Now that the United States has made strides in vaccinating Americans against COVID-19, President Biden has said he wants to marshal global resources to stamp out the pandemic in even the world's poorest countries.
It's a goal that will require convincing other wealthy nations to join in the cause. Biden has put an international development veteran at the helm of this diplomatic push: Gayle Smith, an outspoken advocate for reducing global poverty and unnecessary death from disease.
On Monday, Biden announced part of his strategy, a plan for the United States to share a total of 80 million vaccine doses with other countries by the end of June. By the middle of next month, he wants to announce more steps to increase vaccine supply when he meets with other leaders at the G7 summit in the United Kingdom.
"We'll share these vaccines in service of ending the pandemic everywhere," Biden said. "And we will not use our vaccines to secure favors from other countries."
That was a dig at China and Russia which have done far more vaccine diplomacy thus far than the United States, making bilateral deals with developing countries to share and sell vaccines.
Smith, a former director of the U.S. Agency for International Development during the Obama administration, has described the efforts of China and Russia as cynical. She told a Senate Foreign Relations Committee hearing last week that the global response must be more strategic, and she believes the United States must lead it.
"There is no question but that we need a grand plan and the United States needs to be at the forefront of that," Smith said in the hearing. "Frankly, I think that's the difference between bringing this pandemic to an end in 3 or 4 years, or bringing it to an end in a year, 18 months, 2 years."
When a Republican senator asked Smith if a Marshall plan was in order, referring to the U.S. effort to rebuild Europe after World War II, Smith replied: "I think it is worth thinking that boldly."
Biden named Smith as his coordinator for global COVID response and health security at the State Department last month. Until then, she was chief executive of the ONE Campaign, the advocacy group founded by U2 singer Bono, which was among numerous NGOs pushing the Biden administration to commit to sharing more vaccine doses. The groups urged the administration to announce a strategy that emphasized equitable distribution over strategically valuable bilateral deals.
One of her last tweets before entering government was a retweet of an Associated Press article documenting criticism of the administration's slow movement on global vaccine sharing:
"She was very clear about her intentions before she went in," said Tom Hart, who is the ONE Campaign's acting CEO while Smith takes a six-month leave of absence to work at the State Department. "I don't think there could be any question about her desire to move fast and boldly in this position."
The ONE Campaign found the United States has contracts for more than half a billion vaccine doses in excess of what is needed to vaccinate every single American. Hart praised Biden's announcement on Tuesday as a welcome step, while pointing out that so far, less than 1% of COVID-19 vaccine doses globally have been given to people in low-income countries.
Smith, 65, has been immersed in difficult global challenges since the early 1980s. She was a journalist and aid worker when civil war and famine killed more than a million people in Ethiopia and Eritrea. It left an indelible mark on how she views the world, and the need to work toward greater fairness.
"Activist" isn't generally a term used to describe people working inside government. But again and again, that's how people who know her describe Smith. "She is this combination of an activist, a journalist ... and an administrator," said Abby Maxman, chief executive of Oxfam America. "Those are not all things that always go hand in hand."
Since the Clinton administration, Smith has wielded her advocacy both inside and outside of government. Over the years, she has battled other global health crises, including the HIV/AIDS epidemic, the outbreaks of SARS and MERS respiratory illlnesses. And then came Ebola.
In September 2014, the Ebola virus was ravaging West Africa, moving faster than the global efforts to contain it. Smith, then a top official on the National Security Council, made a call to Susan Rice, a long-time friend, who was the national security adviser.
"I remember vividly being with President Obama at the NATO summit in Wales and Gayle calling me late at night ... to talk about what are we going to do about the Ebola epidemic," Rice told NPR.
Smith had come to the conclusion that U.S. efforts, which had involved personnel from the Centers for Disease Control and Prevention and the U.S. Agency for International Development, were falling short.
"It was spiraling out of control and that the tools we had to address it were insufficient to the challenge," said Rice.
So that night, they came up with a solution: bringing in the U.S. military to build field hospitals and distribute supplies, a humanitarian role like it played after the 2010 Haiti earthquake.
But given the fear around Ebola, a deadly and highly contagious disease that caused some victims to bleed from their eyes, it took a lot of persuasion, and careful work of getting everyone including the president and military leadership on board.
Ten days later, Obama went to CDC headquarters to announce that he would send 3,000 U.S. troops to the region. "Our forces are going to bring their expertise in command and control, in logistics, and engineering," Obama explained.
That commitment galvanized other countries to pitch in. Smith was in the Oval Office as Obama called other world leaders asking them to help.
"Up to that point, it was panic and paralysis in the international response to what was happening in West Africa," said Stephen Morrison, senior vice president at the Center for Strategic and International Studies.
"The turning point was getting President Obama mobilized and focused with a game plan, and Gayle was at the center of that thinking."
On her first day on her new job at the State Department last month, Smith said she had learned two lessons during her experience in global health crises: "If the virus is moving faster than we are, it's winning. The second is that with unity of purpose, science, vigilance and leadership, we can outpace any virus."
Her view, shared in Senate testimony last week, is that a vacuum of international leadership and coordination over the past year gave the virus an advantage. "So we are reaching out to countries all over the world, to our key allies and partners to make sure that what we do as we move out more robustly is a coordinated response that therefore can get to some scale."
Smith and her colleagues at the ONE Campaign started using a phrase that has since become ubiquitous, about the risk of variants if COVID is allowed to spread uncontrolled in poorer countries: "None of us are safe until all of us are safe." Biden delivered a variation on that idea in his remarks Monday.
"We know America will never be fully safe until the pandemic that is raging globally is under control," Biden said. "No ocean is wide enough, no wall is high enough to keep us safe."
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