Chelsea Clinton in 2019

Once a White House resident, Chelsea Clinton is now a professor of health policy at Columbia University in New York.Credit: Jeenah Moon/Reuters/Alamy

Chelsea Clinton typically maintains a low public profile. But lately, she’s using various platforms to decry the lack of COVID-19 vaccines in low- and middle-income countries while wealthy nations are stockpiling jabs and considering third doses. She’s leveraging her background in public health, as well as a lifetime of political connections, to implore world leaders to ramp up vaccine supplies so that everyone can get one.

Before becoming a professor of health policy at the Columbia Mailman School of Public Health in New York City, Clinton had a ringside view of Washington DC politics growing up beside her parents, former US president Bill Clinton and Hillary Clinton, a former senator and secretary of state who was also the 2016 Democratic Party presidential nominee. Chelsea Clinton's graduate work in international relations and public health has also served her in her position as vice-chair of the Clinton Foundation, which aims to bolster public health and economic development in the United States and about three dozen other countries. At a time when politics and economics are swaying the direction of the pandemic as much as science is, Clinton feels prepared to speak about vaccines — the tools she thinks are central to ending the COVID-19 crisis.

Nature spoke to Clinton about her career path, vaccine hesitancy, and the need to make and distribute shots around the world.

After an upbringing in politics, what led you to public health?

My first real interest in public health began around three decades ago, when [basketball player] Magic Johnson gave his courageous speech about being HIV-positive. And when my family moved to Washington DC, I was lucky to have a theatre teacher who did a lot of work with an HIV-positive theatre group. Through that group, I was introduced to the gross inequities around who had access to health care. I started to feel that my father, president at the time, wasn’t doing enough around HIV and AIDS. I remember being at an Easter church service when [the AIDS activist group] ACT-UP barged in to shout at my father — and I thought it was appropriate, because I agreed with them.

When my father left the White House in 2001, I hoped he would devote energy to this. And he did, by helping to found the Clinton HIV/AIDS Initiative, which became the Clinton Health Access Initiative. I was in college then, and right after, I went to graduate school and wrote my master’s thesis on the Global Fund [to Fight AIDS, Tuberculosis and Malaria], and why the world needed a new instrument to help finance prevention and treatment.

You have been advocating for COVID-19 vaccine equity. Are you relieved that the US government has donated shots to more than 60 countries?

I'm incredibly grateful that we've donated 110 million doses of a vaccine, yet it is deeply insufficient given the needs. I hope that we will accelerate the donations to the full 500 million doses that [US President Joe Biden’s] administration committed to earlier. But even then, as many others have pointed out, we cannot donate our way out of this.

That’s why I continue to advocate for the Biden administration to push pharmaceutical companies to license their technologies to the many facilities around the world that could begin to make the vaccines. I hope that the administration will see this not only as the morally right thing for the American government to do, but also as what’s in our best interest to ensure that we’re protecting American lives and livelihoods. We cannot move forward in a durable, sustainable way until we minimize the risk of future variants, which will happen only when we vaccinate the world.

In May, Biden backed proposals asking the World Trade Organization (WTO) to issue waivers on COVID-19 vaccine patents. What is the status of that?

Last I heard, the head of the WTO set an early-December deadline for an agreement on the TRIPS waiver [which would temporarily override the Trade-Related Intellectual Property Rights agreement protecting the organization’s members]. That’s four months away. I worry that our response doesn't match the urgency of the moment. We can't continue to dither. Donations are not a scalable strategy. And that is why I and many others are calling for not only broad-based IP [intellectual property] and the sharing of technical know-how, but also real investment to help ensure that people everywhere can be vaccinated. I think, at some point, we will wind up there. But it’s very painful for me to think about how many lives will be lost between that point and where we are today.

I hope that, somehow, there will be another path out of this, but I don’t see one outside of enabling significantly more vaccines to be produced in significantly more places, with continued funding to ensure that the vaccines can be produced, that their quality can be assured and that they can be distributed to countries and get into arms.

Is there any alternative to a TRIPS waiver?

Right now, [German chancellor] Angela Merkel seems to be strongly opposed to the TRIPS waiver, but if she still wanted Germany to help vaccinate the world she could compel [German biotech firm] BioNTech to license its patents and vaccine technology so that other manufacturers could step in. The German government gave meaningful research grants to BioNTech that helped them to develop the mRNA technology in their vaccine, which they immediately licensed to Pfizer [a pharmaceutical company based in New York City]. But BioNTech retains marketing and distribution rights for the vaccine in Germany and Turkey.

The United States could compel Moderna [a biotech firm in Cambridge, Massachusetts] to do much the same because the government funded much of their vaccine’s development. The NIH [US National Institutes of Health] even owns some of those patents. Besides this being the moral and smart thing to do, it could restore our standing in the world. Multiple surveys indicated a steep decline in how the United States and Americans were perceived during [former president] Donald Trump’s administration. It would seem that there would be no better way to declare that the United States is a leader, and is committed to dignity, solidarity and to global health, than by facilitating access to vaccines around the world. As an American, this is very much what I would hope my country will do, and I also think that it would be good for the global economy and global security, and vital to public health.

Are you concerned about the lack of vaccine uptake within the United States?

Very much. At the Clinton Foundation, we've been working with schools, community organizations and faith leaders to help ensure that people have the information on vaccines that they need to be able to make the choice to get themselves vaccinated. I’ve actually been involved in the push-back against the anti-vaccine movement for many years. I’m ashamed to admit that I wasn’t attuned to how potent it was until I was pregnant with my first child in 2014. I had a woman stop me as I was walking through my local park and say, ‘Please tell me you're not going to vaccinate your child.’ I told her that I certainly would because vaccines will protect my child, but I was taken aback by the vehemence of her responses and the depth of her belief that I was wrong. That prompted me to try to better understand the origins of the anti-vaccine movement in this country, and to support efforts that push back against it.

Do you think an anti-science movement in the United States has grown in the past few decades?

Although there were very intense political debates in the 1980s and early 1990s, we didn’t have the broad-based politicization of science, and the kinds of attack against scientists and the scientific method, that we have today. I disagreed with [former president Ronald] Reagan and his administration on many things, but he led the effort against [ozone-depleting] chlorofluorocarbons, and led the effort to end the scourge of acid rain. In the early 1990s, the American public overwhelmingly listened when scientists warned that humans were contributing to global warming. But in the mid-1990s, [conservative media outlet] Fox News started, as well as organized efforts to create think tanks to churn out papers that spurred doubt by questioning the science behind climate change. Today, we are in a radically different context than when I was a kid. A large portion of the public doubts the scientific method, and even demonizes scientists themselves.

How would you remedy the anti-science situation?

I think we need to help scientists better articulate what they do, how they know what they do, and what they don’t know and are still querying. For so long, I think many scientists have just felt like the data speak for themselves, but oftentimes people will pay a lot more attention to a personal testimony than to a chart — even if it’s the coolest infographic ever.

I also think we need to lift up people that we sometimes disagree with. Right now, the governor of Arkansas is trying to overturn legislation — that he supported only a few weeks ago — that bans mask mandates. Arkansas public schools start up in a couple of weeks, and he wants school authorities to be able to mandate masks if they want to. I think we need to recognize leaders when they reverse course to be more responsive to what public-health authorities say is necessary to protect people.