursday’s announcement of a plan for the first 25 million doses was a down payment of at least 80 million doses by the end of the month, with the promise of more to come. later this summer.

Pressure has grown on the White House to come up with a plan to donate its surplus vaccines to countries that have been hit hard by the virus without the same access to vaccines as richer countries.

But the 80 million doses are enough to reach just 1% of the world’s population, and advocacy groups argue that more needs to be done, including helping developing countries expand manufacturing networks and working with vaccine manufacturers to build global capacity.

Experts fear the limited number of doses distributed immediately may exacerbate the damage from COVID-19 abroad. One concern is that without vaccination, new variants of the virus may appear in other countries that could threaten the rest of the world.

“I have no complaints about hearing the details of a previously planned donation. But here is the reality. We are seeing the catastrophe of this situation all over the world, and time is running out,” said Tom Hart , Interim Managing Director of One Campaign. , a global anti-poverty group.

“The United States and… the rich countries that have excess doses need to urgently release them and plan early to put them in the arms of the people who need them,” Hart added.

As part of the White House plan, 19 million doses would be sent to COVAX, the World Health Organization-backed initiative that aims to provide each participating country with enough doses to cover 20% of its population this time. year.

The doses would be distributed among different regions, with 6 million doses destined for Latin America and the Caribbean, 7 million for Asia and 5 million for Africa. Biden officials and advocates said COVAX already had the logistics to quickly distribute the doses.

The US announcement comes as more than 60 countries around the world have yet to receive a single vaccine through COVAX, which is grappling with supply constraints, especially after the world’s largest maker of Indian vaccines has suspended its exports.

“It’s a great first start, but the reason we call it a drop in the bucket is that America bought 1.2 billion doses, but we know we don’t have 1, 2 billion people here, ”said Carrie Teicher, program director for Doctors Without. Limits.

“Even if the 330 million people in the United States – even pediatricians – were vaccinated and they all received a two-dose vaccine and no one hesitated to vaccinate, we would still have half a billion doses of vaccine.” prepared owned by America. are surplus, ”she added.

But there are additional questions as to why the White House chose certain countries and how authorities ultimately decided on the number of doses sent to each.

“I don’t quite understand… what criteria were used to decide which countries would receive which doses, whether they were somehow using the existing COVAX rules of the game or whether they were suggesting that there would be a different allocation on the basis of a risk or needs assessment in different countries, ”said Amanda Glassman, executive vice president of the Center for Global Development.

While other countries have been less prescriptive about where donated vaccines end up, the national security adviser Jake sullivanJake Sullivan China urges Biden to provide “fair and non-discriminatory” business environment House Democrats call on Biden to do “much more” to vaccinate the world Biden bans US investment in Chinese companies linked to surveillance MORE said the United States has the power to dictate allocations, although this is done “in very close consultation and partnership with COVAX.”

Outside of COVAX, the White House is donating the remaining 6 million doses directly to Haiti, Gaza and the West Bank as well as to countries that Sullivan said are “America’s closest neighbors … and friends” .

Sullivan and other administration officials have made it their business to try to distinguish US efforts from the “vaccine diplomacy” in which Russia and China engage, by leveraging the doses for diplomatic relations. more friendly.

“The United States is not asking anything of any country that we are giving doses to. We are not seeking concessions. We are not extorting. We are not imposing conditions, like other countries that provide doses do.” Sullivan told reporters Thursday.

But at the same time, Sullivan noted that it is useful to help friends and neighbors.

He specifically mentioned the million doses of Johnson & Johnson vaccine allocated to South Korea, intended to protect US troops and “the Korean troops who stand side by side with us in this country.”

Gayle Smith, the State Department’s coordinator for the global response to COVID-19, said countries will know the help has come from the United States.

“I think on the branding side there is a real difference between trying to curry political favor and letting countries know that the help we can provide is from the American people,” Smith said. to reporters on Friday. “Yes, these are from the United States. This is an important fact that many people will be well aware of.”

The choice of which initial countries to prioritize surprised some experts who noted that some doses went to relatively wealthier allies with greater power to secure their own vaccine supply.

“Sharing doses with Canada is like vaccinating our 12 to 15 year olds,” Teicher of Doctors Without Borders said. “It’s not bad public health practice, but it may not be the global priority for equitable vax distribution at this time.”

But it is not just a simple donation of vaccines. Ahead of the Group of Seven summit later this week, experts and advocates want to know how the United States and its allies will help boost global vaccine manufacturing.

Without increased capacity and better access to raw materials, the global vaccine supply will continue to be constrained.

The Biden administration supports lifting intellectual property protections for vaccines as a way to overcome these problems, but experts say more immediate action is needed.

Rohit Malpani, public health consultant and board member of Unitaid, which works on disease prevention and treatment in developing countries, said that manufacturers who “have received very large sums of money from the public sector “should be obliged to help outside facilities to replicate their work. .

“If we had pushed them to share the knowledge, the know-how, the manufacturing, we wouldn’t be in the current situation where we mostly rely on charity to distribute these vaccines in low-income countries. he said.

Malpani said the donations are “needed” right now, but they don’t have to be.

“The donation is … a failure because [wealthy nations] tell governments that they are not in control of their fate, that there is not enough production, and that they are going to have to continue to rely on charity from rich countries to provide the vaccine on this basis which could be snatched up at any time, “he added.