Melissa Harris-Perry: I'm Melissa Harris-Perry in for Tanzina Vega. This is The Takeaway. Over the weekend, world leaders from some of the richest countries gathered at the G7 Summit in England. Normally, it's an annual event, but in 2020, the raging coronavirus pandemic led President Trump initially to delay and then to cancel the summit.

This year, the COVID-19 crisis had receded enough in the world's richest countries to allow the leaders of Canada, France, Germany, Italy, Japan, the UK, and the US to meet together in person and maskless.

Spirits were high as Prime Minister Johnson and his wife Carrie welcomed President and First Lady Biden with smiles and elbow bumps. This relative normalcy of G7 proceedings was set against the continuing reality of COVID's deadly impact on the rest of the world. The day before the summit began, India reported more than 6,000 deaths from coronavirus, the world's most devastating daily mortality since the pandemic began.

This vast global disparity meant that COVID-19 was the top agenda item for the G7. President Biden held a news conference at the end of the summit, announcing a significant contribution by the United States to meet the G7's commitment to allocate one billion vaccine doses to poorer countries.

President Joe Biden: I committed that we would provide a half a billion, a half a billion beyond the 80 million we've already done. Half a billion doses of Pfizer vaccine​, which we contracted to pay for, in addition to money we put into the COVID project.

Melissa Harris-Perry: These commitments are important for battling COVID-19, but some are wondering if relying on the goodwill of richer nations is a sustainable long-term approach to global public health.

Joining me now is Emily Rauhala, who is staff writer for The Washington Post covering foreign affairs and vaccine diplomacy. Emily, welcome to The Takeaway.

Emily Rauhala: Hello, happy to be here.

Melissa Harris-Perry: Also with me is Tom Bollyky, who is Director of Global Health Programs at the Council on Foreign Relations. Tom, so glad to have you today.

Tom Bollyky: My pleasure. Thanks for having me.

Melissa Harris-Perry: Emily, I want to start with you. The Biden administration pledged these 500 million doses to developing countries and helping to make sure that the G7 commitment of one billion gets done. Is this a big deal? Are these a lot of doses?

Emily Rauhala: That's a great question. I think there's really two ways to look at it. First of all, yes, in one way, it is a very big deal. 500 million doses from the United States plus hundreds of millions of other doses from partners, it's a lot of doses. For each and every person who receives one of those doses, it's potentially life-saving, so yes, big deal.

On the other hand, when we put those figures up against a broader picture of global need, both in the immediate short term and looking through to the middle term next year, the year beyond that, it's a relatively modest figure and it really shows how urgent the situation is in terms of global vaccination.

Melissa Harris-Perry: I want to just follow on that with you, Emily, for a second just to ask, imagine we could just wave the magic wand, just how many doses does the world need to beat COVID-19?

Emily Rauhala: The estimate that's typically floated from public health experts and organizations like the World Health Organization is that it's going to take something like 11 billion doses to get the world up to a reasonable standard of vaccination and have a chance of beating this thing back.

A lot of people recognize that that will take a while, but putting that one billion dose in perspective, I think it's really important. It's a lot of doses, it will matter significantly to every person who gets one of those doses, but it's far short of what we're going to need over the next months and even through years.

Melissa Harris-Perry: Now, Tom, you wrote for The Atlantic back in March that in the fight against this disease, the powerful countries with the best access to vaccines have really kept the overwhelming number of available doses to themselves. Has this G7 pledge changed that pattern?

Tom Bollyky: It has. It's at least a step in that direction. For most of the six months that the global vaccination rollout has been happening, the countries that have been the largest donors have been China, India, although that has stopped now amidst its crisis, and to a much lesser extent, but still significant, Russia.

Most democracies, wealthy democracies at least, weren't donating doses at all. The US did loan doses to Mexico and China about a month ago, but this commitment of doses is really the first large commitment to start donating on behalf of these wealthy democracies.

Melissa Harris-Perry: Tom, I just find this fascinating. I feel like I haven't taken an IR class since grad school, but it was one of those rules, that democracies rarely go to war with each other, one of those things you just are supposed to take away. Is it also true then that democracies rarely help the rest of the world in the context of a global pandemic or is this something distinct?

Tom Bollyky: I do think it's an interesting issue. It comes down in two ways. Wealthy democracies had committed cash. COVAX, the multilateral initiative, almost every large funder is a wealthy democracy. That had been scheduled to distribute two billion doses this year. They're sadly far short of that goal, currently at 80 or so million doses distributed so far, but they were helping in that regard. A lot of the global health infrastructure that'll distribute vaccines is funded by the US and other wealthy democracies.

In terms of sharing doses when they were scarce, it does appear that wealthy democracies had a hard time justifying to their public using doses abroad that could be used to satisfy needs at home. That has remained true even as we've moved to less vulnerable populations, like adolescents.

Melissa Harris-Perry: Emily, let's go to-- Tom was just talking a little bit there about the COVAX initiative. Can you help us to understand a little bit more about what it is and where it currently stands?

Emily Rauhala: Sure. COVAX is the multilateral system's answer to this crisis. It started to get underway even last summer, well before there were viable coronavirus vaccines. The idea was, let's pool our resources. Instead of competing against each other for supply, let's pool our resources, negotiate with vaccine makers together, and then equitably split the results with an eye to getting vaccines everywhere. A very good and noble idea.

What happened instead, as Tom has mentioned, was that wealthy countries pledged money and support to this initiative, but at the same time, they really cut side deals directly with drugmakers. You had countries like the United States, Canada buying huge amounts of the projected supply from most of the vaccines ahead of time, well before they were even approved for emergency use.

That really undermined this collective effort because you had the richest countries in the world competing against this WHO-backed multilateral effort for the same doses. COVAX faith took another blow more recently with the crisis in India. A lot of the doses that COVAX said it would deliver were going to be made in India. The delivery of those doses has been slowed a lot down because of the crisis there.

What's seen as the best hope, or what had been seen as the best hope for low and middle-income countries has really struggled to get off the ground. The consequences of that have been quite dire and could indeed be dire going into the months ahead.

Melissa Harris-Perry: It's worth noting, Tom, that during the G7, one of the other big agenda items was China and the idea of marginalizing China a bit on the global stage, but I'm wondering if we come back to the vaccine piece, what role China is currently playing relative to distributing these excess vaccines and if they're doing better than these rich democracies have been doing up to this point.

Tom Bollyky: China has been donating doses. Not huge amounts of doses, ultimately. The vast majority of the vaccines that have left China have been commercial sales, exports, countries buying them from producers in China. China has donated roughly 40 million doses on top of that, I think, at this point. They've pledged more, but a lot of them haven't left the country as they've focused on their own domestic vaccination program.

Those doses, despite China's protestations otherwise, have largely gone to trading partners and strategic interests. All but two of the countries that have received donations of vaccines from China are Belt and Road Initiative countries, so countries that are participating in economic development in partnership programs with China.

What the G7 did this week in addition to committing significantly more doses than China had, they also, those leaders, have articulated a different way of proceeding with vaccines. They have indicated that they won't be traded for political favors, and they will follow the public health data. That part remains to be seen. They've committed to work with COVAX on how those distributions of vaccines occur, but we don't know as of yet where these 1 billion doses that the G7 committed this week will actually go.

Melissa Harris-Perry: I am so appreciative of the way you laid that out for us, Tom. Emily, it does feel to me, like the naked politics are visible in that exporting, or even in donating to strategic partners. There's always politics, those are given. I'm wondering, in the context of the G7 nations what that politics or diplomacy looks like, is it rivalry between the nations? Is it posturing or is there a genuinely politics-free collaborative effort happening here?

Emily Rauhala: There's very much politics at play. One of the things that's been really interesting for me to watch over the last few months to start is how the Biden administration talks about this. Biden comes to office wanting to restore America's role in the multilateral system, work collaboratively with allies. At the same time, there are a lot of voices within his administration saying we have to do more to compete with China, to counter China's overtures on the world stage.

In the administration's early vaccine efforts, we really see them trying to feel their way in terms of how do we give these doses away? In one of the initial rollouts, we said, okay, 75% to COVAX, 25% based on need, and we're also going to do our neighbors. You can see them trying to figure out whether they want to play that hard politics, interest-based game, or commit to the multilateral approach.

In terms of the US interactions with the G7, there's definitely a split. I would say right now the split, in terms of the vision for vaccine diplomacy has the most to do with how well the domestic vaccination campaign is going. The US and the UK who have vaccinated a lot of people at home are feeling the most generous, and countries that have had less successful campaigns so far, are more hesitant.

Melissa Harris-Perry: Tom, let's talk about how it happens. How do we, in fact, get the shots into arms? It's one thing to pledge the doses, it's another thing to make it happen.

Tom Bollyky: That's right. One helpful way to think about this is there are really three constraints on how quickly vaccination happens, both domestically and globally. There are supply constraints, do you have enough vaccines? There are administration constraints, can you actually deliver them into arms? There are demand constraints, do people want to take them?

We've seen that in play domestically, we're about to see it globally. What we've been talking about in terms of donations is addressing that supply constraint. There, the US has indicated, I think they will probably be the fastest, that these doses will start to roll out in August.

Now, these are additional to the smaller donations the US had indicated would happen in June. The US is scheduled to start to donate 25 million doses in June. Now, the challenge will be can we actually distribute these in countries that have limited vaccination infrastructure? Keep in mind, most of these doses are going to go to adults. That is not what global vaccination programs are set up to do. By and large, we vaccinate children in global health, not so much adults, so this will be a challenge.

Then there's the question in some countries about the vaccine hesitancy issues, which are not as palpable as they are in the US, but they are real, and particularly with increasing adoption of social media around the world, something that will also have to be addressed to ensure that we can get the uptake that we need.

Melissa Harris-Perry: Emily, I'm wondering about the geography of this, where will the vaccines go first? You mentioned India earlier, and obviously, Japan, which is itself a G7 but given the nature of the Olympics there, I'm just wondering where on the map we're going to see this start happening?

Emily Rauhala: That's a great question. It's a question that I don't necessarily have an answer to yet, because the messaging that we saw coming out of the G7 was not very particular on that point. The debate seems to be-- among the rich countries, is how do we distribute this? Do we go through COVAX which promises every participating country an equal share, regardless of need? A country like say Canada, that is relatively wealthy and does have access to vaccines is also participating in COVAX, for instance, or do we somehow earmark these doses for the countries in the greatest need?

There's a pretty robust debate, I think, within the G7 countries, also within the public health world. I know this is something that Tom has written about, about what is the most effective and what is the most ethical way to decide who gets what, when, and that is not clear to me at this point.

Melissa Harris-Perry: Tom, that's exactly where I wanted to go next. Obviously, the president there was saying that part of this is to put together a mechanism to anticipate and deal with the next pandemic, and your point that we've had success globally in vaccination but of children. Is this model of hoping that the wealthy nations will either through their own political or existential interest and be sure to contribute to poor nations? Is that the model going forward or is there some other set of structures we should be implementing?

Tom Bollyky: Great question. There are really two issues here. One is production, and one is how we're going to allocate these particular donations. On the production side, right now, nine countries have administered three out of every four doses that have gone out in the first six months of this vaccine rollout. Those countries are, by and large, the same countries making them.

It's understandable that countries that are producing vaccines would want to prioritize the needs of their own population, it is equally understandable that every other country would love to be in the same position.

After experiencing this pandemic, it's not going to be acceptable for countries to be without production, at least regionally. The big push will be how do we set up regional centers of manufacturing so, in the future, you don't have such a small number of countries monopolizing vaccine production so that every other country needs to wait.

The second issue that Emily raised that I just want to quickly flag is around how are we going to distribute these doses? Is it going to be done by population or is it going to be done by current risk?

We did put a piece out in The Lancet list last week, I do think it's pretty clear where the areas of greatest risk are going to be in the next 12 weeks. The question is, can countries direct doses at least initially there first because the goal of vaccination really should ultimately be about preventing premature death, and given scarce resources, we have to make sure we're marshaling vaccines to go to the settings where that public health gain is possible.

Melissa Harris-Perry: Emily, if I'm a listener in a state where we're up to 60% vaccination of adults, I've taken off my mask, I'm about to have hot girl summer. Why should I care whether or not India or South American nations end up with vaccines?

Emily Rauhala: It's a great question. I think it gets to the heart of this issue and the hesitancy of rich countries so far to share. I think there's clearly an ethical case, beyond that, it's a very practical case. Everyone wants this to be over. Everyone wants to move on but until people everywhere are vaccinated, the Coronavirus is going to continue to circulate. It's going to have lots of chances to mutate and it's going to keep spreading and we'll have to see how well the vaccines pulled up against future versions of this virus. We'll have to wait for the global economy to recover. Basically, this disaster that everyone wants to be over is not going to end until everyone is vaccinated.

Melissa Harris-Perry: Vaccine equity is not just philanthropic, it is self-interested. Emily Rauhala is staff writer for The Washington Post covering foreign affairs and vaccine diplomacy, and Tom Bollyky is Senior Fellow for the Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. Thank you both.

Emily Rauhala: Thank you.

Tom Bollyky: Thank you.

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