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Illustration: Rae Cook/Axios

The U.S. is the last major power to enter the race for global vaccine diplomacy, but still has the opportunity to win it.

Why it matters: China, Russia and other world powers began shipping vaccines all over the world months before the U.S. But they've all run into serious obstacles that leave the U.S. with an opening to become the biggest piece in the global vaccination puzzle.

The big picture: China has given or sold doses of its vaccine to around 90 countries, and 70 nations expect to receive Russia's Sputnik V vaccine, per the Economist Intelligence Unit. Those include nearly every country in Latin America.

  • The Biden administration has expressed concerns that Moscow and Beijing could use vaccines as leverage to expand their global influence.
  • Both governments stand to profit commercially from their state-funded vaccine, and diplomatically from the positive headlines the shipments produce.

Yes, but: Both have also struggled to deliver on their promises, as have the other major players: India and the EU.

That leaves the U.S., which is second only to China in terms of production but has barely exported any vaccine doses at all.

  • A major domino fell when President Biden agreed to export the U.S.' AstraZeneca stockpile.
  • Now, the White House has backed Pfizer's plan to begin to export doses made in the U.S., and announced that at least 10% of all doses purchased by the U.S. will be exported by July 4.
  • With its enormous production capacity and dwindling domestic demand, the U.S. could soon pivot to churning out highly effective vaccines — from Pfizer, Moderna, Johnson & Johnson and soon Novavax — for the rest of the world.

Where it stands: China has exported more doses than all the other major players combined — which it can afford to do because its domestic outbreak is largely under control — through a combination of commercial sales, loan deals and donations to friendly countries.

  • But China's homegrown vaccines are less effective than others on the market. Chile has found the Sinovac vaccine offers little protection against symptomatic infections after one dose, and 67% after two. A study in Brazil put the efficacy at just 50%.
  • In countries like Brazil and Hungary, the refusal rate for Chinese-made vaccines is much higher than for western alternatives.
  • The director of China’s CDC acknowledged last month that the efficacy rates for China’s vaccines were “not high.” Discussion of those remarks was quickly censored online in China, per the FT.

Between the lines: An exercise intended in part to show China’s scientific and manufacturing prowess has had mixed results, even as China leads the way on exports.

Russia’s vaccine appears to be far more effective, at least based on one peer-reviewed study published in February, but it has run into troubles of its own.

  • Brazilian regulators recently rejected the vaccine, citing quality-control issues and inadequate data.
  • Russia's limited manufacturing capacity has also left it lagging behind the other major players. It's now hoping that other countries will produce its Sputnik V vaccine for their own domestic use, similar to a deal struck last week with Mexico.
  • France and Germany are considering buying it, but the EU’s foreign policy arm recently accused Russia of using Sputnik V — and misinformation about other vaccines — to "undermine public trust" in the bloc's approach to vaccination.
  • And Slovakia’s prime minister resigned last month over his controversial decision to buy Sputnik V doses, which the country’s drug agency refused to approve.

The EU, meanwhile, has struggled to live up its own rhetoric around “equitable access” to vaccines.

  • While drugmakers have been consistently exporting doses from the EU, the bloc's slow rollout forced Brussels to modify its export policy and pause plans to donate doses to developing countries.
  • The latest: France recently became the first rich country to donate doses to the global COVAX initiative, but the scale (100,000 doses) is a drop in the bucket compared to the gap left by India, which was until recently powering COVAX almost single-handedly.

India has exported doses to over 90 countries, including donations to neighbors, allies and several Caribbean islands.

  • But New Delhi froze most exports in March in order to prioritize the crisis at home.
  • The African CDC is warning that a prolonged pause would be catastrophic for lower-income countries that are counting on COVAX.

What to watch: Biden has said he wants the U.S. to play a central role in supplying vaccines to the world, but he hasn't yet said when or how.

Go deeper

Tina Reed, author of Vitals
May 5, 2021 - Health

Pfizer posts crazy good quarter with major assist from COVID vaccines

Pfizer vaccine bottles are pictured at a COVID-19 vaccine administration center on May 4 in Italy. That same day, Pfizer reported a 42% year over year increase in revenue, a jump driven largely by the vaccine. Photo: by Donato Fasano/Getty Images

Pfizer reported a super strong first quarter, saying it now expects about $26 billion in sales for its COVID-19 vaccine this year. That's up from an earlier projection of about $15 billion.

The big picture: That anticipated windfall comes as the Biden administration announced more ambitious U.S. vaccine goals and the world scrambles to get access to shots.

May 5, 2021 - Health

Why Biden's latest vaccine goal is his hardest yet

Data: CDC, Our World in Data; Note: New Hampshire not including due to conflicting data from source; Chart: Andrew Witherspoon/Axios

President Biden's latest vaccination goal — 70% of adults receiving one shot by July 4 — will be much harder to reach than his previous ones. And if the U.S. gets there, it will likely be driven by blue states.

Between the lines: The U.S. has already inoculated most of its vaccine-enthusiastic population. States are already beginning to see wide disparities in vaccination rates, largely along political lines.

May 5, 2021 - Health

Poll: Mask use drops after CDC relaxes guidelines

Data: Axios/Ipsos Poll; Note: 3.3% margin of error; Chart: Sara Wise/Axios

Vaccinated Americans are easing up on wearing masks — but so are unvaccinated Americans, according to a new Ipsos poll.

Why it matters: The latest findings are an early snapshot of how people are modifying their behavior since the Centers for Disease Control and Prevention announced last week that fully vaccinated people don't have to wear masks outside.