Charges of vaccine hoarding and global protectionism are coloring the debate over our  response to new strains of COVID with vaccinations. The World Health Organization reports so far, only 16% of people in low-income countries have gotten a single vaccine dose. That compares with 80% in some high-income countries. The role vaccinations can play in shortening or ending the pandemic is still critical although COVID fatigue may prevent people from getting their first dose or continuing on to complete the regimen. ‘America first’ has been central to the Biden administration’s vaccination campaign. Now that focus has shifted and there’s more U.S. effort going into producing vaccines for the world. As international organizations work to get shots in arms, the effort continues to face challenges that may well affect our political and medical realities for years to come.