[Senate Hearing 117-227]
[From the U.S. Government Publishing Office]
S. Hrg. 117-227
VACCINE DIPLOMACY IN LATIN AMERICA AND
THE CARIBBEAN: THE IMPORTANCE OF U.S.
ENGAGEMENT
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON WESTERN
HEMISPHERE, TRANSNATIONAL
CRIME, CIVILIAN SECURITY,
DEMOCRACY, HUMAN RIGHTS,
AND GLOBAL WOMEN'S ISSUES
OF THE
COMMITTEE ON FOREIGN RELATIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 18, 2021
__________
Printed for the use of the Committee on Foreign Relations
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-213 PDF WASHINGTON : 2022
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COMMITTEE ON FOREIGN RELATIONS
ROBERT MENENDEZ, New Jersey, Chairman
BENJAMIN L. CARDIN, Maryland JAMES E. RISCH, Idaho
JEANNE SHAHEEN, New Hampshire MARCO RUBIO, Florida
CHRISTOPHER A. COONS, Delaware RON JOHNSON, Wisconsin
CHRISTOPHER MURPHY, Connecticut MITT ROMNEY, Utah
TIM KAINE, Virginia ROB PORTMAN, Ohio
EDWARD J. MARKEY, Massachusetts RAND PAUL, Kentucky
JEFF MERKLEY, Oregon TODD YOUNG, Indiana
CORY A. BOOKER, New Jersey JOHN BARRASSO, Wyoming
BRIAN SCHATZ, Hawaii TED CRUZ, Texas
CHRIS VAN HOLLEN, Maryland MIKE ROUNDS, South Dakota
BILL HAGERTY, Tennessee
Damian Murphy, Staff Director
Christopher M. Socha, Republican Staff Director
John Dutton, Chief Clerk
SUBCOMMITTEE ON WESTERN HEMISPHERE,
TRANSNATIONAL CRIME, CIVILIAN SECURITY, DEMOCRACY,
HUMAN RIGHTS, AND GLOBAL WOMEN'S ISSUES
TIM KAINE, Virginia, Chairman
JEFF MERKLEY, Oregon MARCO RUBIO, Florida
BENJAMIN L. CARDIN, Maryland ROB PORTMAN, Ohio
JEANNE SHAHEEN, New Hampshire JOHN BARRASSO, Wyoming
EDWARD J. MARKEY, Massachusetts BILL HAGERTY, Tennessee
TED CRUZ, Texas
(ii)
C O N T E N T S
----------
Page
Kaine, Hon. Tim, U.S. Senator From Virginia...................... 1
Rubio, Hon. Marco, U.S. Senator From Florida..................... 3
O'Reilly, Kevin, Deputy Assistant Secretary of State for Western
Hemisphere Affairs, U.S. Department of State, Washington, DC... 5
Prepared Statement........................................... 6
Natiello, Peter, Acting Assistant Administrator, Bureau for Latin
America and the Caribbean, United States Agency for
International Development, Washington, DC...................... 9
Prepared Statement........................................... 10
Runde, Daniel F., Senior Vice President, Center for Strategic and
International Studies.......................................... 22
Prepared Statement........................................... 24
Restrepo, Dan, Senior Fellow, Center for American Progress,
Washington, DC................................................. 29
Prepared Statement........................................... 31
Castro, Dr. Arachu, Director of the Collaborative Group for
Health Equity in Latin America [Chela], Tulane University, New
Orleans, LA.................................................... 34
Prepared Statement........................................... 35
(iii)
VACCINE DIPLOMACY IN LATIN AMERICA AND
THE CARIBBEAN: THE IMPORTANCE OF U.S. ENGAGEMENT
----------
THURSDAY, NOVEMBER 18, 2021
U.S. Senate,
Subcommittee on Western Hemisphere,
Transnational Crime, Civilian Security,
Democracy, Human Rights, and
Global Women's Issues;
Committee on Foreign Relations,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:02 a.m., in
room SD-419, Dirksen Senate Office Building, Hon. Tim Kaine,
chairman of the subcommittee, presiding.
Present: Senators Kaine [presiding], Menendez, and Rubio.
OPENING STATEMENT OF HON. TIM KAINE,
U.S. SENATOR FROM VIRGINIA
Senator Kaine. I would like to call the hearing to order.
This is a hearing of the Senate Foreign Relations Subcommittee
on Western Hemisphere, Transnational Crime, Civilian Security,
Democracy, Human Rights, and Global Women's Issues.
Senator Rubio, I think we have the honor of the
subcommittee with the longest name of any in the Senate.
The hearing will come to order, and it is a pleasure to
welcome two distinguished panels of witnesses for this hearing
on vaccine diplomacy in Latin America and the Caribbean, and
the importance of U.S. engagement in the region.
I want to thank Ranking Member Senator Rubio and his team
for helping develop this hearing and for always advancing the
important work of this subcommittee, and always having a
passion for the region.
Americans have learned a lot of hard lessons since the
COVID-19 pandemic first reached our shores in early 2020: the
importance of a strong public health system, the vulnerability
of and the valuable work performed by our essential health
workers, disparities in our economic system that can be
exacerbated by unforeseen crises, the effectiveness of
vaccines, and the difficulties of achieving political consensus
even when faced with a common threat.
Another lesson the pandemic has taught us is that we are
inextricably linked to other nations, particularly our
neighbors in the Americas. Disease does not stop at borders.
Our health, to a degree, depends on the health of our brothers
and sisters in Latin America and the Caribbean.
Latin America and the Caribbean has suffered greatly during
the pandemic. More than a million and a half dead, tens of
millions of cases. Thirty percent of the deaths in the world
attributed to the pandemic are in the Caribbean and the
Americas with only 8 percent of the population. So this has
been a region that has been hit particularly hard.
I saw some of the effects of the pandemic firsthand in the
region this summer when I joined Senator Portman and four other
Senate colleagues in a bipartisan CODEL to visit Mexico,
Ecuador, Colombia, and Guatemala.
We talked in those nations about the effect of a pandemic,
but we also heard the gratitude of these nations for U.S.
vaccine diplomacy in the region, a common story, and we were
arriving in capitals and talking to presidents at about the
same time as significant American vaccines were arriving to be
distributed in these countries.
A common story that we heard was that when it comes to
vaccines, we think the American vaccines are the best and you
are giving them to us. We are getting vaccines from China and
Russia that we are purchasing, and sometimes the shipment gets
delayed, and in the instance of China, if we happen to say
something about Taiwan the contract will mysteriously disappear
and we will never get vaccines.
So there was a real window that was opening, we viewed, in
the Americas because there was gratitude for the U.S. role in
delivering now, I believe, nearly 50 million vaccines into the
Americas and the Caribbean.
There is much more to do. We have stepped up to provide
support to our southern neighbors. It is a little belated
because we wanted to take care, obviously, of our own needs
first, but distribution of vaccines and other humanitarian aid,
most notably through sharp increase in funding through the
American Rescue Plan, has started to flow. More needs to be
done.
While the U.S. initially focused on overcoming the public
health crisis at home, outside actors like China and Russia
have taken this opportunity to exert their influence--really,
continue their influence in Latin America and the Caribbean,
and that has potentially deleterious long-term effects on U.S.
interests and values in the region.
So after almost 2 years now of living with COVID, this
hearing is an opportunity to consider our successes and
failures in responding to the pandemic in the Americas and what
we can do to continue to improve our efforts in the region.
I am hopeful that testimony from our panels of witnesses
both from the State Department and outside experts can help us
better understand these vital issues and chart a path forward.
I now want to turn it over to my ranking member, Senator
Rubio, for his remarks before I introduce our first panel.
STATEMENT OF HON. MARCO RUBIO,
U.S. SENATOR FROM FLORIDA
Senator Rubio. Thank you for holding this hearing, and as
the former chairman of this committee who had to read that long
title, we could never come up with an acronym. So if you can,
that would be great, but I appreciate you both being here
today.
We are coming up on the 2-year anniversary of that day that
patients in Wuhan, China, first publicly reported symptoms of a
disease that we now know has swept and changed the world and no
region has been hit harder, as the chairman said, than Latin
America and the Caribbean, in particular. Not just in terms of
the numbers of those that have been afflicted by the disease
and, ultimately, killed by this virus, but also the effects
that it has had on unemployment, on rising poverty, on
political instability.
It has been pretty dramatic, and what that has done is it
has made the region ripe and vulnerable to malign actors to
come in and try to leverage them.
We have seen that, of course, from the Chinese Communist
Party. We have seen it from Putin's Russia, and now even Cuba
appears to be threatening to get into that game, basically,
exploiting access to a vaccine in the absence of a better
alternative to extract concessions from different countries in
the region.
They have, very frankly, made no effort to hide the fact
that these vaccines come with strings attached. One example is
Paraguay.
In April of this year, Paraguay had its largest outbreak
wave of COVID cases, and the Chinese Communist Party's
diplomats made it very clear that they would only deliver
vaccines to Paraguay if they severed ties with Taiwan.
In Brazil, there seems to have been some success in
convincing Brazilian officials to allow Huawei to compete to
develop the 5G network. Strong evidence of that is the fact
that 2 weeks after Brazil's communication minister went to
Beijing to ask for vaccines, it reversed its decision to ban
Huawei from competing.
Then, of course, Putin's Russia has gotten into this as
well, providing, really, millions of dubious Sputnik vaccines
to countries around the region, and I say dubious because there
has been cases now where what is in that little vial is
actually not any vaccine, much less an effective one.
After delivering vaccines to Bolivia, the President of
Bolivia agreed to reactivate a Russian nuclear power plant
project and to allow Russia access to Bolivia's lithium
reserves and their natural gas.
Now on top of all this, we face the Cuban regime with its
fake Abdala vaccine, which we know nothing about in terms of
its effectiveness or what long-term consequences it might have,
and they are now talking about potentially exporting it to
other countries, I imagine, in return for their silence and
their support in the face of really brutal tactics to repress
protests.
The bottom line is that the lives of people across this
region have become bargaining chips and exchanged in return for
higher profits for Chinese tech companies and lucrative
business deals for Russian oligarchs.
So what I hope to learn from our witnesses today is why the
U.S. has allowed for this to go on for so long in Latin
America. Russia delivered its first vaccines in February of
2021. China made its first delivery in March of '21.
President Biden's administration did not deliver vaccines
until June, a full month after Senator Kaine and Menendez, who
chairs the full committee, and myself sent a letter
highlighting the urgent need for vaccines in Latin America.
Even now, more than 109 million Chinese vaccines have been
delivered, far more than the 89 million American vaccines that
so far have been delivered to the region.
So I was glad to see the U.S. announce the donation of
approximately 500 million vaccines to 92 countries, but only 10
of those countries were in Latin America and the Caribbean.
So I am very interested in how we came up with the list of
who gets these vaccines. I imagine some of it has to do with
the capacity to store and deliver and some of it--I am curious
to see how we picked who got it and how much and so forth.
So I appreciate you being here today because I think it
will be insightful as we look forward to how we move forward on
this issue.
Thank you.
Senator Kaine. Thank you, Senator Rubio. I am going to
introduce our witnesses now.
Kevin O'Reilly is the Deputy Assistant Secretary for
Western Hemisphere Affairs at the Department of State. He
became the Deputy Assistant Secretary after having served as
the Director of the Office of Brazil and Southern Cone Affairs.
He previously served as DCM at the U.S. Embassy in Panama
City, Panama. He is a career member of the U.S. Foreign
Service. He has held many other senior level positions,
including the Director of the Office of Mexican Affairs.
He has served as the White House National Security Council
Director for North American Affairs from 2009 to 2011, served
as a foreign policy fellow in Senator Durbin's office, and he
is a native of Illinois with a Master's degree from the U.S.
Naval War College and Johns Hopkins SAIS. Received his Bachelor
of Arts degree from Loyola University.
Peter Natiello serves as the Acting Assistant Administrator
in the U.S. Agency for International Development's Latin
American and Caribbean Bureau. Before that, he served as
USAID's mission director in Kabul, Afghanistan.
He has extensive experience in Latin America with USAID
serving as Missions Director in El Salvador and Colombia, and
from 2003 to 2009 he was in Bolivia where he was Deputy Mission
Director and Director of the Alternative Development Program at
USAID.
He has also managed USAID's Democracy in Conflict
Mitigation Portfolio in Ecuador where he served as a Peace
Corps volunteer and subsequently as a research analyst with the
Inter-American Development Bank.
Fluent in Spanish and proficient in Portuguese, he has a
Bachelor of Arts degree from Colorado College and a Master's of
International Affairs from Columbia University.
It is great to have both of you before us to discuss this
important issue and I would like to have, first, Mr. O'Reilly
and then Mr. Natiello do opening statements. Try to confine
them to 5 minutes. Your full statements will be included in the
record and then we will proceed to questions.
I will just let you know we are a little bit uncertain
about the voting schedule today. I think you may see members
coming and going based on votes, but I think we should have
good attendance over the course of the hearing. This is an
important topic. We are glad to have you with us.
Mr. O'Reilly.
STATEMENT OF KEVIN O'REILLY, DEPUTY ASSISTANT SECRETARY OF
STATE FOR WESTERN HEMISPHERE AFFAIRS, U.S. DEPARTMENT OF STATE,
WASHINGTON, DC
Mr. O'Reilly. Chairman Kaine, Ranking Member Rubio, thank
you for this opportunity to discuss the Biden-Harris
administration's efforts to support Latin America and the
Caribbean as they respond to and recover from the COVID-19
pandemic.
They make up an important part of our efforts across the
globe to save lives, end this pandemic in 2022, and prepare for
the next pandemic. COVID-19 has hit the hemisphere hard and it
has worsened long-standing problems, challenges to public
security, confidence in democratic institutions, corruption,
and inequality.
Just 8.4 percent of humanity lives in Latin America and the
Caribbean. Yet, as of the 1st of November, this region has had
more than 46 million reported infections, 20 percent of cases
worldwide, 31 percent of reported deaths, approximately 1.5
million souls lost.
The pandemic hit a continent weakened by anemic growth. The
IMF estimated in October that the global economy contracted by
3.1 percent in 2020, but the economies of Latin America and the
Caribbean contracted by 7. Caribbean nations suffered declines
of more than 15 percent.
The IMF projects a return to growth of 5.8 percent this
year, but the shock of the downturn remains. We have donated
more vaccines globally than all other countries combined. That
includes more than 49 million doses donated in partnership with
COVAX or bilaterally to 29 countries in our hemisphere.
In September, President Biden announced that the United
States would donate an additional half a billion Pfizer
BioNTech doses through the COVAX facility to low and middle
income countries, bringing the total commitment to those
countries to 1.2 billion. Beneficiaries include countries in
Latin America and the Caribbean.
We share these doses without political conditions or
expectations with the purpose of saving lives. Beating back
this pandemic requires full vaccination of 60 to 70 percent of
each country's population.
Now, the Pan American Health Organization estimates that
Latin America and the Caribbean need about 720 million
additional doses administered to reach that goal.
Thirteen countries in the region now report over 60 percent
partial vaccination with several others close behind, but 12
have yet to reach 40 percent partial vaccination with about
half of those below the 20 percent full vaccination rate, and
we have to help close that gap and do more to ensure equitable
vaccine distribution across the hemisphere.
We support the rapid rollout of vaccines that meet
internationally accepted standards of efficacy and safety
because protecting the vulnerable demands rigor and high
standards. Vaccines without sufficient clinical data to
demonstrate safety and compelling evidence of efficacy put
people at risk and undermine trust.
At a time of global vaccine scarcity, some governments
turned to suppliers from the People's Republic of China and the
Russian Federation. We have seen PRC coercion ramping up or
tapering off supplies based on a willingness to adopt policies
favorable to Beijing, a less than admirable wolf at the door
form of diplomacy.
The PRC has even offered to trade vaccines for changes in
political recognition from Taipei to Beijing, a particularly
cruel tactic. Russia has struggled to provide contracted
amounts of Sputnik V in a timely fashion to countries from
Argentina to even Mr. Maduro's regime in Venezuela, and the
Russians have yet to provide adequate documentation to secure
an emergency use listing from the World Health Organization.
Now, next year, when the United States hosts the ninth
Summit of the Americas, the President intends to place health
and the state of our health systems high on the agenda. We need
to work together to do better on health security with
transparency and accountability. As COVID has reminded us,
people's lives depend on it.
Congressional support for these donations has saved lives,
prevented and reduced the severity of human suffering, and
helped our hemisphere begin the long and arduous process of
recovering from the worst of this pandemic, building back
better than before.
We look forward to working with you to promote health
resilience, security, and equity in our hemisphere. I thank you
for your time and I welcome your questions and comments.
[The prepared statement of Mr. O'Reilly follows:]
Prepared Statement of Kevin O'Reilly
Chairman Kaine, Ranking Member Rubio, Members of the Subcommittee,
thank you for this opportunity to discuss the Biden-Harris
administration's efforts to support Latin America and the Caribbean as
they respond to, and recover from, the COVID-19 pandemic, and to work
together with partners across the hemisphere to prepare for the future.
Our efforts here in our own hemisphere make up an important part of
our efforts to work with people of goodwill from across the globe to
save lives, end this pandemic in 2022, and do what we need to do to
prepare for the next pandemic.
This pandemic has hit the Western Hemisphere hard, and the economic
crisis that it has provoked worsened long-standing problems the region
knows only too well--challenges to public security; confidence in
democratic institutions; corruption; and inequality in all countries
with economies deeply dependent on commodities exports for growth. The
pandemic has spotlighted and exacerbated many real development
challenges as well.
Just 8.4 percent of the world's population lives in Latin America
and the Caribbean, yet as of November 1, this region had more than 46
million reported COVID-19 infections, an estimated 20 percent of cases
worldwide; and 31 percent of reported deaths worldwide, approximately
1.5 million souls lost.
The region also suffered disproportionate economic losses, as the
pandemic hit a continent already weakened by recession anemic growth.
The International Monetary Fund estimated in its October World Economic
Outlook that the global economy contracted by 3.1 percent in 2020, but
the economies of Latin America and the Caribbean contracted by seven
percent overall. Caribbean nations that depend heavily on tourism
suffered declines of more than 15 percent. The IMF projects a return to
growth of 5.8 percent in 2021, but the shock of the downturn sharply
increased poverty and exacerbated pervasive income inequality.
So, we see the scope of the challenge, we bring the same urgency to
international response and recovery efforts that we have demonstrated
at home, and we focus on spurring vaccinations worldwide and across our
hemisphere, sharing pandemic response best practices, and countering
vaccine disinformation and coercive diplomacy.
To that end, the United States has donated more vaccines globally
than all other countries combined, and as of last week that includes
more than 50 million vaccine doses donated, in partnership with COVAX
or bilaterally, to 29 countries in the Western Hemisphere. These
contributions represent a large portion of our broader global
commitment, which by late October reached over 243 million doses
donated worldwide.
The region will continue to benefit from our efforts to help
vaccinate the world. At the Global COVID-19 Summit convened by
President Biden on September 22, the President announced that the
United States would donate an additional 500 million Pfizer-BioNTech
vaccine doses through the COVAX facility to low- and middle-income
countries and economies in need, bringing the total U.S. commitment to
these countries to 1.2 billion doses. Beneficiaries include 10
countries in Latin America and the Caribbean. The U.S. Government
shares these vaccine doses, whether bilaterally or through COVAX,
without political conditions or expectations, with the sole purpose of
saving lives.
Let's consider for a moment what we have helped achieve so far, and
the work that remains. Beating back this pandemic, at least to the
extent needed to allow people to resume everyday activities, requires
full vaccination of 60 to 70 percent of each country's population. And
we support the World Health Organization's global COVID-19 vaccination
goal to reach that 70 percent target everywhere by September 2022. We
can see our way to that objective now, far more clearly than we could a
year ago, but we have work to do to get there. The Pan American Health
Organization estimates that Latin America and the Caribbean need 720
million additional COVID-19 vaccine doses administered to reach 70
percent coverage. We must work closely with our counterparts across the
region and the broader international community to support vaccine
administration and uptake.
As global vaccine supply increases, many countries in the region
have approached or reached the 70 percent goal. Thirteen countries in
the region report over 60 percent partial vaccination, with several
others close behind. Larger and relatively prosperous countries in the
region have vaccination rates that rival, and in some cases, surpass
our own.
Unfortunately, vaccination rates diverge greatly, with many lower-
income and smaller countries lagging. As of November 15, 12 countries
in the region had yet to reach 40 percent partial vaccination, with
half of these below 20 percent full vaccination, nearly all located in
the Caribbean and Central America--traditionally areas with strong ties
to the United States. Haiti, racked by insecurity, a fuel shortage, and
the lingering effects of the 7.2 magnitude earthquake in August, has
administered approximately 138,330 doses of COVID vaccines so far,
which adds up to about 0.6 percent of its population vaccinated with
two doses. To increase that vaccination rate, the U.S. Government has
provided vaccines to Haiti and is organizing additional shipments this
year.
We must help close that gap and do more to ensure equitable vaccine
distribution across the hemisphere to boost vaccination rates.
Donations to five Caribbean Community (CARICOM) governments in
early November provided needed support to governments that had
exhausted their supplies of vaccine doses. These followed earlier
donations to all CARICOM members, and of course our COVAX donations
provide essential support to those who live in the region's eleven low
and lower-middle-income countries, many of which still struggle with
low vaccination rates.
The Western Hemisphere remains a region of largely middle and
upper-middle income countries that are not Advanced Market Commitment
(AMC)-eligible, however, and those countries participate in COVAX as
self-financing partners. They have struggled to purchase vaccines
directly from manufacturers, and--as in so many other places across the
world--even those that have completed purchase agreements saw delivery
delays.
This virus and its variants do not respect borders. This pandemic
demands a global response to support worldwide efforts for effective
and safe vaccine distribution, with no political strings attached. As
part of global and national strategies to combat the pandemic, the U.S.
Government supports the rapid rollout of vaccines that meet
internationally accepted standards of efficacy and safety. We take no
position on nations accepting vaccines authorized by their respective
regulators; we respect the authorization processes of other
governments.
We support COVAX and the role it plays as a distributor for sharing
vaccines authorized by the World Health Organization.
Protecting people, and protecting the vulnerable, demands rigor and
high standards. Distributing vaccines without sufficient clinical data
to demonstrate safety and compelling evidence of efficacy puts people
at risk, does not serve the public interest, and undermines trust and
the integrity of the scientific process.
We must also fight vaccine disinformation to build and sustain
public trust in these lifesaving tools.
At a time of global vaccine scarcity, many of our hemisphere's
governments initially turned to suppliers from the People's Republic of
China and the Russian Federation. Products manufactured in the PRC
still comprise a large percentage of the vaccine mix for many
countries.
At times we have seen evidence of PRC coercion in making supplies
available to governments in need--ramping up or tapering off supplies
based on a government's willingness to adopt policies favorable to the
Government in Beijing, a less-than-admirable wolf-at-the-door form of
diplomacy. The PRC has even offered ready access to vaccines in
exchange for changes in political recognition from Taipei to Beijing in
those countries that recognize Taipei, a particularly harsh tactic in
counties struggling to vaccinate their citizens.
Deliveries from Russia of the Gamaleya Research Institute's Sputnik
V vaccine have faltered as Russia has failed to provide the contracted
amounts of Sputnik V in a timely fashion to Latin American countries
such as Argentina and even Mr. Maduro's regime in Venezuela. Russia's
Direct Investment Fund commercializes Sputnik V, but the Russians have
yet to provide adequate documentation to secure an Emergency Use
Listing from the World Health Organization.
Beyond its direct impact, the COVID-19 pandemic revealed profound
deficiencies in the world's ability to detect and appropriately respond
to infectious diseases with pandemic potential. To do better in the
future we need to improve regional cooperation and the effectiveness of
the international institutions we all rely on. Next year, when the
United States hosts the Ninth Summit of the Americas, the President
intends to place health and the state of our health systems high on the
agenda for leaders and for the multilateral organizations, civil
society, academic institutions, and private sector players that
participate in the Summit process. We need to work together to develop
the region's health security capacity, and to do so with transparency
and accountability. As COVID-19 has reminded us, people's lives depend
on it.
I would like to briefly expand on an issue that has gained
attention in recent months: The expansion of vaccine manufacturing in
the region.
Latin America and the Caribbean trail other middle-income regions
in COVID-19 vaccine production, and the pandemic has prompted some of
the region's governments to look for ways to reduce their extreme
dependence on vaccines, therapeutics, and other essential medical
products produced outside of our hemisphere. Increasing vaccine
manufacturing in Latin America would not take root in time to curb the
current pandemic, but it remains a legitimate goal. Any government that
able to invest adequately in education and professional development for
its people and create an attractive regulatory framework that
encourages intellectual property rights protections could help our
hemisphere prepare for future health security threats, create good
jobs, new technological capabilities, and new business opportunities,
and promote scientific ties with the United States.
Several Latin American countries are already producing or could
potentially produce COVID-19 vaccines, therapeutics, diagnostics, and
other essential medical products, including Argentina, Brazil,
Colombia, Mexico, Panama, and perhaps Chile and Uruguay. This would
increase access to these life-saving commodities in those nations and
the region. Successful production will depend on solving supply chain,
financing, technical capacity, and regulatory climate issues that
countries in the region are working to address.
Congressional generosity in support of these vaccine donations has
saved lives, prevented and reduced the severity of human suffering, and
helped the nations of our hemisphere begin the long and arduous process
of recovering from the worst of this pandemic--building back, better
than before. We look forward to working with you to promote resilience,
health security, and health equity in the Western Hemisphere.
I thank you for your time, and I welcome your questions and
comments.
Senator Kaine. Thank you.
Mr. Natiello.
STATEMENT OF PETER NATIELLO, ACTING ASSISTANT ADMINISTRATOR,
BUREAU FOR LATIN AMERICA AND THE CARIBBEAN, UNITED STATES
AGENCY FOR INTERNATIONAL DEVELOPMENT, WASHINGTON, DC
Mr. Natiello. Chairman Kaine, Ranking Member Rubio, members
of the subcommittee, thank you for the invitation to testify
today. I am grateful for the committee's support for USAID's
work particularly as we respond to COVID-19 in Latin America
and the Caribbean.
The countries of Latin America and the Caribbean have been
hit hard by the pandemic, as we have heard this morning.
Although it is home only to 8 percent of the world's
population, the region is seeing 20 percent of all cases and
just over 30 percent of all global deaths.
The American people have demonstrated incredible generosity
and solidarity with our neighbors, providing more than 500
million for USAID's COVID-19 response in Latin America and the
Caribbean since March 2020.
Since the beginning of the pandemic, USAID has moved
quickly to mobilize new health assistance, respond to emerging
food and protection needs, adapt current programming, and plan
for the long-term impacts that we know will plague the region
for years to come.
I commend our staff and our partners and all those on the
front lines who are working relentlessly to help those most in
need.
On the health front, our efforts include working with
health ministries to minimize the risk of transmission and
prevent and control infections in health care facilities,
training and equipping rapid response teams to better track and
record cases, helping countries to provide the public with
reliable verifiable information that keep citizens informed
about how best to protect themselves and each other, and
providing oxygen to treat patients in the most dire need.
Of course, the availability and wider distribution of
vaccines has been key to the region's significant strides this
year. In the last 5 months, the United States provided more
than 50 million vaccines throughout the region. These vaccines
are being provided safely, equitably, and with no political
strings attached.
USAID is providing crucial assistance that has enabled
countries to receive and distribute these life-saving vaccines.
Our efforts to get shots in arms include support for cold chain
management, training of vaccinators and establishment of
vaccination sites, support for communications campaigns to help
overcome vaccine hesitancy, and work with ministries of health
to better track vaccination rates.
Just last month, I saw progress on the health front
firsthand when I visited Medellin, Colombia. The Department of
Antioquia, of which Medellin is the capital, was severely
impacted by COVID-19, seeing daily cases in excess of 4,000 and
a 98 percent ICU occupancy rate in June 2021.
Thanks to the Government of Colombia's concerted response,
which included distribution of vaccines donated by the United
States and others purchased by Colombia through COVAX, as well
as USAID's support for vaccine distribution, Antioquia was able
to significantly reduce infection prevalence and death rates,
decreasing from 4,000 in June to 301 recorded infections a day
in mid-October.
Region wide, infection rates and death rates due to COVID-
19 have decreased by 84 percent over the past 5 months. The
region's economy, as has been noted, is also improving with the
International Monetary Fund projecting an economic rebound of
6.3 percent in 2021, second only to emerging and developing
economies in Asia. This is the kind of progress that USAID
seeks to support throughout the region.
As we have addressed the critical health situation, we have
been keenly aware of the secondary impacts of the pandemic
including job losses and kids out of the classroom, growing
food insecurity, increases in gender-based violence, and
contraction of civil liberties and rights.
USAID continues to address long-term challenges in the
region through programs that foster inclusive economic growth,
address climate change, improve citizen security, promote
respect for human rights, fight corruption and promote
transparency, elevate the voices of civil society and other
community leaders, and enable diversity and participation by
historically marginalized groups.
Our efforts have not gone unnoticed. Partner nations
regularly recognize and thank the United States for our
steadfast support in the face of this unprecedented emergency.
The solidarity reminds us all that this pandemic affects
the entire world. We must continue to be good neighbors,
partners, and friends so that we can overcome this challenge
together. We are safe when everyone is safe.
Even as we maintain our vigilance and continue to respond
to the virus, we remain committed to helping countries adapt to
new realities presented by the pandemic and shore up hard-won
development gains.
Ultimately, we seek to help the people of the region live
in peace and prosperity and realize a more healthy hopeful
future.
Mr. Chairman, Senator Rubio, thanks again for the
opportunity to testify. I welcome your questions.
[The prepared statement of Mr. Natiello follows:]
Prepared Statement of Peter Natiello
Chairman Kaine, Ranking Member Rubio, and members of the
Subcommittee, thank you for the invitation to testify today about the
Biden-Harris administration's response to COVID-19 in Latin America and
the Caribbean. I am grateful for the Committee's support for the United
States Agency for International Development's work, particularly as we
work as part of a larger U.S. Government effort to address the impacts
of the pandemic in the region.
context
The countries of Latin America and the Caribbean have been hit hard
by COVID-19. In the last 18 months, the virus has swept through the
region, infecting more than 46 million people and killing more than 1.5
million; although it is home to only 8 percent of the world's
population, the region has seen 20 percent of all cases, and just over
30 percent of all global deaths. We mourn with the families of those
impacted both at home and abroad.
As is the case around the world, the pandemic has reverberated
through all sectors of society and jeopardized important development
gains made in recent decades. As countries went into a series of
lockdowns and quarantines, many people worked significantly fewer hours
or lost their sources of income entirely; in fact, the International
Labor Organization estimates that the region lost 31 million jobs in
2020 due to the pandemic, and its economies contracted by seven percent
in 2020, according to International Monetary Fund estimates. Gender-
based violence, an issue that I know is of particular concern to this
subcommittee, also has increased during the pandemic; in Argentina,
Mexico, and Colombia, for example, calls to domestic violence hotlines
rose by 40, 80, and more than 100 percent, respectively, in the first
months after mandatory stay-at-home orders were issued. Children were
unable to go to school, and many who do not have access to technology
or reliable internet to continue their education at home are in danger
of being left behind. Authoritarian leaders used COVID-19 as an excuse
to consolidate power, take further anti-democratic actions, and imperil
human rights and fundamental freedoms.
That said, the region is in a much different position than it was
even 6 months ago, and United States assistance has been pivotal to the
progress that has been made. As we address the pandemic at home, the
American people have demonstrated incredible generosity and solidarity
with our neighbors around the world, providing more than $9 billion for
USAID's global COVID-19 response, including more than $500 million in
Latin America and the Caribbean since March 2020, in addition to
support from other U.S. departments and agencies. Infection and death
rates due to COVID-19 have decreased by 84 percent over the past 5
months. The region's economy is also improving, with the International
Monetary Fund projecting an economic rebound of 6.3 percent in 2021,
second only to emerging and developing economies in Asia; the United
States' support to the region has undoubtedly played a part in this
encouraging progress.
usaid response
USAID is supporting COVID-19 efforts in 29 countries in the region.
We are working in close partnership with local governments,
international organizations, the private sector both in the region and
the United States, faith-based organizations, and other non-
governmental organizations to deliver urgent assistance to those most
in need. Since the beginning of the pandemic, USAID personnel in
Washington and our field missions have moved quickly to mobilize new
health assistance, respond to emerging food and protection needs, adapt
current programming, and plan for the long-term impacts that we know
will plague the region for years to come. I commend our staff,
partners, and all those on the front lines, who are working
relentlessly to help those most in need.
USAID mobilized from the earliest days of the pandemic to respond
to the urgent health situation in Latin America and the Caribbean. As
COVID-19 emerged, we began the work we continue to this day: partnering
with countries to treat those affected and stop the virus from
spreading. We are working with health ministries to minimize the risk
of transmission and prevent and control infections in healthcare
facilities, including through the donation of personal protective
equipment for health care workers. We train and equip rapid-response
teams to better track and record cases. We support the rehabilitation
and repair of water systems to ensure that there is access to clean
water at health facilities, promote healthy hand-washing behaviors, and
partner with utilities and other service providers to maintain water
and sanitation services so that businesses and markets can operate
safely. We help countries to provide the public with reliable,
verifiable information that keeps citizens informed about how best to
protect themselves and each other. Along with training health
professionals to ensure they are able and equipped to manage COVID-19
cases, we have also provided both oxygen and ventilator support
throughout the region to treat patients in the most dire need.
For example, as part of our region-wide communications efforts,
USAID funded a COVID-19 campaign in Santo Domingo, Dominican Republic
to promote public awareness on preventive practices and counter
misinformation, and targeted areas of the border with Haiti to raise
awareness of the dangers of the disease. As with other countries in the
region and the world, in Honduras, USAID provided training to help more
than 2,600 health workers care for COVID-19 patients, including
patients with severe COVID-19, improving the quality of care offered in
hospitals, triage centers, and other health centers across the country.
In Haiti, USAID donated oxygen supplies, including 50 oxygen
concentrators in June and 250 oxygen-filled cylinders this month, to
help ensure the uninterrupted availability of oxygen for critical
COVID-19 patients receiving treatment.
Of course, the availability and wider distribution of vaccines has
been key to the region's significant strides this year. In the last 5
months, the United States--bilaterally or in partnership with COVAX--
has provided more than 50 million vaccines to countries throughout the
region, enabling millions of people to be fully vaccinated against the
deadly virus. These vaccines are being provided safely, equitably, and
with no political strings attached.
USAID is providing crucial assistance that has enabled countries to
receive and distribute these life-saving vaccines. Our efforts to get
shots in arms include support for cold chain management to ensure that
vaccines remain viable and effective, training of vaccinators and
establishment of vaccination sites, support for communications
campaigns to provide accurate information and help overcome vaccine
hesitancy, and work with ministries of health to better track
vaccination rates.
For example, in Guatemala, we have supported the establishment and
quality improvement of more than 690 vaccination sites across the
country, including walk-up, drive-up, and hybrid walk-up/drive-up sites
in public and private sector venues. In Peru, USAID is supporting the
implementation of the Government of Peru's national COVID-19
vaccination plan, including by training more than 1,750 (56 percent of
whom are women) health workers in planning, conservation of vaccines in
the cold chain, vaccination process, and handling and application of
vaccines. And in Barbados, USAID supported public service announcements
that reached more than 50,000 parents with messaging on COVID-19
vaccination for children aged 12-18.
Just last month, I saw this progress firsthand when I visited
Medellin, Colombia. The Department of Antioquia, of which Medellin is
the capital, was severely impacted by COVID-19, seeing daily cases in
excess of 4,000 and a 98 percent ICU occupancy rate in June 2021.
Thanks to the Government of Colombia's concerted response, which
included distribution of vaccines donated by the United States and
purchased by Colombia through COVAX, as well as USAID support for
vaccine distribution planning, communications, and service delivery,
Antioquia was able to significantly reduce infection prevalence and
death rates, decreasing to 301 recorded infections a day in mid-October
2021. This is the kind of progress that USAID seeks to replicate
throughout the region.
As a result of these concerted efforts by the United States and the
people of the region, over the past 5 months, the region's death and
infection rates have both dropped by 84 percent. USAID's widespread
programs in support of our partner nations' COVID-19 response have been
key to making that good news possible, and we remain committed to
supporting our neighbors in their ongoing efforts.
As we have addressed the critical health situation, we have been
keenly aware of the secondary impacts of the pandemic, including job
losses and kids out of the classroom, growing food insecurity,
increases in gender-based violence, and contraction of civil liberties
and rights. When the pandemic tore through the region, and even as our
own staff was affected by infection and lockdowns, our field missions
quickly pivoted programs to adapt, addressing both these emerging
issues while also ensuring that the important work of development can
advance. USAID continues to address long-term challenges in the region
through programs that foster inclusive economic growth, address climate
change, improve citizen security, promote respect for human rights
(including freedom of expression, including for members of the press),
fight corruption and promote transparency, elevate the voices of civil
society and other community leaders, and enable diversity and
participation by historically marginalized groups.
For example, in Colombia, where COVID-19 disrupted traditional
supply chains and markets nationwide, USAID worked with the U.S.
Development Finance Corporation and seven local microfinance
institutions to guarantee an additional $35 million in productive loans
to micro businesses affected by COVID lockdowns. With USAID assistance,
state and municipal authorities in Mexico developed new interventions
during the initial phase of the pandemic to stop domestic violence
against women before it potentially progressed to femicide; in the
unique COVID context, new protection and victim response models tailor
services to victims' needs while supporting state authorities to better
prosecute these crimes. In the Dominican Republic, USAID's programs
with the private sector are providing food assistance to more than
270,000 people to supplement government relief efforts and reach
targeted vulnerable populations affected by the pandemic. In Paraguay,
USAID is helping 6,500 micro and small businesses overcome the economic
consequences of the pandemic by improving housing structures and
providing support such as training in entrepreneurship and business
plan development so that vulnerable people can set up micro-businesses
in their homes. In Jamaica, USAID provided laptops and tablets to keep
children connected to school in the absence of face-to-face classes, in
support of the Government of Jamaica's one tablet or laptop per child
initiative. In Ecuador, where economic exclusion of vulnerable
populations has been exacerbated by the pandemic, USAID programs
enabled nearly 22,000 Ecuadorians and Venezuelans to access formal
financial services by opening a savings account and/or obtaining a
credit product or facility from a bank or other financial institution.
And in El Salvador, USAID helped 4,370 small and medium-sized
enterprises in fiscal year 2021, including more than 780 micro, small,
and medium businesses that received direct support for economic
recovery due to COVID-19.
Our efforts have not gone unnoticed. Partner nations regularly
recognize and thank the United States for our steadfast support in the
face of this unprecedented emergency. We have seen expressions of
gratitude on social media from everyday people in countries like
Paraguay, where one recipient of U.S.-donated vaccines posted, ``Hope
is what keeps us connected to life. Thank you, U.S.!'' Honduran
officials have stated that their vaccination campaigns, which have
raised the number of Hondurans who are fully vaccinated from less than
one percent in July to 43 percent in early November, ``would not be
possible'' without COVID-19 vaccine donations from the United States
and USAID's assistance for vaccine distribution and administration to
the people. The Government of Peru has repeatedly thanked the U.S. for
life-saving COVID-19 support, including donation of 2 million doses of
vaccine, eight mobile military hospitals, personal protective
equipment, and other technical assistance. This kind of solidarity
reminds us all that this pandemic affects the entire world and we must
continue to be good neighbors, partners, and friends so that we can
overcome this challenge together. We're safe when everyone is safe.
We must remain vigilant to ensure that this kind of progress can
continue. While conditions in the region have improved, and we are in a
better place than we were only a few months ago, the pandemic has
taught us that we cannot become complacent and must guard against
future variants and surges. USAID programming continues, including with
American Rescue Plan Act (ARPA) funding generously appropriated by this
Congress. As part of our commitment to localization, a portion of
USAID's programming in the region under ARPA will be managed by local
partners. We will continue to work with countries to increase
vaccination rates, including for marginalized or underserved
populations, so that people can be better protected against severe
illness. We will continue to support surveillance of and testing for
COVID-19 so that we can stop the spread of the virus. We will continue
to provide crucial training and medical supplies, including oxygen, so
that the most critical patients can be treated and healed. And we will
continue our support for longer-term development programs to help the
region recover and emerge from the pandemic with as little disruption
as possible.
conclusion
As it is around the world, the COVID-19 situation in Latin America
and the Caribbean remains dangerous. However, thanks to the generosity
of the American people and the support of Congress, USAID has been able
to help the countries of the region make real progress despite the
unprecedented health and economic impacts of the pandemic. Even as we
maintain our vigilance and continue to respond to the virus, we remain
committed to helping countries adapt to new realities presented by the
pandemic and shore up hard-won development gains.
Ultimately, we seek to help the people of the region live in peace
and prosperity and realize a more healthy, hopeful future.
Senator Kaine. We will have a 5-minute round of questions
for the witnesses and I would just like to begin by asking you
both this question.
The U.S. total delivery of vaccines to the region is about
49 million and that is significantly behind Chinese vaccine
delivery to the region. The three of us did join together in a
letter to the Administration many months ago saying there are a
lot of reasons to prioritize the Americas, one, because of
family and other ties between the United States and folks in
the Americas, a disease that knows no borders. If we prioritize
the region, it will keep us healthier.
Second, the follow-on consequences of this health pandemic
in the region produce economic and other instabilities that can
be a push factor for migration.
We are dealing with tough migration issues. It would help
us deal with those issues if we were more forward leaning in
helping nations in the region access vaccines.
Third, we pointed out and have been very aware of the
efforts of China and Russia to use vaccines in the region and
why would we want to be on our back foot while they are racing
ahead.
Even though we are the single biggest donor of vaccines in
the world, what explains why our vaccine donations to the
Americas, which has suffered so disproportionately, still are
lagging behind China?
Mr. O'Reilly. Mr. Chairman, one of the factors is the--as
you mentioned in your own opening remarks was the priority that
we had to give to domestic requirements.
Secondly, that we went through rigorous procedures to make
sure that anything that we donated was safe and reliable, and
encompassed some of the sorts of the broader support elements
that Mr. Natiello was just referring to.
When you add these along with--there are also commercial
deals that companies have and some of those are also American
providers, we have tried to focus our donations on the areas
most in need and we are taking a look at the hard numbers, at
the facts--the case rates, the death rates, the current
vaccination rates in particular countries--and to respond to
surges in the most agile way that we can to make sure that the
vaccines that we donate are safe, reliable, and are turned from
vaccines into vaccinations because a vaccine is not any good to
anyone until it gets into somebody's shoulder and gets into
someone's arm.
Senator Kaine. Let me push a little bit farther on that. I
actually understand why we might have been slow out of the
blocks to do deliveries in June when other nations were faster,
because we were putting a priority, first, on making sure folks
in the United States were vaccinated, and we also have quality
standards about vaccines that are superior to what China and
Russia have and that encompasses some delay that I understand.
If I just look at the amount of vaccines delivered by the
United States into the region, you would think one of the
factors might be, well, if this is a region that is
experiencing 30 percent of the deaths in the world then why
would not 30 percent of American vaccines be going into the
region?
I have not done the math on it, but it seems to me that
vastly less than 30 percent of American vaccines going abroad
have gone into the region. So I sort of wonder about the--and
Senator Rubio mentioned this in his opening comments--what are
the allocation factors that the Administration is using and
might we expect to see, particularly in the run-up to the
Summit for the Americas, might we expect to see even a more
aggressive approach from the United States in terms of
delivering vaccines to the region?
Mr. O'Reilly. I can say that as we prepare for the summit,
as we look through 2022, the President has made a commitment to
try to beat back this pandemic worldwide by the time the world
next convenes at the U.N. General Assembly, and that we want to
push through to the summit as well.
Senator Kaine. My time is about up. I am going to yield to
Senator Rubio.
Senator Rubio. Again, I just want to continue to touch upon
when we determine who gets what, when we make this big purchase
of vaccines and we start sending them, what is the criteria we
use to determine this country is going to get it, this country
is not, this country is going to get X amount, this country is
going to get that amount?
Is there a criteria that is being used to determine how
this is being distributed globally and, in particular, how that
impacts this region?
Mr. O'Reilly. I think that the goal is looking at capacity,
how we can maximize the number of vaccine doses available in a
country and do so equitably for the greatest number of
countries and the greatest number of people at risk within
those societies.
Take a look at the data in terms of surges and how to
mitigate potential surges, how to cut off surges when they have
already appeared, and giving priority to protecting people in
the healthcare sectors who need to care for those who are ill.
So we try to base it on the best and most reliable public
health data that we have available and we do try to give
priority as well to areas at risk.
Mr. Natiello. If I could just add to that, Senator.
We look at a variety of factors including case rates, death
rates, and hospitalizations, current vaccination rates in a
country, again, responding to surges and a country's ability to
receive vaccines and put shots into arms as well as U.S.
national and economic security.
Senator Rubio. So when you say--obviously, the case numbers
are what they are. Everyone has had a surge, some bigger than
others. Depends on how much they are testing, how much they are
monitoring. The hospitalization rates are often dependent on
whether there are hospitals or hospital availability.
What I am hearing, though, potentially, is that part of it
is if a country does not have, for example, a health care
system that can actually organize people and get people
vaccinated, if a country does not have the ability to store
vaccines and get them to people fast enough before they expire,
that, I would imagine, is a big factor in how we are
determining this.
Donating 10 million vaccines to a country that does not
have health care infrastructure to distribute them and,
therefore, they are going to go bad, they are going to expire,
they are not going to get to people--is that a major factor in
how this is being decided?
Mr. Natiello. So those are important criteria, and that is
precisely why USAID is focused on strengthening health systems
in our partner nations, because we want them to be able to not
only receive the vaccine but, clearly, to get shots in arms,
which is why we do things like support the cold chain, support
training of vaccinators, support communications campaigns to
overcome vaccine hesitancy.
In some countries, the level of readiness far exceeds that
in other countries. So the challenge, for instance, in a
country like Haiti is very, very different than a country like
Brazil or Honduras.
So these are the kind of things that we look at. These are
the kind of things that we apply U.S. technical assistance to,
to help get those vaccines in arms.
Senator Rubio. Now, the other thing I wanted to ask is both
the Kremlin and the Communist Party in China are engaged
globally in a large-scale disinformation campaign trying to
discredit the American-origin vaccines, particularly Moderna
and Pfizer, and promote their own.
So what are we doing in the region, in particular? I think
there is a broader communication issue. We have seen the RT,
Spanish version, has grown in audience, unfortunately, and it
is a big challenge in the region that we have to confront as
well.
What are we doing to counter that, in particular, this sort
of disinformation campaign about vaccines, specifically, in
Latin America?
Mr. O'Reilly. First off, sir, bringing light to exactly
what you spoke about, you cannot play whack-a-mole on every bit
of disinformation. What you have to do is make sure that you
bring true facts, accurate information. You have to do it
repetitively and you have to make sure that you work to get
those messages out to communities. I think Peter could probably
speak a little bit more on the details of how we do that, but
the fundamental principle is you have to beat bad information,
which is rife, and disinformation, which is rife and has been
motivated from Russia, in particular, but also from China.
You have to flood the zone with better, more reliable
information and make sure that people who are trusted in the
communities all over this hemisphere where their governments
are having uptake problems bring that information to their
publics so that they overcome this challenge.
Senator Kaine. Senator Menendez.
Senator Menendez. Thank you, Mr. Chairman, you and the
ranking member. I appreciate you holding this hearing on a very
important topic.
Deputy Assistant Secretary O'Reilly, the pandemic exposed
many of the region's weaknesses, including widening social
inequalities, widespread informality, growing environmental
risks, a gender-based violence epidemic, and weak healthcare
and education institutions.
When you pair that with massive population displacement and
efforts by certain leaders to systematically dismantle
democratic institutions, I am concerned that the next decade in
the hemisphere will be a turbulent one unless the United
States, the international communities, and our partners in the
region are strategic in addressing these increasingly complex
challenges.
Now, from my own perspective, the Administration's vaccine
diplomacy and policy in the Western Hemisphere has been a
failure. Let me give you an example.
I was talking to a president in the hemisphere and he said
to me, I am pro-America, but in the midst of the pandemic I
wanted to buy--I was not even looking for donations of
vaccines--I wanted to buy vaccines for my people.
I could not get anywhere with the U.S. Government. China
sold them the vaccines. They may be less efficient, but if you
have got nothing then you will take something, at the end of
the day.
I am privatizing, for the first time, our energy
infrastructure. Tried to get America interested in the
possibilities. China comes along and says, we will buy the
bonds.
We are having challenges with the IMF, which is a problem
that is beyond this country that I am referring to. It is
hemispheric. Because look at what we did as a government to,
ultimately, deal with the economic challenges of the pandemic,
how much money we pumped into the economy and to help families,
but not every country has that wherewithal.
Yet, the IMF is creating a series of conditions that they
insist without creating a smoothing period so that these
countries can get through this difficult time and the economic
consequences of the COVID pandemic.
So the Chinese come to this president and say, okay, we
will lend to you at 1 percent. Now, we missed the boat on
vaccines in the Western Hemisphere and all of us wrote to you--
to you, meaning the Administration--urging you to take a much
different course.
You can have all the calculuses you want. I can create the
little boxes and checks to say that we systematically did it
this way, but the reality is in our own hemisphere, in our own
front yard, with all of the nexus of family and trade and
migration, in our own interests--forget about being a good
neighbor--in our own interests, it made eminent sense to
significantly deploy the vaccine in the hemisphere.
We failed. China was in there. They got the goodwill, and
we failed. So now the question is how do we deal with the
aftermath of that failure in the context of the economic
challenges that are facing these countries?
So can you tell us how you are working with the Treasury
Department to ensure that the United States uses its voice and
its vote at the IMF and the World Bank to ensure greater
flexibility and increase access to resources for these
developing countries as they pursue their post-COVID-19
recovery?
Mr. O'Reilly. Well, thank you. Thank you, Senator, for the
question.
I mean, one of the things that the Administration is doing
is working with other members of the International Monetary
Fund to develop the resilience and sustainability trust over at
the IMF, and seeking also authorization to lend $21 billion to
poor and low income countries and putting a focus,
particularly, on areas which have been really walloped by this
first year and a half to 2 years of the pandemic, small
islands' economies, and there is a particular focus in doing so
on the Caribbean, and I think that is going to be one
significant process underway.
We also work very closely with the Inter-American
Development Bank and I also have responsibilities for preparing
for the Summit of the Americas next year and we have a process
underway of reviewing, I know, keen interest that you and other
members of this committee have in the future of our----
Senator Menendez. Mr. Chairman, if I may, just--so I
appreciate all that, but here is the point. If we do not use
our voice and our vote at the IMF and the World Bank, you will
see more of what you saw in Colombia.
Colombia is being squeezed by the IMF. The Duque
administration responded by doing a series of fiscal issues
that the IMF wanted to see and there was social unrest.
I am not talking about people walking away from their
obligations. I am talking about creating a smoothing period so
that they can get through what we are getting through as a
country, but they do not have the wherewithal to get through as
a country, so that, in fact, they can then meet their
obligations.
If we do not do that, we are going to see enormous social
unrest and we might as well turn the hemisphere over to
authoritarian figures because they will say the way to solve
your problems is not through this democratic process but
through authoritarianism, which is, unfortunately, rampant.
I am glad you raised the IDB. It is the last point I will
make. All of us here have been advocating for a capital
increase for the Inter-American Development Bank as part of the
U.S. effort to support the region's economic recovery, and I
thought this Administration would embrace our bipartisan effort
to do exactly that because if you want to deal with China in
terms of its pervasive presence in the hemisphere, you create
the wherewithal to meet the challenge of what they are doing in
the hemisphere by an institution like the IDB and by the DFC
and others.
At the end of the day, why is it that the Administration
has not embraced a 10th capital increase?
Mr. O'Reilly. My understanding, Senator, is that the issue
remains under review, and we certainly have had discussions
about this with our colleagues over at the Treasury Department,
and we do recognize the absolutely essential role that the
Inter-American Development Bank plays in this hemisphere and
that it needs to be able to act in the most robust way possible
within its authority.
Senator Menendez. Well, while we are navel gazing about
this issue, it seems to me it is rather straightforward. China
is displacing our influence in the region and we have no tools
to effectively deal with that.
So maybe we can stop looking at our navel, figure out how
we are going to support an increase and under what conditions,
and then get the IDB with the U.S. representative there to
start engaging in the hemisphere in a way that can turn the
dynamics around.
Because I am telling you, as someone who has spent 30 years
not only in foreign affairs but most specifically focused on
the hemisphere, we are losing and losing fast.
This is not just this Administration, but nonetheless, it
is this Administration that has the power to change it and it
should.
Thank you for your indulgence, Mr. Chair.
Senator Kaine. Second round of questions. I have two topics
that I would like to raise.
Help the committee understand the decision makers on
allocation of American vaccines. So there is criteria and there
is factors, but we are the most generous in the world totally,
but who is making the decisions about allocations to countries
and regions?
Ultimately, the decisions are the President's, but is this
a State Department function? Is it a multi-agency roundtable?
Help us understand this.
Mr. Natiello. Thank you for the question, Mr. Chair. So the
process to determine vaccine provision internationally is led
by the National Security Council and the White House COVID-19
teams. It does include inputs from USAID, from the State
Department, HHS, and the CDC. That is my understanding of that
process.
Senator Kaine. Do you know who the leader at the NSC of
this allocation decision-making process is?
Mr. Natiello. Well, it is the NSC COVID team, but I cannot
tell you exactly who the person is. I do not know if my
colleague, Ambassador O'Reilly, has----
Senator Kaine. Mr. O'Reilly, do you know who at the NSC has
this billet?
Mr. O'Reilly. I will confess that it is somewhere on the
tip of the tongue. I cannot pull it up at this moment.
Senator Kaine. I will ask it for the record, but if you
think of it in the next couple of minutes, please let us know.
[Editor's note.--Senator Kaine chose not to submit the question
for the record.]
Mr. O'Reilly. Absolutely.
Senator Kaine. Because, again, I mean, there are many
factors that you would use, but if you just look at the
critical nature of the Americas, the connection between the
Americas and the United States and the death toll in the
Americas as a percentage of the global death toll, it just
still seems like the allocation of vaccines is pretty out of
whack with what the threat in the region and the threat to the
United States is.
Second question. One of the things that we can do to really
help any region is inspire local production of vaccines. So the
Pan American Health Organization in September announced that it
had selected two biomedical centers in Argentina and Brazil to
develop and produce COVID vaccines and China's Sinovac biotech
also announced in August that they would open a manufacturing
facility in Chile in the first half of 2022. What is the U.S.
doing, if anything, to support local development of vaccines in
the Americas?
Mr. O'Reilly. I have certainly seen and I have heard
directly from colleagues, counterparts, in governments from
Argentina to Colombia, I know also expressions of interest in
Mexico and elsewhere that they have taken a look at the
circumstances in which our hemisphere has found itself, and
these long and sometimes politically unreliable supply chains
concern them deeply.
So we have, certainly, entered into discussions. Just
recently we sent down--actually, the Administration sent down a
team led by our colleagues from HHS and CDC to dive deep into
the topic in Colombia, for example, and take a look at the
kinds of regulatory frameworks, the types of protections of
intellectual property, the types of technical training, the
standards that they would need.
We have had similar discussions with--perhaps not at the
same depth, but we have had similar discussions over the course
of this pandemic, elsewhere in South America, I know, and to
try to figure out or help people figure out how they need to
adapt their policies and their investment environments to
attract those kinds of investments, and it is a priority, also,
because it is a good way to create good reliable jobs and
strengthen connections and ties with the U.S. and the United
States industry.
Senator Kaine. Senator Rubio.
Senator Rubio. Mr. O'Reilly, just while we have you here
today. I want to take this opportunity to talk about the Summit
of Democracies that is coming up in December.
The Government of interim President Juan Guaido, we
recognize that. The official U.S. policy remains that that is
the legitimate government in Venezuela. Is that correct?
Mr. O'Reilly. That is correct.
Senator Rubio. Why is not Venezuela on the list and his
government on the list of countries that are being invited to
the Summit of Democracies? Or has that changed?
Mr. O'Reilly. The White House makes the final calls as to
how to organize this White House scheduled and structured
event. I am not aware that the final list of participants and
speakers has been completed. We, certainly, have not invited
every government in the hemisphere around the globe to this
event.
It will be a representative group of government and
nongovernmental officials and representatives, and it is the
first phase of a two-set phase summit process, which will end
in an in-person event next year. Its principles are a
fundamental through-line as well for our Summit of the Americas
preparations.
Senator Rubio. No. No. I understand all that. My point is
if the U.S. policy is that the interim Government of President
Guaido is a legitimate government and we are trying to
strengthen both the leverage and credibility of the pro-
democracy movement in Venezuela, not inviting them even in the
initial list to a Summit of Democracies is, certainly, not
helpful to that and, I would argue, is quite damaging.
So I guess my point is, I get that the White House makes
the final decision, but I am curious, what is the State
Department's position on it or what--if you could share with
us--is the State Department against them being included in the
list?
Are you involved in the formation of the list? I would
imagine that they are talking to you as the Deputy Assistant
Secretary of State for the Western Hemisphere about who should
be on that list.
Mr. O'Reilly. Yes. We have been in consultations with the
organizers within the Administration of the event pretty much
from the get-go, Senator. And, first, to the fundamental
question, look, we recognize the National Assembly, and the
National Assembly decided to elect Juan Guaido as its
President, given that Nicolas Maduro stole the presidential
election, manipulated the prior election for--election, we
could call it, last year for the National Assembly, and has
skewed the table so rawly that Sunday's event will in no way
represent anything that is free and fair.
We understand where democratic principles rest in terms of
our relationship with Venezuela and we understand who is
blunting the democratic aspirations of the Venezuelan people.
Senator Rubio. So then why are not they on the--that is all
great. Why is that not reflected? I would imagine in the first
iteration of the list that has been put out there you would
think that it would be at the top of the list, not an
afterthought, or we will wait and see what we are going to do.
My question--I mean, do you favor them being on the list?
Is there anybody in the State Department that is against them
being on the list? That is what I am trying to get at.
Why are not they on there? I mean, I do not--I cannot
imagine, given everything you have just said, that we have
forgotten about how important this would be for them to be
included.
Mr. O'Reilly. Senator, I must say in terms of the regional
focus of my portfolio, it is my highest priority to work to
support the democratic aspirations of the Venezuelan people.
It is, I think, exceptionally important that Mr. Maduro
accept the reality of what he has done to his country and to
come back to the table to negotiate a fairer, a more
democratic, and a more open system.
Senator Rubio. No, I understand, but that does not explain
why Guaido is not--or whoever they choose as their--whether it
is him or somebody else to be the speaker of the National
Assembly, why they are not on the list, given everything you
have just said.
Mr. O'Reilly. I understand the concern, and I will bring it
back with me, Senator.
Senator Rubio. Okay. I think my time is up on this.
Senator Kaine. I want to thank both witnesses on this first
panel for your questions. We may have questions for the record
to submit as well. I will make an announcement about that at
the end of the hearing.
Should there be questions for the record we would encourage
you to be prompt in responses. Thank you so much for your
service and for appearing today.
With that, let us get the witnesses from the second panel
to come out and we will proceed with them. Thank you very much.
Mr. O'Reilly. Thank you.
[Pause.]
Senator Kaine. We want to welcome the witnesses on Panel
II. Very important hearing. Let me now introduce you. I am
going to begin with Mr. Runde.
Daniel Runde is the Senior Vice President of the Project on
Prosperity and Development in Americas program and holds the
William Schreyer Chair on Global Analysis at the Center for
Strategic and International Studies.
Previously, he held senior leadership roles at the
International Finance Corporation and from 2005 to 2007 he was
the director of the Office of Global Development Alliances at
USAID. Lifetime member of the Council on Foreign Relations and
a graduate of both Dartmouth College and Harvard University's
Kennedy School of Government. Mr. Runde, welcome. Glad to have
you with us today.
Dan Restrepo, senior fellow at the Center for American
Progress for nearly 6 years and through two presidential
campaigns served as the Principal Advisor to President Obama on
issues related to Latin America, the Caribbean, and Canada, and
then served as Special Assistant to the President and senior
director for Western Hemisphere Affairs at the National
Security Council.
Previously, he created and directed the Americas Project,
which focused on Latin America and the role of Hispanics in the
United States at the Center for American Progress.
He served as a judicial clerk on the U.S. Court of Appeals
for the Third Circuit and worked for former Representative Lee
Hamilton on the staff of the House Foreign Affairs Committee.
He is a graduate of the University of Virginia and University
of Pennsylvania School of Law.
Finally, Dr. Arachu Castro, who is the Samuel Z. Stone
Chair of Public Health in Latin America and director of the
Collaborative Group for Health Equity in Latin America at
Tulane School of Public Health and Tropical Medicine.
Prior to joining Tulane in 2013, she was the Associate
Professor of global health and social medicine at Harvard
Medical School. She is a member of the World Health
Organization's Strategic and Technical Advisory Group of
Experts for maternal, newborn, child, adolescent health and
nutrition, and has also worked as a consultant for numerous
intergovernmental public health organizations including Pan
American Health Organization, the WHO, and UNICEF.
Dr. Castro has a Ph.D. from the School for Advanced Studies
in Social Sciences in Paris, a Ph.D. in Social Sciences from
the University of Barcelona, and a Master of Public Health from
the Harvard School of Public Health.
I want to thank all the witnesses. Beginning in the order
that I introduced you, if you would each testify. Confine your
comments to about 5 minutes. Your full comments will be
included in the record, and then we will look forward to
engaging in dialogue with you.
Mr. Runde.
STATEMENT OF DANIEL F. RUNDE, SENIOR VICE PRESIDENT, CENTER FOR
STRATEGIC AND INTERNATIONAL STUDIES
Mr. Runde. Thank you, Senator Kaine. Thank you, Senator
Rubio. It is a privilege to be here before this committee.
In addition to being a moral and the right thing to do from
a public health standpoint, whichever country is seen as
solving the COVID-19 vaccine challenge is going to reap
enormous public diplomacy benefits.
The United States must play a more prominent, more decisive
role in leading distribution of safe and effective vaccines,
particularly in the Western Hemisphere. Vaccine delays in the
Americas will mean economic stagnation in the region, likely
resulting in more migration to our southern border.
The Chinese and Russian governments took advantage of a 9-
month window when the United States and the West could not
provide vaccines to the developing world because of a mix of
vaccine nationalism, lack of coordination, and disagreement
over how to distribute the vaccines.
China has used its global vaccine campaign to advance long-
term foreign policy objectives. The following examples are
anecdotal but highly believable, and the committee should
remain vigilant.
China has allegedly tied its vaccine manufacturing capacity
and distribution to pushing Huawei-driven ICT solutions in
countries like Brazil and the Dominican Republic, two allies of
the United States.
On the issue of Taiwan, China is accused of pressuring
Paraguay to recognize the mainland in return for vaccines.
Similarly, China assured El Salvador of a higher level of
vaccines, highly likely related to its non-recognition of
Taiwan.
The other two countries that comprise the Northern
Triangle, Guatemala and Honduras, recognize Taiwan and have not
received the same levels of vaccines from China and, as a
result, there are credible reports in Honduras and Guatemala
that if we had only recognized the mainland we would get more
vaccines and there also seems to be, for some reason, a series
of vaccine campaigns on border towns bordering El Salvador and
Guatemala with El Salvador. They seem to be awash in Chinese
vaccines.
The good news is that the U.S. has made substantial but
incomplete progress in reversing the narrative by aggressively
ramping up its distribution of COVID-19 vaccines globally. We
have an opportunity because the Chinese- and Russian-funded
vaccines are just not as good as Western vaccines, so we have a
chance to close the gap.
We need to do several things. The first is we need to
strengthen a coherent interagency response to addressing the
COVID-19 pandemic in the region. This response should include a
comprehensive vaccination plan with clear strategies regarding
vaccine supply logistics, communication, monitoring, and
evaluation impact.
Second, the U.S. should move to a 50/50 strategy, where 50
percent of vaccines are delivered bilaterally and the other 50
percent of vaccines are delivered multilaterally. Currently,
the Biden-Harris administration has said we are going to
deliver 75 percent multilaterally and 25 percent bilaterally. I
would suggest 50/50, not 75/25.
Also, the Biden-Harris administration should prioritize
countries in Latin America and the Caribbean that have not yet
reached 70 percent national vaccination rates. We still have a
long way to go in a number of countries.
Third, the U.S. should directly assist governments in the
region that still require preparing for national level
vaccination campaigns.
Fourth, we need to develop for the future capable regional
manufacturing platforms so that other countries can help us
answer the mail on vaccine production in the future.
Any democratic government is going to prioritize
Pennsylvania over Paraguay--no offense to Paraguay--just
because of the political realities and so we are going to just
need to have more production capacity to respond to this. The
iron laws of vaccine nationalism are going to be really hard to
break.
So, ultimately, we need to find partners. It could be
Uruguay, it could be Costa Rica--countries that have strong
rule of law, a respect for democracy, a capable workforce. We
need additional surge capacity to make vaccines because that
is, ultimately, the long-term answer to this.
We need, fifth, public-private partnerships to assist on
things like pandemic early warning systems. We have a number of
ways of dealing with early warning, but frankly, we could do
more. There are new technologies and we should be leveraging
the private sector.
Finally, we should be thinking about how we are working
with partners. That could include Taiwan. That can include
Canada. That can include Brazil, and we should absolutely be
leveraging the multilateral institutions that are part of how
we respond.
Finally, the U.S. has an opportunity to finish strong on
solving the COVID-19 pandemic. If countries do not receive
vaccines from America or our allies they will seek vaccines
from our strategic competitors.
Great power competition has come to global health. We
should commit to achieving widespread immunity in the region
and prepare for future pandemics. Thank you.
[The prepared statement of Mr. Runde follows:]
Prepared Statement of Daniel F. Runde
Chairman Kaine, Ranking Member Rubio, and distinguished members of
the Senate Subcommittee on Western Hemisphere, Transnational Crime,
Civilian Security, Democracy, Human Rights, and Global Women's Issues,
thank you for the opportunity to appear before you today to discuss the
importance of U.S.-led vaccine diplomacy in Latin America and the
Caribbean.
brief overview of the impact of covid-19 on latin america and the
caribbean
The Covid-19 pandemic is arguably the most significant economic and
social disruption since World War II. In addition to being the moral
and right thing to do from a public health standpoint, whichever
country is seen as ``solving'' the Covid-19 vaccine challenge will reap
enormous public diplomacy benefits. The United States should play a
more prominent, more decisive role in leading distribution of safe and
effective vaccines, particularly in Latin America and the Caribbean.
Given the rise of strategic competitors--China and Russia--the United
States needs to address global health challenges more effectively.
Latin America and the Caribbean (LAC) is the most devastated region
(https://news.harvard.edu/gazette/story/2021/07/how-the-pandemic-has-
affected-latin-america/) by the pandemic in terms of fatality rates and
negative economic impacts. Latin America and the Caribbean represent
(https://crsreports.congress.gov/product/pdf/R/R46336) 18.2 percent of
Covid-19 cases contracted and 31 percent of fatalities globally, both
far above the region's share of the world's population. Countries
(https://crsreports.congress.gov/product/pdf/IF/IF11581) with the
highest number of deaths in the region include Brazil, Mexico, Peru,
Colombia, and Argentina. Covid-19 has impacted politics (e.g.,
Argentina, Brazil, and Haiti), drastically set back education, and put
pressure on democratic governance in the region. Critically, vaccine
delays in the Americas will mean economic stagnation in the region,
which very likely means more migration to our Southern border.
The Chinese and Russian governments took advantage (https://
www.economist.com/graphic-detail/2021/04/29/vaccine-diplomacy-boosts-
russias-and-chinas-global-standing) of a 9-month window when the United
States and the West could not provide vaccines for the developing world
because of a mix of vaccine nationalism, a lack of coordination, and
disagreement over how to distribute the vaccines. China sought and
achieved significant geopolitical benefits from this vacuum. If Russia
and China can fill a void, they will.
China, in particular, has used its global vaccine campaigns to
advance long-term foreign policy objectives, including pushing Huawei-
driven information and communications technology (ICT), coercing
countries to reduce recognition of Taiwan, and tamping down criticism
of Uighurs in Xinjiang. The following examples are ``anecdotal but
highly believable,'' nonetheless this committee should remain vigilant
of them.
China has allegedly pressured various governments in Latin America
and the Caribbean including in Brazil, the Dominican Republic, and
Paraguay. In the Western Hemisphere, where eight countries still
recognize Taiwan, China only offers vaccines to those governments that
recognize the mainland.
In Brazil, China allegedly tied its vaccine manufacturing capacity
to the allowance of Huawei to participate in Brazil's 5G network
(https://www.nytimes.com/2021/03/15/world/americas/brazil-vaccine-
china.html), something that the pro-U.S. Bolsonaro Government had
assured the Trump administration would not happen. Likewise, after
initial plans to exclude Huawei from its telecom system, and after
receiving 20 million doses from China, the Dominican Republic (https://
wng.org/roundups/china-peddles-influence-with-vaccines-1630687161)
suddenly reversed its position allowed Huawei to participate in its
telecommunications market.
On the issue of Taiwan, China is accused of pressuring Paraguay in
return (https://www.nytimes.com/2021/04/16/world/americas/paraguay-
china-vaccine-diplomacy.html) for vaccines. Similarly, China assured El
Salvador of a higher level of vaccines, possibly related to its
position on Taiwan (https://www.as-coa.org/articles/vaccines-reignite-
china-vs-taiwan-debate-latin-america). Guatemala and Honduras (https://
www.ft.com/content/c0717932-0d88-4cea-b55c-ff561ed1f70e), the other
countries that compose the Northern Triangle, which do recognize
Taiwan, have not received vaccines from China and do not have the same
levels of vaccination as El Salvador. Honduras has requested (https://
apnews.com/article/latin-america-honduras-el-salvador-coronavirus-
pandemic-health-ed1e04523bc501a847e8de700d141bdd) that El Salvador
share surplus Chinese-funded vaccines. It seems that Salvadoran border
towns are flush with Chinese vaccines sending the signal that ``if
Guatemala or Honduras would only recognize Mainland China, then
Guatemala and Honduras would not have such low vaccination rates.''
Taiwan, it should be noted, is supporting the development of a new
vaccine, Medigen, and hopes to share it with the world soon.
Ensuring the delivery and administration of safe and effective
vaccines across Latin America and the Caribbean will help solve a
global pandemic and pay diplomatic dividends for the United States.
Increasing vaccine efforts in our Hemisphere is a necessary
demonstration of U.S. leadership and is both a moral and foreign policy
imperative essential to global health security.
Over the last 2 years, the United States has made substantial but
incomplete progress in reversing the narrative by aggressively ramping
up its distribution of Covid-19 vaccines in partner countries. Chinese-
funded vaccines are seen as less desirable and perceived as less
effective than Western vaccines, including in the Americas. In
addition, the World Health Organization has not accepted the Sputnik V
vaccine due to the Russian Government's refusal to provide data across
trials and reported side effects.
However, The U.S. cannot take its foot off the gas and must
accelerate its efforts to help respond to the pandemic swiftly and
effectively. This likely means moving from ``75/25'' ``COVAX/bilateral
distribution'' to ``50/50 ``COVAX/bilateral distribution.'' COVAX's
efforts to supply and distribute vaccines to the developing world are
essential but have faced various obstacles (https://www.pmi.org/
learning/publications/pm-network/digital-exclusives/vaccine-rollout).
COVAX planned to provide 2 billion doses (https://www.gavi.org/
vaccineswork/covax-explained) the end of 2021, but as of November 14,
it had only delivered 435 million doses. Challenges include supply
bottlenecks distribution and transportation, infrastructure, and
meeting timetables and needs of cold chains. The United States should
ensure that it remains at the forefront of Covid-19 assistance and
vaccine delivery and that it gets proper ``credit,'' including and
especially when COVAX delivers U.S. donated vaccines in a country.
To effectively deliver vaccines, the United States will need to
work closely with partners such as the private sector, regional
partners such as Canada and Brazil, allies operating in the region such
as Taiwan, and multilateral partners (e.g., the Pan-American Health
Organization (PAHO), the regional office of the WHO, the Inter-American
Development Bank (IADB), and the World Bank). Covid-19 will require
multilateral and bilateral actions and significant public-private
partnerships that respond to the current crisis and endeavor to improve
global preparedness for future pandemics. The current Covid-19 pandemic
will likely require routine booster vaccines and continued support in
delivery efforts, manufacturing, and local healthcare to administer
vaccines.
covid-19 pandemic impact and vaccine diplomacy in the western
hemisphere
Despite significant rates of Covid-19 deaths and cases, the region
is making positive strides. As of November 13, PAHO reports that 44
percent of the population of Latin America and the Caribbean is
vaccinated. Vaccination rates are steadily increasing (https://www.as-
coa.org/articles/timeline-tracking-latin-americas-road-vaccination);
however, distribution is much higher in some countries compared to
others. Those who are unvaccinated or have only received one dose of a
vaccine remain increasingly vulnerable to variants and new waves of the
virus.
Countries leading in vaccinations include Chile and Uruguay, which
have vaccinated 75 percent (https://crsreports.congress.gov/product/
pdf/IF/IF11581) of their populations, and Brazil, which has vaccinated
close to 60 percent of its population. Meanwhile, Argentina, Ecuador,
and Panama are not far behind with 50 percent (https://www.cnbc.com/
2021/10/06/latin-america-and-caribbean-islands-have-vaccinated-just-
37percent-of-populations-against-covid-who-officials-say.html)
vaccination rates. However, there is a significant disparity between
countries, as Guatemala, Haiti, Jamaica, Nicaragua, and St. Vincent and
the Grenadines have fully vaccinated less than 20 percent (https://
crsreports.congress.gov/product/pdf/IF/IF11581) of their populations.
However, Haiti is most concerning in the region, having vaccinated less
than 1 percent (https://www.cnbc.com/2021/10/06/latin-america-and-
caribbean-islands-have-vaccinated-just-37percent-of-populations-
against-covid-who-officials-say.html) of its population. We will not
have widespread vaccination, particularly in some Central American
countries and small Caribbean Island states, such as Jamaica and Haiti,
until 2022 or even 2023. The U.S. needs to help close this gap.
Covid-19 has markedly impacted economic and political conditions in
the region. For example, the IMF reported that 2020 saw a 7 percent
(https://crsreports.congress.gov/product/pdf/IF/IF11581) economic
contraction in LAC, the region's largest recorded economic contraction
in history. This contraction impacted the financial resources available
to regional countries' governments and, thus, their ability to
purchase/distribute vaccines and respond to pressing social needs
aggravated by Covid-19. Economic declines were even more severe for
Caribbean countries heavily dependent on tourism, some of which saw
more than 15 percent (https://crsreports.congress.gov/product/pdf/IF/
IF11581) economic declines in 2020. A report from March 2021 by the
U.N. Economic Commission for Latin America and the Caribbean found that
in 2020: approximately 22 million (https://crsreports.congress.gov/
product/pdf/IF/IF11581) people in Latin America moved below the poverty
line, and the poverty rate rose 3.2 percent (https://
crsreports.congress.gov/product/pdf/IF/IF11581) from levels recorded in
2019. In addition, losses in education will likely result in an
economic loss of 16 percent of regional GDP (https://
blogs.worldbank.org/education/covid-19-and-learning-crisis-latin-
america-and-caribbean-how-can-we-prevent-tragedy) or $1.7 trillion.
Covid-19 also exacerbated existing political unrest (https://
crsreports.congress.gov/product/pdf/IF/IF11581). Any vaccination
strategy should complement economic initiatives that will help the
region to recover from the pandemic. This economic plan must include
the digitalization of the region's countries to help reduce the digital
divide that Covid-19 accelerated. The U.S. should ensure that it helps
close the digital divide before others close that divide.
vaccine initiatives: united states
The U.S. is currently outpacing China (https://
www.atlanticcouncil.org/content-series/aviso-latam-covid-19/aviso-
latam-covid-19-october-29-2021/) regarding Covid-19 vaccine donations
to LAC and must continue this momentum. On June 21, 2021, the Biden
administration announced (https://www.whitehouse.gov/briefing-room/
statements-releases/2021/06/21/fact-sheet-biden-harris-administration-
announces-allocation-plan-for-55-million-doses-to-be-shared-globally/)
the distribution of 80 million vaccine doses to developing countries,
75 percent via COVAX, co-led by the Coalition for Epidemic Preparedness
Innovations (CEPI), the Global Vaccine Alliance (GAVI), WHO, and United
Nations Children's Fund (UNICEF), and 25 percent to be distributed
bilaterally from the U.S. Government to partner countries.
As of October 2021, the U.S. Agency for International Development
has distributed over $482 million (https://www.usaid.gov/sites/default/
files/documents/USAID_COVID-19_LAC_Response_Fact_Sheet_2_FINAL.pdf) of
total funding for Covid-19 response in Latin America and the Caribbean.
This is part of a larger $9.3 billion in FY 2021 used in over 120
countries to fight against Covid-19.
The State Department reports that since mid-October 2021, the U.S.
has delivered more than 44 million (https://crsreports.congress.gov/
product/pdf/IF/IF11581) doses of Covid-19 vaccines to countries in the
Western Hemisphere (Canada included). Countries that have received the
most doses include Mexico with 7.5 million (https://
crsreports.congress.gov/product/pdf/IF/IF11581), Colombia with 6
million (https://crsreports.congress.gov/product/pdf/IF/IF11581),
Guatemala with 4.5 million (https://crsreports.congress.gov/product/
pdf/IF/IF11581), and Argentina with 3.5 million (https://
crsreports.congress.gov/product/pdf/IF/IF11581). Other U.S. vaccine
initiatives in LAC include President Biden's pledge in April 2021 of 60
million (https://www.as-coa.org/articles/tracker-us-vaccine-donations-
latin-america) vaccines to be donated through COVAX, 20 million
(https://www.as-coa.org/articles/tracker-us-vaccine-donations-latin-
america) of which were designated for LAC. Furthermore, in June 2021,
Biden expanded these efforts by pledging to purchase and donate 500
million (https://www.as-coa.org/articles/tracker-us-vaccine-donations-
latin-america) Pfizer doses for low- and lower-middle-income countries
(such as Bolivia, El Salvador, Honduras, and Nicaragua). Over the next
2 years, these doses will be distributed via COVAX (https://www.as-
coa.org/articles/tracker-us-vaccine-donations-latin-america).
vaccine initiatives: multilateral organizations (non-covax)
PAHO
PAHO has helped countries in LAC gain access to Covid-19 vaccines
through the COVAX Facility, with 22 countries (https://
crsreports.congress.gov/product/pdf/IF/IF11581) in the region having
signed agreements to receive vaccines via the facility.
World Bank
The World Bank has provided $725 million (https://
www.worldbank.org/en/who-we-are/news/coronavirus-covid19/world-bank-
support-for-country-access-to-covid-19-vaccines) in operations to
support the rollout of Covid-19 vaccines in Latin America and the
Caribbean. Since April 2021, the World Bank has provided $4.6 billion
(https://www.worldbank.org/en/news/factsheet/2020/04/02/world-bank-
response-to-covid-19-coronavirus-latin-america-and-caribbean) in Covid-
related IBRD/IDA operations. These funds will be crucial in helping
resolve problems that inhibit or complicate access to and distribution
of vaccines, such as supply chain and delivery issues (https://
www.worldbank.org/en/news/factsheet/2020/04/02/world-bank-response-to-
covid-19-coronavirus-latin-america-and-caribbean).
Inter-American Development Bank
In December 2020, the IDB announced the allocation of $1 billion
(https://www.iadb.org/en/news/idb-mobilizes-1-billion-covid-19-vaccine-
financing-latin-america-and-caribbean) to countries in LAC to
facilitate the acquisition and distribution of Covid-19 vaccines. IDB
support will occur primarily in three areas (https://www.iadb.org/en/
news/idb-mobilizes-1-billion-covid-19-vaccine-financing-latin-america-
and-caribbean): acquisition of vaccines via multilateral collaboration
or singular country efforts; strengthening of institutions to bolster
the development of vaccine deployment mechanisms; investment to build
capacity for immunization/fund operational costs. In March 2021, the
IDB introduced an instrument (https://www.iadb.org/en/news/idb-support-
latin-america-and-caribbean-negotiate-faster-access-vaccines) to
facilitate LAC countries' access to Covid-19 vaccines, allowing them to
better compete for vaccines. The instrument helps resolve indemnity
obligations (https://www.iadb.org/en/news/idb-support-latin-america-
and-caribbean-negotiate-faster-access-vaccines)--a pivotal barrier to
reaching consensus in many vaccine contract negotiations--and introduce
regulatory (https://www.iadb.org/en/news/idb-support-latin-america-and-
caribbean-negotiate-faster-access-vaccines) reforms to simplify the
purchase and delivery of vaccines.
vaccine initiatives: russia and china
China and Russia developed vaccines that were available earlier
internationally and advertised as ``cheaper'' and easier to transport
and store than Western mRNA vaccines that require ultra-cold storage.
Although first to launch global vaccine campaigns, China and Russia
vaccine diplomacy efforts have not been entirely successful (https://
time.com/6086028/chinese-russian-covid-19-vaccines-geopolitics/) and
allow an opportunity for the U.S. to retake the vaccine diplomacy lead.
Russia
Russia initially approved the Sputnik V vaccine (https://
www.nature.com/articles/d41586-021-01813-2), a two-dose viral vaccine,
in August 2020. Currently, Russia has overpromised, and underdelivered
(https://www.as-coa.org/articles/vaccine-manufacturing-race-russia-
trips) Sputnik V contracted to Latin America. For example, due to
production delays, Russia is not completing contracts, notably in
Argentina, Mexico, and Peru, which together are waiting on
approximately 20 million doses. Additionally, many of the shipments of
the Russian vaccines delivered have only been able to provide one of
the two doses required, leaving people with limited immunity.
Nonetheless, Russia is still moving its vaccination campaign forward--
on October 14, the Russian Direct Investment Fund signed an agreement
with the (https://www.elfinanciero.com.mx/nacional/2021/10/14/cerrado-
la-vacuna-sputnik-v-se-envasara-en-mexico/) Mexican Government.
China
China has pledged to deliver 2 billion vaccine doses (https://
apnews.com/article/2020-tokyo-olympics-joe-biden-health-coronavirus-
pandemic-coronavirus-vaccine-c2712b56c0464ec0b95c41cd18cc38dd)
worldwide by the end of 2021--China has currently sold 1.4 billion
doses, donated 99 million, and delivered 1.1 billion doses (https://
bridgebeijing.com/our-publications/our-publications-1/china-covid-19-
vaccines-tracker/). With moderate success, China has reworked its image
from being the origin of the pandemic to helping other countries
respond and recover with a significant effort in Latin America and the
Caribbean. For example, Brazil has contracted 160 million vaccines from
China. However, Chinese-funded vaccines have much lower efficacy rates
than western vaccines like Moderna and Pfizer. Chinese-funded vaccines
ranged from 51 to 79 percent effective (https://www.nature.com/
articles/d41586-021-02796-w) compared to 90 percent and higher efficacy
ratings of Moderna and Pfizer. However, when there is no other option,
countries will accept Chinese-funded vaccines to ensure that people
have some immunity rather than none. Chinese-funded vaccines are stored
at standard refrigeration, which is much easier for developing
countries to manage in supply chain infrastructure. China is leading
vaccination campaigns in Chile, the Dominican Republic, and Ecuador and
boasts a significant presence in Argentina.
recommendations for continued and increased
u.s. engagement in lac vaccine diplomacy
The United States has an opportunity to ``finish'' strong on
``solving'' Covid-19. The U.S. should create partnerships to fix
longer-term systemic problems in the region related to global
pandemics. Even countries that accept non-U.S. vaccines will need
continued funding and technical assistance (https://www.nytimes.com/
2021/03/16/world/brazil-needs-vaccines-and-china-is-benefiting.html) in
delivering and administering vaccines and booster shots to populations.
First, the U.S. should increase donations to Latin America and the
Caribbean. The U.S. should also make arrangements for the hundreds of
thousands of private U.S. citizens abroad to access vaccines.
Second, the United States should strengthen a coherent interagency
response to address the Covid-19 pandemic. This response should include
a comprehensive vaccination plan, with clear strategies regarding
vaccine supply logistics, communication, monitoring and evaluation, and
impact. All distribution, progress, and impact data should be defined,
transparent and available. USAID would be in charge in partnership with
the Department of State and HHS. The U.S. can build on existing
strategies and supply chain operations associated with existing U.S.
global health programs such as PEPFAR (https://www.state.gov/pepfar/),
PMI, and other vaccination programs.
Third, the U.S. should move to a 50/50 strategy where 50 percent of
vaccines are delivered bilaterally, and the other 50 percent of
vaccines are delivered multilaterally. Multilateral initiatives like
COVAX are a necessary component of the Covid-19 response, but it is not
the most efficient mechanism available. Within the bilateral
allocation, the Biden administration and Congress should prioritize
countries in Latin America and the Caribbean that have not reached 70
percent national vaccination rates, provide more funding towards the
region, and monitor and make sure doses are procured, delivered, and
administered on the promised timelines. There could also be an
opportunity to offer U.S. mRNA booster shots to bolster less effective
Sputnik V and Chinese government-funded vaccines. We should take full
advantage of Russia's supply chain challenges.
Fourth, the U.S. should directly assist those LAC governments that
still require it with preparing for national-level vaccination
campaigns. This includes:
Helping determine what steps each government can take to
expand access to personal protective equipment (PPE), treatment
protocols, contact tracing, access to vaccines, and public
health measure to reduce further transmission;
Identifying the requirements of each country to execute
necessary cold chains, and if possible, enable manufacturing
capacity. This includes following vaccines through the ``last
mile'' and avoiding scenarios where doses may expire. For
example, preventing situations such as what happened in Haiti,
where the Haitian Government announced they would return
thousands of Moderna vaccine doses to the United States
(https://www.bloomberg.com/news/articles/2021-10-13/haiti-to-
send-back-expiring-u-s-donated-moderna-vaccines?sref=VEVHJ4cS)
that were close to expiring; and
Working with civil society actors (community organizations,
health focused organizations) to engage with local perspectives
that are essential to understand in-county health systems and
optimize vaccine distribution campaigns.
Fifth, the United States needs to help create regional
manufacturing platforms for future pandemics in LAC countries with a
strong rule of law, a commitment to democracy, and an educated
workforce, such as Costa Rica and Uruguay. Any democratically elected
leader in the United States will prioritize vaccine distribution to
Pennsylvania over Paraguay. Therefore, we need small, capable countries
who can quickly ``answer the mail'' on meeting their vaccine
requirements and then export to the region and burden share. We need a
broader ``culture of immunization'' in the region for such
manufacturing platforms to work.
Sixth, the United States should leverage existing multilateral
architecture, namely COVAX and PAHO, to reinforce vaccine supply
chains. While not sufficient on their own, the efforts of COVAX, the
World Bank, the IDB, and PAHO are necessary aspects of the global
vaccination effort. The U.S. should play a decisive leadership role in
these multilateral organizations. It ought to strengthen coordination
amongst multilateral actors and help facilitate an implementation plan
to coordinate both the USG and the multilateral system.
The United States should leverage PAHO's technical support and the
PAHO Revolving Fund for vaccines and Strategic Fund. The U.S. should
provide $100 million to cover the costs of implementing those measures.
It should also use PAHO and COVAX vaccine facilities (https://
www.reuters.com/business/healthcare-pharmaceuticals/brazil-argentina-
tapped-make-mrna-vaccines-latin-america-2021-09-21/) to ensure the
fastest possible acquisition of vaccines.
Seventh, as part of an expanded bilateral effort, the United States
must engage more robustly with the private sector, universities, city
governments (especially mayors) and people to people networks (e.g.
networks of trained emergency personnel throughout the region) through
public-private partnerships (PPPs) (https://www.csis.org/analysis/
beyond-covax-importance-public-private-partnerships-covid-19-vaccine-
delivery-developing) to amplify reach and execution, complement
multilateral efforts, and demonstrate additional U.S. leadership in
vaccine distribution and administration in Latin America and the
Caribbean. Organizations such as the Pan-American Development
Foundation are well positioned to broker such partnerships across the
hemisphere. Operation Warp Speed (https://www.gao.gov/products/gao-21-
319) proved what can be accomplished to create and manufacture safe and
effective vaccines. We need an ``Operation Warp Speed'' focused on the
distribution of vaccines in developing countries. U.S. agencies,
specifically, USAID should identify priority local gaps for vaccination
and build in-country and local vaccination public-private partnerships.
More immediately, the Administration should partner with U.S.
companies with significant workforces throughout Latin America to
protect their employees as a safeguard against more economic
devastation. The U.S. should also work with Pfizer and Moderna to
increase procurement for Latin America and the Caribbean. For example,
facilitate partnerships such as Pfizer's recent commitment (https://
www.mcclatchydc.com/news/coronavirus/article253746158.html) to partner
with a Brazilian biopharmaceutical company, Eurofarma Laboratorios SA,
to mass-produce doses in the region.
In the long-term, public-private partnerships can assist with the
supply and equitable distribution of vaccinations. The United States
should also encourage and implement private-sector innovations to
update outdated systems regarding the supply and distribution of
vaccines. For example, applying better cold chain and storage
technologies to strengthen transport and storage capacity in places
that lack adequate infrastructure. PPP's are needed to bolster existing
early-warning systems (https://www.foreignaffairs.com/articles/united-
states/2020-07-14/predicting-next-pandemic) through innovative data
collection mechanisms (https://www.medicalnewstoday.com/articles/how-
google-search-data-can-predict-covid-19-outbreaks).
To conclude, we cannot fight something with nothing. If countries
do not have vaccines from the U.S. or our allies, they will seek
vaccines from our strategic competitors. Great power competition has
come to global health, and we should commit to achieving widespread
immunity in the region and prepare for future pandemics.
Senator Kaine. Thank you very much.
Mr. Restrepo.
STATEMENT OF DAN RESTREPO, SENIOR FELLOW, CENTER FOR AMERICAN
PROGRESS, WASHINGTON, DC
Mr. Restrepo. Chairman Kaine, Senator Rubio, thank you very
much for this opportunity.
As has been well established so far in this hearing, it is
difficult to overstate the importance of U.S. vaccine diplomacy
in Latin America and the Caribbean. In fact, one can argue that
through its vaccine diplomacy the Biden administration has
engaged in the most important U.S. strategic initiative in the
Americas in decades.
To understand why, it is critical to step back and examine
the cascading crises that faced Latin America and the Caribbean
before COVID-19, how the pandemic exacerbated them, and what it
all means for U.S. interests.
In early 2020, the countries of Latin America and the
Caribbean were amidst a historic dislocation of vulnerable
populations, home to some of the highest levels of citizen
insecurity in the world, awash in mis- and disinformation, both
homegrown and state actor generated, undermining the region's
basic social fabric, buffeted by the intensifying effects of
the climate crisis, plagued by multiple governance failures
and, worse, characterized by corruption, populism, and
authoritarianism.
Perhaps most fundamentally concerning, the region was
suffering a profound crisis in confidence in democracies'
ability to deliver at scale for the people of the Americas. In
2018, fewer than half of all Latin Americans viewed democracy
as the preferred form of government and only 24 percent
reported being satisfied with their democracy, and then COVID-
19 hit.
To date, the pandemic has claimed at least a million and a
half lives across the region, representing more than 30 percent
of all worldwide reported deaths in a region with 8 percent of
the world's population, triggered the most severe regional
economic contraction in the world and the slowest economic
recovery.
It plunged 22 million people into poverty and 8 million
into extreme poverty, and that was only in the last 9 months of
2020. It exacerbated the irregular movement of people
throughout the hemisphere.
So the nearly 50 million doses of U.S.-manufactured COVID-
19 vaccines distributed to date by the United States is sound
policy on numerous levels. It is a vital component of any
effective strategy to mitigate the unprecedented movement of
people that I just mentioned.
It is an investment in the U.S. economy and, particularly,
our export sector, given that fully a third of U.S. exports are
to countries in the Western Hemisphere.
It is also pretty sound basic public health policy, given
that most foreign visitors to the United States, particularly
relevant as we open up international travel, are from our
closest neighbors.
Above all else, it is better application of U.S. power for
geopolitical benefit. It is the best possible demonstration
project that democracy can deliver for the people of the
Americas.
It draws a stark contrast with China's attempts, which we
have been discussing this morning, to use vaccine diplomacy for
its own ends, particularly because the superior efficacy of
U.S.-manufactured vaccines has made the U.S. the increasingly
sought after partner of choice, including by countries that
were high-profile recipients of initial Chinese and, to a
lesser extent, Russian largesse.
Because they are delivered without strings, U.S.-
manufactured vaccines also underscore a steady confidence in
the power of innovation and collaboration, two characteristics
that made those vaccines possible, but also they draw a
critical distinction between what is great about the United
States and what fuels China's rise.
In short, helping end the COVID-19 pandemic, making
economic recovery more possible, and instilling greater faith
in the promise of democracy across the Americas amounts to an
essential historic demonstration of U.S. leadership in the face
of a region and regional tumult likely to continue for years to
come.
Thank you very much. I look forward to your questions.
[The prepared statement of Mr. Restrepo follows:]
Prepared Statement of Daniel A. Restrepo \1\
It is difficult to overstate the importance of U.S. vaccine
diplomacy across Latin America and the Caribbean. To understand why
this is true, it is important to take a step back and understand the
broader context of the cascading set of crises affecting the region.
Front of mind among these, of course, is the unprecedented COVID-19
pandemic. Since it arrived in Latin America and the Caribbean, the
pandemic has claimed at least 1.5 million lives, representing more than
30 percent of all reported deaths world-wide for a region with 8
percent of the world's population.\2\ At various points in the past 20
months, multiple countries throughout the region have laid claim to the
dubious distinction of leading the world in infection and mortality
rates. We will not soon forget scenes of bodies piling up on the
streets of Guayaquil, Ecuador nor forget stories of entire cities in
Brazil running out of bottled oxygen.
The pandemic's economic fallout has, in many ways, been even more
severe. In 2020, Latin America and the Caribbean endured, according to
the World Bank, the most significant economic contraction of any region
in the world, with regional GDP contracting by 7 percent.\3\ The first
9 months of the pandemic saw 22 million people fall into poverty,
including 8 million into extreme poverty--whipping out, respectively,
12 and 20 years of progress, on these fronts.\4\ Latin America and the
Caribbean has also been among the slowest regions of the world to
bounce back for its COVID-onset economic contraction. Economic growth
in 2021 is expected to be 6.3 percent but regional GDP is not expected
to be above pre-pandemic levels until 2023 at the earliest.\5\ Given
the pandemic's persistence, the economic wreckage continues to pile up
and millions more will have slipped into poverty and extreme poverty
during this calendar year.
Although the region's overall COVID profile has begun to improve
markedly, the region is also being buffeted by the accelerating effects
of the climate crisis and by multiple governance failures--and worse--
fueled by a plague of corruption, populism, and authoritarianism. The
region is also seeing an historic displacement of vulnerable
populations both within and across international borders, including:
100,000s of Haitians dislocated by the 2010 earthquake; \6\
More than 5.9 million Venezuelans driven from their country
since 2015; \7\
Nicaraguans fleeing an authoritarian regime; \8\
Haitians dislocated by 2021 earthquake and post-Moise
assassination political tumult; \9\
Central Americans uprooted by Ida and Iota that befell them
on top of COVID and the historically predatory conditions under
which they live; \10\ and
Mexicans subject to spiraling violence and loss of economic
opportunity.\11\
COVID's impact, however, is perhaps most troubling for U.S.
interests in the Western hemisphere because it hit at a time when
democracy was under its most significant strain since the region's
post-Cold War democratic transformation and its 2001 embrace, through
the Inter-American Democratic Charter, of a shared responsibility to
protect it.
In 2020, less than half of all Latin Americans, 49 percent,
according to Latinobarometro, the region's leading public opinion
survey, viewed democracy as the preferred form of government and only
25 percent report being satisfied with their democracy.\12\ Although
some take solace in the fact that those levels were virtually unchanged
from 2018, which saw 48 percent preference for democracy and 24 percent
satisfaction with democracy, such ``stability'' should be cold
comfort.\13\ A steady downward trend has perhaps temporarily been
arrested, but a fundamental crisis of confidence in democracy still
prevails, opening up ample space for populists--of the Left and the
Right--to fill with divisive rhetoric, empty promises, and nostalgia
for oftentimes illusory, by-gone, golden eras.
The reasons behind this loss of faith are multi-factor, but a clear
thread is a belief that democracy is incapable of addressing people's
basic needs with pronounced majorities believing basics like education
(58 percent), healthcare (64 percent) and justice (77 percent) are not
equitably available.\14\ Only majorities in the curious trio of Costa
Rica, Uruguay, and Nicaragua view these three basic services as being
equitably available.\15\
It is in the context of this complex backdrop that, in my
estimation, it is no exaggeration to say that for the past several
months, away from the glare of camera lights, the Biden administration
through its vaccine diplomacy has been executing the most important
U.S. geostrategic initiative in the Americas in decades with lasting
implications for democracy in the region--and for U.S. democracy here
at home.
Since President Biden first prioritized our closest neighbors for
distribution of U.S.-manufactured COVID-19 vaccines, the United States
has distributed nearly 50 million vaccine doses throughout the
Americas,\16\ including more than 10 million via COVAX.\17\
This clear prioritization of the Western hemisphere is sound policy
on numerous levels. It is a vital component of any effective strategy
to mitigate the unprecedented irregular movement of people throughout
the region triggered, in no small measure, by the impacts of COVID-19.
It is good for our economy and for export-supported sectors, in
particular, given that one-third of all U.S. exports go to countries in
the Western hemisphere.\18\ It has been an excellent, basic public
health policy given that most foreign visitors to the United States
originate in our closest neighbors.
It has, however, been an even better application of U.S. power with
clear geopolitical benefits.
It demonstrates the U.S. competitive advantages compared to China
and unquestionably advances U.S. interests, as helping governments put
vaccines in arms, turn the tide on COVID-19, and bolster economic
recovery is the best possible demonstration project that democracy can
deliver for the people of the Americas.
The efficacy of U.S.-manufactured vaccines--made possible by
international and public-private collaboration--also provides a stark
contrast with China's much-touted vaccine diplomacy. Although China--
and to a lesser extent Russia--enjoyed ``first-mover'' advantages
distributing vaccines across the region before the United States and
doing so with more emphasis on making headlines than delivering impact,
Chinese and Russian vaccines have proven far less effective than their
U.S.-manufactured counterparts.\19\ As a result, they have been
increasingly less sought-after with countries that were high-profile
recipients of Chinese and/or Russian largesse earlier this year turning
to the United States as the partner of choice.
That U.S. vaccines are delivered with no strings also sends a
powerful, albeit indirect, message. It underscores a confidence in the
power of innovation and openness to collaboration, two characteristics
that not only made the highly effective, U.S.-manufactured vaccines
possible, but which also draw perhaps the most critical distinction
between the power of the American experiment writ large and that which
fuels China's rise.
Finally, shoring up faith in democracy in the Americas is not just
good for the above stated reasons. Nor does it simply advance abstract
U.S. interests abroad. It is also important for what it portends for
the interplay between a crisis of faith in democracy across the
Americas and its effects on U.S. democracy considering the deep
interconnection that binds the United States to the rest of the
countries of the Americas.
As it has done with so many other pre-existing conditions, COVID-19
has laid bare a dark underside of interconnection in the Americas. Over
the course of the past 9 months lies and distortions--communicated in
Spanish and emanating from Latin America--have fueled vaccine hesitancy
among U.S. Latinos.\20\ A similar, robust, negative feedback loop
exists around mis- and disinformation campaigns in and from the region
fueling skepticism in democracy--there and here--via platforms like
WhatsApp \21\ and YouTube.\22\ Platforms on which U.S. Latinos over-
index and which are falling short in countering Spanish-language
propaganda.\23\ As a result, the more the United States can do to shore
up democracy across Latin America and the Caribbean, the more it will
do to shore up democracy at home as well.
Aligning the United States with the democratic aspirations of the
approximately 600 million individuals with whom we share the Americas,
of course, does not end with vaccines. It requires using the full range
of U.S. policy tools to support peaceful, prosperous, and resilient
communities throughout the Americas. But helping end the COVID-19
pandemic, making economic recovery more possible, and instilling
greater faith in the promise of democracy across the Americas
nonetheless amounts to an essential, historic step forward in the face
of regional tumult likely to continue for years to come.
----------------
Notes
\1\ The views reflected in this testimony are my personal views and
do not represent the views of any institution with which I am or have
been affiliated.
\2\ In Focus, ``Latin America and the Caribbean: Impact of COVID-
19,'' Congressional Research Service, November 15, 2021 available at
IF11581.pdf (fas.org) (https://sgp.fas.org/crs/row/IF11581.pdf).
\3\ International Monetary Fund, Regional Economic Outlook Western
Hemisphere: A Long and Winding Road to Recovery, October 2021,
available at Regional Economic Outlook for Western Hemisphere, October
2021 (imf.org) (https://www.imf.org/en/Publications/REO/WH/Issues/2021/
10/21/Regional-Economic-Outlook-October-2021-Western-Hemisphere).
\4\ U.N. Economic Commission for Latin America and the Caribbean,
``Social Panorama of Latin America,'' March 2021, available at Pandemic
Prompts Rise in Poverty to Levels Unprecedented in Recent Decades and
Sharply Affects Inequality and Employment--Press Release--Economic
Commission for Latin America and the Caribbean (cepal.org) (https://
www.cepal.org/en/pressreleases/pandemic-prompts-rise-poverty-levels-
unprecedented-recent-decades-and-sharply-affects).
\5\ U.N. Economic Commission for Latin America and the Caribbean,
``The recovery paradox in Latin America and the Caribbean. Growth amid
persisting structural problems: inequality, poverty and low investment
and productivity,'' July 8, 2021 available at Growth in Latin America
and the Caribbean in 2021 Will Not Manage to Reverse the Adverse
Effects of the Pandemic--Press Release--Economic Commission for Latin
America and the Caribbean (cepal.org) (https://www.cepal.org/en/
pressreleases/growth-latin-america-and-caribbean-2021-will-not-manage-
reverse-adverse-effects).
\6\ Jacqueline Charles, ``In aftermath of Haiti's 2010 earthquake,
many still face immigration uncertainty,'' Miami Herald, January 13,
2021 available at Haitian immigrants who fled 2010 earthquake face
uncertainty--Miami Herald (https://www.miamiherald.com/news/nation-
world/world/americas/haiti/article248450275.html).
\7\ Inter-Agency Coordination Platform for Refugees and Migrants
from Venezuela available at Home--R4V (https://www.r4v.info/en).
\8\ Alvaro Murillo, ``Soaring numbers of Nicaraguans seek refuge in
Costa Rica amid domestic crackdown,'' Reuters, August 10, 2021
available at Soaring number of Nicaraguans seek refuge in Costa Rica
amid domestic crackdown--Reuters (https://www.reuters.com/world/
americas/soaring-number-nicaraguans-seek-refuge-costa-rica-amid-
domestic-crackdown-2021-08-11/).
\9\ Lisa Deaderick, ``A perfect storm of crises and instability
leading Haitian migrants to seek U.S. asylum,'' San Diego Tribune,
September 26, 2021 available at A perfect storm of crises and
instability leading Haitian migrants to seek U.S. asylum--The San Diego
Union-Tribune (sandiegouniontribune.com) (https://
www.sandiegouniontribune.com/columnists/story/2021-09-26/a-perfect-
storm-of-crises-and-instability-leading-haitian-migrants-to-seek-u-s-
asylum).
\10\ Dan Restrepo, ``Central Americans Are Fleeing Bad
Governments,'' Foreign Affairs, March 5, 2021 available at Central
Americans Are Fleeing Bad Governments--Foreign Affairs (https://
www.foreignaffairs.com/articles/central-america-caribbean/2021-03-05/
central-americans-are-fleeing-bad-governments).
\11\ Kirk Semple, ``Violence Drives Swell in Mexican Migration,''
New York Times, December 7, 2019 available at Violence Drives a Swell
in Mexican Migration--The New York Times (nytimes.com) (https://
www.nytimes.com/2019/12/07/world/americas/mexico-border-migration-
asylum.html).
\12\ Latinobarometro, Latinobarometro Report 2021, available at
Latinobarometro (https://www.latinobarometro.org/lat.jsp).
\13\ Latinobarometro, Latinobarometro Report 2021, available at
Latinobarometro (https://www.latinobarometro.org/lat.jsp).
\14\ Latinobarometro, Latinobarometro Report 2021, available at
Latinobarometro (https://www.latinobarometro.org/lat.jsp).
\15\ Latinobarometro, Latinobarometro Report 2021, available at
Latinobarometro (https://www.latinobarometro.org/lat.jsp).
\16\ Chase Harrison, ``Tracker: U.S. Vaccine Donations to Latin
America,'' AS/COA, November 3, 2021 available at Tracker: U.S. Vaccine
Donations to Latin America--AS/COA (as-coa.org) (https://www.as-
coa.org/articles/tracker-us-vaccine-donations-latin-america).
\17\ Chase Harrison, ``Tracker: U.S. Vaccine Donations to Latin
America,'' AS/COA, November 3, 2021 available at Tracker: U.S. Vaccine
Donations to Latin Americ--AS/COA (as-coa.org) (https://www.as-coa.org/
articles/tracker-us-vaccine-donations-latin-america).
\18\ Office of the United States Trade Representative, Countries &
Regions, available at Countries & Regions--United States Trade
Representative (ustr.gov) (https://ustr.gov/countries-regions).
\19\ Sui-Lee Wee, ``They Relied on Chinese Vaccines. Now They're
Battling Outbreaks.,'' New York Times, June 22, 2021 available at They
Relied on Chinese Vaccines. Now They're Battling Outbreaks--The New
York Times (nytimes.com) (https://www.nytimes.com/2021/06/22/business/
economy/china-vaccines-covid-outbreak.html).
\20\ Nada Hassanein, ``'You can't trust the government': Spanish-
speaking social media spreads COVID-19 vaccine disinformation, adds to
hesitancy,'' USA Today, March 29, 2021 available at COVID-19
'infodemic': Social media in Spanish spreads myths, hoaxes
(usatoday.com) (https://www.usatoday.com/story/news/health/2021/03/29/
covid-19-vaccine-infodemic-social-media-spanish-disinformation-
coronavirus/4592379001/).
\21\ Sam Sabin, ``Hispanic Adults Use WhatsApp More Than the
General Public. Disinformation Campaigns Are Targeting That
Vulnerability,'' Morning Consult, October 30, 2020 available at
Hispanic Adults Use WhatsApp More Than the General Public.
Disinformation Campaigns Are Targeting That Vulnerability--Morning
Consult (https://morningconsult.com/2020/10/30/hispanic-adults-use-
whatsapp-more-than-the-general-public-disinformation-campaigns-are-
targeting-that-vulnerability/).
\22\ ``2021 Hispanic Digital Fact Pact,'' H Code available at
DocSend (https://hcode.docsend.com/view/ni6ftqnh4uwtbwkj/d/
azgd6a593i9nkqca).
\23\ Stephanie Valencia, ``Misinformation online is bad in English.
But it's far worse in Spanish,'' Washington Post, October 28, 2021
available at Social media misinformation is bad in English. But it's
far worse in Spanish.--The Washington Post (https://
www.washingtonpost.com/outlook/2021/10/28/misinformation-spanish-
facebook-social
-media/).
Senator Kaine. Thank you so much.
Dr. Castro.
STATEMENT OF DR. ARACHU CASTRO, DIRECTOR OF THE COLLABORATIVE
GROUP FOR HEALTH EQUITY IN LATIN AMERICA [CHELA], TULANE
UNIVERSITY, NEW ORLEANS, LA
Dr. Castro. Thank you, Mr. Chairman, Tim Kaine, and Ranking
Member Marco Rubio for inviting me to testify today. My
comments complement the written statement that I submitted
yesterday.
The pandemic continues to create great human suffering in
Latin America and the Caribbean, where an estimated 2.2 million
people have died of COVID-19. This includes both reported and
an estimate of under reported deaths.
Although more men than women have died of COVID, not
included in these mortality statistics are the thousands who
have died due to the disruption of essential health services
such as women of reproductive age, children, and adolescents.
Additionally, last year the pandemic caused the worst
economic contraction in more than a century, deepening social
and economic inequalities and increasing poverty. The
underfunding of scientific and technological research and
development in most countries in the region is at the root of
the limited capacity to develop novel vaccines and the uneven
rollout of vaccines.
Despite a regional vaccine procurement mechanism since
1979, the Pan American Health Organization's Revolving Fund for
Vaccine Procurement, most countries negotiated access to COVID-
19 vaccines last year through bilateral agreements with vaccine
developers from the United States, Europe, Russia, and China.
At the same time, most also participated in the COVAX
mechanism whose procurement agent in the Americas is the
Revolving Fund. Although half of the population is fully
vaccinated, significant differences exist between countries.
The inequity behind the distribution of vaccines is
primarily explained by the type of participation in the COVAX
mechanism, which has been severely affected by the
concentration of doses in high income countries and the
interruption of vaccine export from the largest manufacturer of
vaccines in the world, located in India.
As of last Friday, among the 10 countries that participate
in COVAX as donor dependent, only 26 percent of the population
is fully vaccinated. Coverage ranges from less than 1 percent
in Haiti to 61 percent in El Salvador.
On the other hand, among the self-financing participants in
COVAX, twice as many--51 percent--of the population is fully
vaccinated. Coverage ranges from 16 percent in Jamaica to 81
percent in Chile.
Cuba, which did not participate in COVAX and is the only
country in the region that has developed its own COVID
vaccines, has fully vaccinated 70 percent of its population.
The divide reflected by these data can undermine all
efforts to bring the pandemic to an end in the Americas, where
it continues to have a devastating impact due to the uneven
deployment of vaccines, the lack of a regional systematic
vaccination strategy, the limited capacity to develop novel
vaccines, and the reliance on imported vaccines.
Consequently, 2 months ago, the Community of Latin American
and Caribbean States approved the plan for self-sufficiency in
health matters in Latin America and the Caribbean, prepared by
the Economic Commission for Latin America and the Caribbean,
ECLAC.
The United States has the opportunity to help support this
regional plan by: number one, facilitating technology transfer
and the development of manufacturing capacity for mRNA
vaccines; two, training and qualifying specialized human
resources; three, equipping national and regional laboratories;
and four, leveraging regional supply chains to help increase
production capacity in a region of 660 million and insufficient
vaccine development.
Latin America and the Caribbean has, however, research
capacity, scientific development, and technological innovation
centers that are underfunded and that should be strengthened to
discover and manufacture vaccines.
Thank you for your attention.
[The prepared statement of Dr. Castro follows:]
Prepared Statement of Dr. Arachu Castro
In Latin America and the Caribbean, a region inhabited by 8.5
percent of the world's population, 46.7 million people have been
diagnosed with COVID-19 (18 percent of world cases), and more than 1.5
million deaths have been reported (30 percent of world deaths) as of
November 15, 2021.\1\ Including underreported deaths, it is estimated
that the actual figure as of this date is 2.2 million deaths.\2\ Figure
1 shows the reported and underreported deaths per 100,000 population in
27 countries and the Commonwealth of Puerto Rico, as well as the
projected additional deaths in the next three and a half months.
According to these estimates, Bolivia, Peru, and Venezuela will surpass
500 deaths per 100,000 population by March 1, 2022, followed closely by
Ecuador and Mexico.\2\ Nicaragua, Venezuela, and Haiti have the
greatest underreporting of deaths.\2\ Table 1 provides the number of
reported cases and deaths and the projected deaths per country or
territory.
Mortality among males has been greater than among females.\3\
However, not included in these statistics are the thousands--including
women of reproductive age, adolescents, and children--who are estimated
to have died due to the disruption of essential health services, the
decrease in the use of these services for fear of acquiring COVID-19,
and other indirect effects of lockdown-related measures that affect
women disproportionately.\4\ \5\ \6\ Several studies have found a
higher prevalence of COVID-19 infection among indigenous,
Afrodescendant, and migrant populations compared to other groups and
among those in the lower socioeconomic positions, further increasing
health equity gaps in the region.\7\ \8\ \9\
In Latin America and the Caribbean, in 2020, the pandemic caused
the worse economic contraction in more than a century.\9\ The sharp
increase in unemployment and loss of income has particularly affected
informal workers, deepening social and economic inequalities and
increasing poverty.\10\ \11\
Governments have allocated resources to strengthen the capacity of
the health sector to face the pandemic.\12\ Still, the response has
been insufficient in most of the region due to the chronic underfunding
and pre-existing weaknesses of public health systems. In most
countries, segmentation between public services, social security
services, and private medicine, the concentration of human resources
and medical technology in some urban hospitals, the under-financing of
primary health care (PHC) and epidemiological surveillance, and the
lack of articulation between the different levels of care have weakened
the coordinated actions of the national response.\5\ \10\
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Institute for Health Metrics and Evaluation, COVID-19
Projections (https://covid19.healthdata.org/global?view=cumulative-
deaths&tab=trend), 2021.\2\
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: World Health Organization, Coronavirus Dashboard (https://
covid19.who.int/), 2021; \1\ Institute for Health Metrics and
Evaluation, COVID-19 Projections (https://covid19.healthdata.org/
global?view=cumulative-deaths&tab=trend), 2021.\2\
Note: n/a = not available.
The underfunding of scientific and technological research and
development in most Latin American and Caribbean countries is at the
root of the limited capacity to develop novel vaccines in the region.
Despite the existence of a regional vaccine procurement mechanism since
1979--the Pan American Health Organization's Revolving Fund for Vaccine
Procurement \13\--most countries negotiated access to COVID-19 vaccines
in 2020 through bilateral agreements with vaccine developers from the
United States, Europe, Russia, and China.\14\ At the same time, most
also participated in the COVID-19 Vaccines Global Access (COVAX)
facility, whose procurement agent in the Americas is the Revolving
Fund.\15\ As a result, the roll-out of vaccines in the region has been
highly uneven. Table 2 shows the COVID-19 vaccination coverage as of
November 12, 2021. Although half of the population in the region is
fully vaccinated, large differences exist between countries.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Pan American Health Organization, COVID-19 Vaccination in the
Americas (https://ais.paho.org/imm/IM_DosisAdmin-Vacunacion.asp),
2021.\16\
The inequity behind the distribution of COVID vaccines in Latin
American and the Caribbean is primarily explained by the type of
participation in the COVAX mechanism, which has been severely affected
by the concentration of doses in high-income countries and the
interruption of vaccine exports from the largest manufacturer of
vaccines, located in India.\9\ As of November 12, 2021, among the 10
countries that participate as donor-dependant--Bolivia, Dominica, El
Salvador, Guyana, Grenada, Haiti, Honduras, Nicaragua, Saint Lucia, and
Saint Vincent and the Grenadines--, 26.1 percent of the population is
fully vaccinated. Coverage ranges from less than 1 percent in Haiti to
60.8 percent in El Salvador, shown in Figure 2.\16\ On the other hand,
among the self-financing participants in COVAX--Antigua and Barbuda,
Argentina, Bahamas, Barbados, Belize, Brazil, Chile, Colombia, Costa
Rica, Dominican Republic, Ecuador, Guatemala, Jamaica, Mexico, Panama,
Paraguay, Peru, Saint Kitts and Nevis, Suriname, Trinidad and Tobago,
Uruguay, and Venezuela--, 51.1 percent of the population is fully
vaccinated. Coverage ranges from 15.8 percent in Jamaica to 81.2
percent in Chile.\16\ Cuba, which did not participate in COVAX and is
the only country in the region that has developed its own vaccines, has
fully vaccinated 69.6 percent of its population.\16\
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Source: Pan American Health Organization, COVID-19 Vaccination in the
Americas (https://ais.paho.org/imm/IM_DosisAdmin-Vacunacion.asp),
2021.\16\
The divide reflected by these data can undermine all efforts to
bring the pandemic to an end in the Americas, where the COVID-19
pandemic continues to have a devastating impact in part due to the
uneven deployment of vaccines, the lack of a regional systematic
vaccination strategy, the limited capacity to develop novel vaccines,
and the reliance on imported vaccines. Consequently, in September 2021,
the Community of Latin American and Caribbean States (CELAC) approved
the Plan for self-sufficiency in health matters in Latin America and
the Caribbean,\17\ which includes seven priorities:
1. Strengthen mechanisms for pooled international procurement of
vaccines and essential medicines.
2. Use public procurement mechanisms for medicines to develop
regional markets.
3. Create consortiums for the development and production of
vaccines.
4. Implement a regional clinical trials platform.
5. Take advantage of regulatory flexibilities to gain access to
intellectual property.
6. Strengthen regulatory convergence and recognition mechanisms.
7. Strengthen primary health systems for equitable distribution of
vaccines and universal access to them.
The United States has the opportunity to help support this regional
plan by facilitating technology transfer and the development of
manufacturing capacity for mRNA vaccines, training and qualification of
specialized human resources, the equipment of national and regional
laboratories, and leveraging regional supply chains to help increase
production capacity in a region with a population of 660 million and
insufficient vaccine development.\18\ Latin America and the Caribbean
is a region with research capacity, scientific development, and
technological innovation centers that should be strengthened to
discover and manufacture vaccines.
----------------
Notes
\1\ WHO. Coronavirus Dashboard. Available at: https://
covid19.who.int. Geneva: World Health Organization; 2021.
\2\ IHME. COVID-19 Projections. Available at https://
covid19.healthdata.org. Seattle: University of Washington; 2021.
\3\ PAHO. COVID-19 Health Outcomes by Sex in the Americas. From
January 2020 to January 2021, https://iris.paho.org/handle/10665.2/
53372. Washington, DC: Pan American Health Organization; 2021.
\4\ Castro A. Maternal and child mortality worsens in Latin America
and the Caribbean. Lancet 2020;396:e85.
\5\ Castro A. Challenges posed by the COVID-19 pandemic in the
health of women, children, and adolescents in Latin America and the
Caribbean. UNDP Latin American and the Caribbean, COVID-19 Policy
Documents Series Number 19, September 2020. Available at: https://
www.latinamerica.undp.org/content/rblac/en/home/library/
crisis_prevention_and_recovery/desafios-de-la-pandemia-de-covid-19-en-
la-salud-de-la-mujer--de-.html. New York: United Nations Development
Programme; 2020.
\6\ Villalobos Dintrans P, Maddaleno M, Granizo Roman Y, et al.
Interrupcion de servicios de salud para embarazadas, recien nacidos,
ninos y ninas, adolescentes y mujeres durante la pandemia de COVID-19:
proyecto ISLAC 2020 [Disruption of health services for pregnant women,
newborns, children, adolescents, and women during the COVID-19
pandemic: ISLAC 2020 Project]. Rev Panam Salud Publica 2021;45:e140.
\7\ Coates A, Castro A, Marmot M, Mujica OJ, Eijkemans G, Victora
CG. Just societies: A new vision for health equity in the Americas
after COVID-19. Rev Panam Salud Publica 2020;44:e137.
\8\ Castro MC, Gurzenda S, Macario EM, Franca GVA. Characteristics,
outcomes and risk factors for mortality of 522 167 patients
hospitalised with COVID-19 in Brazil: a retrospective cohort study. BMJ
Open 2021;11:e049089.
\9\ ECLAC, PAHO. The prolongation of the health crisis and its
impact on health, the economy and social development. Available at
https://hdl.handle.net/11362/47302. Santiago, Chile: Economic
Commission for Latin America and the Caribbean; 2021.
\10\ ECLAC, PAHO. Health and the economy: A convergence needed to
address COVID-19 and retake the path of sustainable development in
Latin America and the Caribbean. Available at: https://www.cepal.org/
en/publications/45841-health-and-economy-convergence-needed-address-
covid-19-and-retake-path. Santiago: Economic Commission for Latin
America and the Caribbean and Pan American Health Organization.; 2020.
\11\ ECLAC. Employment Situation in Latin America and the
Caribbean. Employment trends in an unprecedented crisis: policy
challenges. Available at: https://www.cepal.org/en/publications/46309-
employment-situation-latin-america-and-caribbean-employment-trends-
unprecedented. Santiago, Chile: Economic Commission for Latin America
and the Caribbean; 2020.
\12\ ECLAC. Measuring the impact of COVID-19 with a view to
reactivation. Available at: https://www.cepal.org/en/publications/
45477-measuring-impact-covid-19-view-reactivation. Santiago, Chile:
Economic Commission for Latin America and the Caribbean; 2020.
\13\ PAHO. PAHO Revolving Fund, https://www.paho.org/en/
revolvingfund. Washington, DC: Pan American Health Organization.
\14\ Castro A. A Race Against Time: Deploying Vaccines and
Addressing the Disproportionate Impacts of COVID-19 in Latin America
and the Caribbean. Available at Hearing before the Subcommittee on the
Western Hemisphere, Civilian Security, Migration, and International
Economic Policy, May 13. Washington DC: United States Congress; 2021.
\15\ PAHO. COVAX vaccines COVID-19 deliveries in the Americas,
https://app.powerbi.com/
view?r=eyJrIjoiMjA5ZDAxMmEtYTljNC00M2I0LWE5MjUtYWQzZGQxNDc4OThhI
iwidCI6ImU2MTBlNzljLTJlYzAtNGUwZi04YTE0LTFlNGIxMDE1
MTlmNyIsImMiOjR9. Washington, DC: Pan American Health Organization;
2021.
\16\ PAHO. COVID-19 vaccinations in the Americas. Available at:
https://ais.paho.org/imm/IM_DosisAdmin-Vacunacion.asp. Washington, DC:
Pan American Health Organization; 2021.
\17\ ECLAC. Plan for self-sufficiency in health matters in Latin
America and the Caribbean: Lines of action and proposals. Available at
https://repositorio.cepal.org/bitstream/handle/11362/47253/1/
S2100556_en.pdf. Santiago, Chile: Economic Commission for Latin America
and the Caribbean; 2021.
\18\ Saenz R, Castro A. Can Latin America Develop New Ways to
Procure Vaccines? Latin America Advisor 2021;August 11:pp. 4-5.
Senator Kaine. We will move to questions now.
Just to let you know, there is a voting schedule that is a
little bit up in the air. There is no vote called now. That is
great. If there is a vote, you could see us coming and going,
but we will jump right in.
I think we are all on the same page in terms of realizing
the importance of American vaccine diplomacy in the Americas.
They are our neighbors. Travel and family connections and
connections of commerce are intense.
The pandemic has hurt neighboring countries in such a way
that it creates migration pressures that we feel here and our
chief strategic adversary, China, is very engaged in trying to
grab the mantle of leadership in the Americas from the United
States.
All those things are true and, yet, I am puzzled about the
American deployment of vaccines to the region because it does
not seem to match up with the things that I have just stated,
which I think are kind of consensus positions.
We have donated about 49 million vaccines to the region. I
traveled to the region in July. They like the quality of the
American vaccines. They like that there is no strings attached.
They like that they are donated rather than sold, but if I look
overall at what the United States is doing, and I believe we
are the most generous donor of vaccines in the world, but the
percentage of our vaccines that are going into the Americas,
which is disproportionately suffering and disproportionately
connected to us, seems very, very small.
Those decisions are made by a process and, ultimately, made
at the National Security Council, but let me put the
proposition on the table, and I would love to hear you respond
to it, that we should be allocating a percentage of the
American vaccines into the Americas that is more equivalent to
the suffering level in the Americas.
If it is 30 percent of deaths with 8 percent of the
population, I do not think we should be giving 8 percent of
vaccines to the Americas. I think we should be giving
significantly more, both because of the extent of suffering and
because of the direct connection between conditions in the
Americas and conditions here.
What do any of you think of that proposition I put on the
table?
Mr. Runde. Senator, if I may.
We have been very generous, but we could be doing more. I
would propose that we might consider thinking about our health
border going all the way to Panama and prioritizing at least
North America plus Central America in a special way in the
future in terms of future pandemics.
I know that the world is crying out for vaccines, but in
some ways, as I said earlier, in a democracy we are always
going to prioritize Pennsylvania over Paraguay, but if we
consider the entire Western Hemisphere our health border
because microbes do not respect walls, then we would, perhaps,
think differently about how we are allocating vaccines in that
construct. There have been suggestions by serious public health
professionals to do something like that.
So I do think that is something for us to consider. It is
good news that we produce far higher quality vaccines and they
are in demand. I have spoken to a number of embassies in
preparation for this hearing, and a number of countries that
have taken Sinovac, the Chinese vaccines, are adding Pfizer as
boosters because they know what China is offering is not very
good. I could use other words, but I will go with not very
good, Senator.
So I would just say that we have an opportunity to finish
strong. It has been unfortunate that they took advantage of a
tactical window and they have pressed other geostrategic
priorities--Huawei, Taiwan recognition.
A friend of mine who is a prominent political consultant in
the region is friends with the President of Paraguay and he
said, tell your friends in America I am not going to flip to
the mainland, but tell them the Americans are offering me
nothing.
Now, this was at one point. I think we need to think about
we cannot fight something with nothing. So I do think,
ultimately, we are going to have other funny name diseases
happen like clockwork for a whole series of reasons.
So I do not want to sit in my basement again for 18 months
and I do not think anyone else in the Western Hemisphere does,
and so I think we need to prepare differently and one of the
things is we need to have surge capacity to manufacture not
just in the United States but in places.
It could be Uruguay. It could because Costa Rica. We could
partner with Argentina. We could partner with Brazil, but in
the meantime, we have a job to do. We need to finish the job
strong.
Senator Kaine. Mr. Restrepo.
Yes, finish strong. I got that from your testimony. I like
that idea.
Mr. Restrepo.
Then I have a second question for you, Dr. Castro.
Mr. Restrepo. Certainly. Senator, if I may.
I think two things are important here. One is COVID-19
exposed preexisting conditions of all shapes and sizes, one of
which is a lack of strategic attention to the Americas that has
been long-standing by the United States in terms of our
geostrategic balance in the world, and I think this is a result
of kind of hardwired structural biases towards time and
attention to the national security space to other parts of the
world ahead of the Americas.
I think your recommendation is a very solid one, that given
the deep interconnection and the deep strategic interests the
United States does have in the Americas and given the level of
devastation wrought by this pandemic in this region, our
response should be proportionate to that and not proportionate
to our preexisting lack of attention, and, again, over decades.
This is not a preexisting just with this Administration or even
the Administration under which I served.
Senator Kaine. Dr. Castro, you mentioned something in your
testimony that I think is really important and that is U.S.
participation in local manufacturing of vaccines and trying to
play a leadership role there.
The Caribbean and Latin American nations are exploring
that, and I think there is a lot of good that we can do. Even
better than donating would be the U.S. playing a significant
role in the development of local capacity and I am, certainly,
going to urge that on the Administration.
We asked the panel before what the U.S. is doing, and there
was a nice answer, but it was, basically, well, we are thinking
about it. We are kind of talking to them and seeing what we
might be able to do.
We need to be doing better than that because Sinovac is
committed to doing vaccine production in Chile. There is other
local vaccine production initiatives. The U.S. should be using
our innovation and our technical expertise to try to help those
initiatives, and I really appreciate you putting that on the
table.
I have gone over my time and I want to yield now to Senator
Rubio.
Senator Rubio. Thank you. I could probably ask this of the
entire panel. I will start with you, Mr. Runde.
One of the things I am fascinated by, in general, is supply
chains, right, and the fact that our supply chains in this
country are deeply dependent on locations in the Asia Pacific
region for a lot of different reasons.
It strikes me that if we had some of these supply chains,
obviously, in the United States, preferably, but if not in the
U.S. in the Western Hemisphere, it would have a dual purpose.
First, it would create some diversity and, therefore, we
would not see some of the container backlogs and there would be
other ports that would be available to take some of this, and
second, it would solve a lot of the socioeconomic issues in
some of these countries.
In essence, I am not--I know the answer, okay, but I am not
sure--but I imagine a world in which Guatemala, Honduras, El
Salvador, Haiti, were countries that had vibrant manufacturing
sectors, downscale on the production, but that created stable
employment for young people so they would not have to leave
their countries.
I get rule of law and other things of that nature become a
problem in many of these places. In particular, as I look at
Pfizer designating factories in China as the main manufacturer
of vaccines for the greater region that includes Taiwan, you
can only imagine how that would be used, and third, because I
think we are entering an era that I think there is going to
be--the best way to say it is biomedical nationalism.
There are plenty of countries around the world that have
gone through this and said, never again will we not have the
inability to make oxygen, the inability to make PPE, the
inability to make medicine, the inability to manufacture
vaccine and our basic goods because pandemics disrupt supply
chains but so, potentially, can geopolitical conflict.
So in specific and then in general, in specific, why have
we not seen and what can we do to make it more so that places
like Pfizer, Moderna, and other pharmaceutical companies return
or enter the Western Hemisphere as a place to manufacture?
Obviously, it is a U.S. territory, but Puerto Rico is a
logical place and it is one that I deeply believe that we
should reinstate and everything we can in tax policy. What more
can we do to encourage that, specifically when it comes to the
pandemic and then, more broadly, in general in the region on
other topics?
I know these countries have to do a lot, but what can we do
to make the region more attractive in both the short and long
term for this?
I will start with you, Mr. Runde, but I open it up to the
whole panel.
Mr. Runde. Thank you, Senator. This is one of the key
questions of the COVID pandemic. I have done 1,500 Zoom calls
since March 12, 2020, and so have you, Senator, and one of my
deep thoughts is that we are going to get a partial economic
divorce from China.
Maybe they can visit with their spouse and come--they can
bring their new spouse to Thanksgiving and maybe we can sit
together at graduation for the kids, but we are going to have a
very different kind of relationship with mainland China, going
forward. So I think that is--I will not call it the silver
lining, but perhaps it is a----
Senator Rubio. By the way, that is not just us.
Mr. Runde. Yes. Oh, everybody.
Senator Rubio. Everyone in the world.
Mr. Runde. I think everyone is going to get a partial
economic divorce from China.
Senator Rubio. China plus one. Yes, they are going to look
for some----
Mr. Runde. Yes. China--right. They can bring--right, to the
blended family a holiday picture. You get the idea, Senator.
I think--the point is, is I think that there are a number
of steps at--we are going to move from a just in time supply
chain world to a just in case supply chain world.
I do not think anybody in this room ever wants to depend on
mainland China ever again for PPEs, pills, ventilators. When
they started making threats about we are going to cut you off,
those are fighting words. So I think that was a wakeup call.
So I think there are several things we could do
specifically and you, the senators, could do. Ecuador wants a
free trade agreement. We ought to do it.
Uruguay wants a free trade agreement. We ought to do it.
Brazil would like a free trade agreement. We ought to do it. We
ought to also fulfill the promise of CAFTA-DR. We have not
fully seen that happen.
I think we have an opportunity to some of the Americas to
put some concrete things on the table. So I think one of the
opportunities will be to ask the Biden-Harris administration
what are you doing in the aspects of trade to enable some of
these things.
I also think we ought to be using our foreign aid to grease
the skids of some of these shifts in global supply chains.
Japan is doing this. They are providing a billion dollars to
have Japanese companies move their factories from mainland
China to, say, Southeast Asia.
In theory, Mexico and Central America and the Caribbean
could be--and Colombia and Brazil could be net winners of sort
of these global shifts in supply chains.
So some of it are trade agreements. Some of it is about
foreign aid. I think we ought to continue to have a
constructive dialogue with the Government of Mexico. I think,
in theory, Mexico ought to be a net winner of some of these
shifts in global supply chains.
Then finally, on Puerto Rico, I absolutely agree with you,
Senator. We ought to revisit some of those tax agreements that,
I guess, went away in the 1990s. We ought to look at that. I
know Governor Fortuno is someone who is very knowledgeable
about these issues and would be someone who I would be
consulting about the details of that.
I think you put your finger on something very important,
Senator. Thank you.
Dr. Castro. Senator Rubio, helping Latin American and
Caribbean countries strengthen their manufacturing capacity and
helping transfer mRNA technology, which definitely the mRNA
vaccines are the superior vaccines, and those are U.S.--the
U.S. Government can do so much to facilitate that technology
transfer from Pfizer and Moderna.
Those--strengthening also local laboratories could have a
great impact for the current pandemic and also for preparedness
for future pandemics, and definitely would answer a lot of your
concerns regarding the lack of employment opportunities and all
the factors that trigger migration to the United States.
So, definitely, strengthening the local production,
strengthening public health systems, and because what has
happened throughout the region in most countries, not in all,
is that essential health services have been disrupted because
of the covidization, as they say in Latin America, la
covidizacion, and of the health systems.
So everything else--for example, people give birth every
day and a lot of women have been unable to give birth in a good
quality setting because of the way that COVID has overtaken a
lot of their health services.
So definitely strengthening local capacity to be able to
respond better now and in the future is the best thing that the
United States Government can do. Thank you.
Senator Kaine. I have one additional question that I would
like to just put on the table. Senator Rubio, thank you. This
is an important hearing and I think you have given us a lot we
want to follow up on.
Here is my last question. Without repeating anything you
have already said, for example, in your opening testimony, if
the White House were to call you tomorrow and say, hey, the
Summit for the Americas, the primary focus of it is going to be
public health--and that is in fact the case--so what should the
United States be putting on the table at that summit in terms
of a commitment in the public health space to deal with this
covidizacion and the next chapter? What would your advice to
the White House in prepping for the Summit for the Americas be?
Dr. Castro. Well, certainly, getting prepared--thank you--
getting prepared for the next epidemic. Hopefully, we do not
have another pandemic, but there will be----
Senator Kaine. Yes.
Dr. Castro. --and we need to look into the future because
the present has been so dire with the crisis that COVID has
created throughout the entire--all of the Americas and
strengthening health systems and looking at the future and
improve the ties between the United States and the region could
be what I would, certainly, hope that is discussed at the
Summit.
Thank you.
Senator Kaine. Mr. Restrepo.
Mr. Restrepo. Senator, along those lines, the--we have an
antiquated set of inter-American institutions, right. The
inter-American institutions were built primarily in the
forties, they were revamped in the sixties, and they correspond
to issues of the forties and the sixties much more than they do
to the dawn or--not even the dawn of the 21st century, and one
of these areas is public health and pandemic response.
There is an interesting model to build off in terms of
pandemic response mechanisms in North America that can be--
through the North American Leaders Summit several summits ago
that is being held again today here in Washington, to build off
of that platform to be ready for the next one and to be--and to
deepen public health cooperation in the region.
PAHO is an organization with its challenges and it needs to
be modernized and brought so it is a more effective mechanism
within the inter-American system to deal with very much 21st
century challenges.
Unfortunately, none of us want to be relegated to our
basements. I think all of us are going to be facing future
pandemics and we need the international infrastructure in place
now, and the Summit of the Americas provides a very good
opportunity to begin the work of building that architecture.
Senator Kaine. Thank you.
Mr. Runde, finally.
Mr. Runde. Thank you. There has been more digital payments,
digital commerce, and distance learning in the last 80 weeks
than in the last 80 years. So one of the things is thinking
about how--and it has not just been in Fairfax County, but it
has been all over the Western Hemisphere.
So the digital pipes of the future should not be Huawei and
ZTE. It ought to be somebody other than that. So one of the
things we ought to have at the Summit of the Americas is
digitize the hemisphere and make sure that it is the good stuff
and it is not mainland Chinese digital.
Second, I think we need to get real about a capital
increase for the Inter-American Development Bank. I understand
what the issues are and there is some hesitancy in the
Administration and some folks in the Congress about this.
Frankly, the main solution--collective action vehicle for
the Americas is the Inter-American Development Bank. I believe
it is going to be very difficult for those who dislike the
current president of the Inter-American Development Bank to
dislodge him. So we should work with him.
So my view is we should announce at the Summit of the
Americas a capital increase and as part of it we should say we
are going to make Taiwan a member, we are going to add
Australia and the Quad as members of the Inter-American
Development Bank and as part of the ask we are going to say we
want to use some of that money to help set up new manufacturing
capacities for vaccines in places like Costa Rica and Uruguay
and put that on steroids.
I would also use some of that money for things like early
warning systems. So that would be another thing I would be
asking for. So digital--a capital increase for the IDB. I have
said, finish the job on vaccines, early warning systems.
On PAHO and the WHO, the WHO was born in the mid-1940s and
in some ways born in sin because we had set up PAHO 50 years
before and was sort of the--it is a very well regarded
organization in the hemisphere, PAHO. It has got some
understandable criticisms here in the Senate and the Congress
about some of its relations with Cuba, but overall, it is a
very good organization. However, we get to pick the head of
PAHO and we did not want to stop picking the head of PAHO. So
when we set up the WHO, the WHO head is sort of like the Holy
Roman Emperor.
It is neither holy nor Roman nor an emperor, and so they do
not get to pick the head of PAHO. So we said, well, we will set
up a whole bunch of PAHOs in Asia and Africa and the Middle
East.
So it is the same model. The regional folks get to pick. So
the one employee of PAHO who is an employee of WHO is the head
of PAHO. So it creates all sorts of weird distortions, and I
think one of the problems with this pandemic and perhaps in
Ebola as well in Africa was that the regional heads are very
responsive and sometimes, perhaps, too responsive to regional
folks.
So I think one of the problems with the WHO is they took
too darn long to go to, you know, DEFCON 5 in terms of this
pandemic. I would disagree with the Administration's decision
to re-up the head of WHO. I thought we ought to find--and there
are plenty of other excellent candidates in Africa. We could
have gone to the African Union and said we could find somebody
else.
So, anyway, so I think one of the things at the Summit of
the Americas would be to look at this issue of the PAHO and the
WHO relationship because I think anyone who has looked at it
seriously will say it is a screwy arrangement that has been--
that ought to be looked at.
Senator Kaine. Well, I want to thank the witnesses for your
work and for being here today and your testimony. I am going to
ask colleagues if they would like to submit questions for the
record to try to do that by--let us see, today is Thursday, so
we will say by the close of business tomorrow, Friday, November
19, and I would ask that members submit those questions and if
there are questions that are directed to any of you we would
appreciate prompt and thorough responses.
Again, we thank you for your willingness to appear today,
your public service. You have given us a lot to think about and
a lot to follow up on.
With that, the hearing is adjourned.
[Whereupon, at 11:22 a.m., the hearing was adjourned.]
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