Thirty-one countries around the globe have reserved more COVID-19 vaccine per capita than the U.S., according to a Bloomberg analysis of country vaccine agreements.

The U.S. Operation Warp Speed program is credited with shaving years off the typical development timeline for vaccines that are now on the brink of being deployed. But after leading that effort, the U.S. has yet to exercise some options to lock down additional supplies that could offer extra insurance against manufacturing problems or scientific delays.

Bloomberg has reviewed more than 80 agreements between vaccine makers and countries around the globe to reserve allocations while they are still in development. Canada, the U.K. and Australia top the list, with enough vaccine doses reserved to cover their populations several times over. 

The U.S., meanwhile, ranks 32nd in per-capita vaccine reservations. It is behind the 27 European Union countries that banded together to pre-order vaccines in larger quantities, and sandwiched between Chile and Japan in 31st and 33rd, respectively, according to Bloomberg’s analysis.

“On any dimension you want to talk about, it's a shocking abdication of government responsibility,” said Craig Garthwaite, the Director of the Program on Healthcare at Northwestern University’s Kellogg School of Management. “I’m so demoralized this will delay by another month or two getting the economy going.”

Those worries are not abstract. Pfizer Inc., which makes the first vaccine expected to be cleared for use in the U.S., earlier this year reduced its near-term production targets. Another leading shot from AstraZeneca Plc is expected to require additional study in the U.S. to confirm its effectiveness — delaying access to the inoculation.

U.S. officials have sharply disagreed with the idea that there will be any delay for most Americans to get the shots by the middle of next year and have said they are in talks to expand supply under the agreements. 

“Operation Warp Speed signed contracts over the past several months with six companies with options for up to a total of three billion vaccine doses,” a spokesman for the Department of Health and Human Services said in an emailed statement. “We are confident that we will meet our goal to have enough vaccine doses for any American who wants one in the second quarter of 2021. We disagree with any analysis that suggests that we might not reach that goal.”

Bloomberg’s review looks at deals between countries and manufacturers and favors agreements with a confirmed purchase size over add-on options that have yet to be exercised. Other analyses have reached different conclusions: The London-based research firm Airfinity Ltd. has projected that the EU would have enough vaccines to cover two-thirds of its population by September, four months later than the U.S.

The U.S. has deals with Pfizer and Moderna Inc., the two companies closest to getting their shots approved by regulators here. But while the U.S. locked up a deal with Pfizer to buy 100 million doses of vaccine for its population of about 330 million, the EU pre-bought 200 million doses for its about 450 million people. The EU also outpaced the U.S. in acquisitions from Johnson & Johnson and a vaccine being developed by Sanofi and GlaxoSmithKline Plc.

The Moderna shot is the only one for which the U.S. has made a bigger allotment, with 100 million doses versus the EU’s 80 million. Together with the Pfizer shot, it’s enough for the U.S. to theoretically vaccinate 100 million Americans. Pre-purchases are not the only factor in getting access to vaccines. Also crucial is a company's ability to deliver what it promises to a given market. 

Pfizer Disagreement

On Tuesday, a Pfizer board member said that the U.S. government had about a month ago been offered 100 million more doses that could be delivered in the spring, but declined. 

“Pfizer did offer an additional allotment,” said Scott Gottlieb, who sits on Pfizer’s board of directors and is the Trump administration’s former Food and Drug Administration commissioner, said on CNBC Tuesday.

Gottlieb said the company made multiple offers, as recently as about a month ago when the company said it had shown the shot was highly effective. But the Trump administration declined.

“So Pfizer has gone ahead and entered into agreements with other countries to sell them some of that vaccine” instead, Gottlieb said. 

The Department of Health and Human Services said that description of events was incorrect and that the U.S. was negotiating with Pfizer for more doses.

“At no time did OWS turn down an offer from Pfizer for any number of millions of doses having a firm delivery date and quantity,” the department said on its Twitter account. 

The U.S. deal with Pfizer has an option to buy as many as 500 million more doses, but any add-on has to be negotiated separately from the original agreement, Pfizer has said. Health and Human Services Secretary Alex Azar said on CNN Wednesday that the U.S. had not made the additional purchase in part because it wasn’t yet certain when Pfizer could actually deliver the shots. 

“We have over the last couple of months been working with Pfizer to secure their commitment and agreement to deliver additional doses under our options by a date certain, we’re very optimistic that will happen,” Azar said.

Later Wednesday, Azar said the government was “actively in discussions with Pfizer, as we are with Moderna and others, about expanding our acquisition of production capacity, and I have made clear we’ll use every power that the Defense Production Act gives the president and myself to ensure Americans get what they want and need.”

The U.S. deal with Moderna is for 100 million doses, with an option to buy 400 million more — but the U.S. has yet to exercise that clause. Moderna has said it would take until around April to start delivering doses under the option.

Garthwaite, the Northwestern professor, said a delay in vaccine access would likely lead to more deaths. Since the pandemic began at the start of the year, more than 286,000 American have died, and deaths have hit new records in recent weeks as the outbreak has intensified. 

"There's got to be more to this story,” Garthwaite said of the lack of a deal for more doses from Pfizer. “It can't be this stupid.”

Countries have been buying up rights to multiple shots as an insurance policy against vaccines that might fail in clinical trials or not be produced in enough quantity to meet immediate needs. 

AstraZeneca’s initial clinical results were mixed, and further study may be required for approval by the FDA. Johnson & Johnson in November started a new study of 30,000 people using a new dosing regimen in case its primary study fails. Novavax, a small biotech company, has never brought a product to market. 

And history is filled with cautionary tales. During the autumn wave of the 2009 swine flu pandemic, vaccines arrived in a trickle — months later than expected. Those delays would have been catastrophic if the virus had proven to be as deadly as COVID-19. More recently, manufacturing issues led Pfizer to cut its 2020 delivery target by half, to the current amount.

President-elect Joe Biden said Tuesday the U.S. should quickly buy more doses. 

“We also need the Trump administration to act now to purchase the doses it has negotiated with Pfizer and Moderna and to work swiftly to scale manufacturing for the U.S. population and the world,” Biden said.