[Ip-health] New York Times: Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Poor

Thiru Balasubramaniam thiru at keionline.org
Sat Oct 9 10:52:36 PDT 2021

Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Poor


Some poorer countries are paying more and waiting longer for the company’s
vaccine than the wealthy — if they have access at all.

A Moderna Covid-19 vaccination in Nairobi, Kenya, a middle-income country
where the United States has donated doses.Credit...Simon Maina/Agence
France-Presse — Getty Images

By Rebecca Robbins

Oct. 9, 2021

Updated 11:06 a.m. ET

Moderna, whose coronavirus vaccine appears to be the world’s best defense
against Covid-19, has been supplying its shots almost exclusively to
wealthy nations, keeping poorer countries waiting and earning billions in

After developing a breakthrough vaccine with the financial and scientific
support of the U.S. government, Moderna has shipped a greater share of its
doses to wealthy countries than any other vaccine manufacturer, according
to Airfinity, a data firm that tracks vaccine shipments.

About one million doses of Moderna’s vaccine have gone to countries that
the World Bank classifies as low income. By contrast, 8.4 million Pfizer
doses and about 25 million single-shot Johnson & Johnson doses have gone to
those countries.

Of the handful of middle-income countries that have reached deals to buy
Moderna’s shots, most have not yet received any doses, and at least three
have had to pay more than the United States or European Union did,
according to government officials in those countries.


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Thailand and Colombia are paying a premium. Botswana’s doses are late.
Tunisia couldn’t get in touch with Moderna.

Unlike Pfizer, Johnson & Johnson and AstraZeneca, which have diverse
rosters of drugs and other products, Moderna sells only the Covid vaccine.
The Massachusetts company’s future hinges on the commercial success of its

“They are behaving as if they have absolutely no responsibility beyond
maximizing the return on investment,” said Dr. Tom Frieden, a former head
of the Centers for Disease Control and Prevention.

Moderna executives have said that they are doing all they can to make as
many doses as possible as quickly as possible but that their production
capacity remains limited. All of the doses they produce this year are
filling existing orders from governments like the European Union.


Continue reading the main story

Even so, the Biden administration has grown increasingly frustrated with
Moderna for not making its vaccine more available to poorer countries, two
senior administration officials said. The administration has been pressing
Moderna executives to increase production at U.S. plants and to license the
company’s technology to overseas manufacturers that could make doses for
foreign markets.

Moderna is now scrambling to defend itself against accusations that it is
putting a priority on the rich.

On Friday, after The New York Times sent detailed questions about how few
poor countries had been given access to Moderna’s vaccine, the company
announced that it was “currently investing” to increase its output so it
could deliver one billion doses to poorer countries in 2022. The company
also said this past week that it would open a factory in Africa, without
specifying when.

Moderna executives have been talking with the Biden administration about
selling low-cost doses to the federal government, which would donate them
to poorer countries, as Pfizer has agreed to do, the two senior officials
said. The negotiations are continuing.

In an interview on Friday, Moderna’s chief executive, Stéphane Bancel, said
“it is sad” that his company’s vaccine had not reached more people in
poorer countries but that the situation was out of his control.

He said that Moderna tried and failed last year to get governments to kick
in money to expand the company’s scant production capacity and that the
company decides how much to charge based on factors including how many
doses are ordered and how wealthy a country is. (A Moderna spokeswoman
disputed Airfinity’s calculation that the company had provided 900,000
doses to low-income countries, but she didn’t provide an alternate figure.)

Nearly a year after Western countries began sprinting to vaccinate their
populations, the focus in recent months has shifted to the severe vaccine
shortages in many parts of the world. Dozens of poorer countries, mostly in
Africa and the Middle East, had vaccinated less than 10 percent of their
populations as of Sept. 30.

In August, for example, Johnson & Johnson faced rebukes from the director
general of the World Health Organization and public health activists after
The Times reported that doses of that shot produced in South Africa were
being exported to wealthier countries.

The United States wants Moderna to provide more doses for low-income
countries like Uganda, where a Kampala site took registrations for Pfizer’s
vaccine. Credit...Luke Dray/Getty Images

Biden administration officials are especially frustrated with what they see
as Moderna’s lack of cooperation, because the U.S. government has provided
the company with critical assistance.

Scientists at the National Institutes of Health worked with the company to
develop the vaccine. The United States kicked in $1.3 billion for clinical
trials and other research. And in August 2020, the government agreed to
preorder $1.5 billion of the vaccine, guaranteeing that Moderna would have
a market for what was an unproven product.

While clinical trials last year found that the Moderna and Pfizer vaccines
were similarly effective, more recent studies suggest that Moderna’s shot
is superior. It offers longer-lasting protection and is easier to transport
and store.

Moderna’s shot is “essentially the premium vaccine,” said Karen Andersen,
an industry analyst at Morningstar. “They’re in a position where they
probably don’t need to sacrifice too much on pricing in a lot of these

There is limited public information about the deals that Moderna has struck
with individual governments. Of the 22 countries, plus the European Union,
to which Moderna and its distributors have reported selling the shots, none
are low income, and only the Philippines is classified as lower middle
income. (Six are upper middle income.)

Pfizer, by comparison, said it had agreed to sell its vaccine at discounted
prices to 12 upper-middle-income countries, five lower-middle-income
governments and one poor country, Rwanda. (Tunisia, for example, is paying
about $7 per dose.)

Only a handful of governments have disclosed how much they’re paying for
Moderna doses. The United States paid $15 to $16.50 for each shot, on top
of the $1.3 billion the government gave Moderna to develop its vaccine. The
European Union has paid $22.60 to $25.50 for its Moderna doses.

Botswana, Thailand and Colombia, which the World Bank classifies as
upper-middle-income countries, have said they are paying $27 to $30 per
Moderna dose.

The lack of transparency about how much other governments are paying has
put relatively poor countries in a weak bargaining position. They are
“negotiating totally in the dark,” said Kate Elder, who advises Doctors
Without Borders on vaccine policy.

In some cases, Moderna has offered to provide poorer countries the vaccine
at relatively low prices, but only after it has fulfilled other countries’

In May, Moderna offered the African Union doses for about $10 each,
according to a bloc official involved in the discussions. But the doses
wouldn’t be available until next year, causing the talks to fall apart,
according to two African Union officials.

Dr. Ayoade Alakija, who helps run the African Union’s vaccine delivery
program but was not involved in the procurement discussions, said Moderna’s
attitude amounted to: “We’re here to make money. We’ve stumbled upon a good
thing, and we’re not even trying to pretend that we’re trying to save the

Moderna’s Covid vaccine has been transformative for the company and its
leaders. The company has said it expects its vaccine to generate at least
$20 billion in revenue this year, which would make it one of the most
lucrative medical products in history. Ms. Andersen, the Morningstar
analyst, projected that the company’s profits on the vaccine could be as
high as $14 billion. In 2019, Moderna reported total revenue of $60 million.

Moderna’s market value has nearly tripled this year to more than $120
billion. Two of its founders, as well as an early investor, this month made
Forbes magazine’s list of the 400 richest people in the United States.

As the coronavirus spread in early 2020, Moderna raced to design its
vaccine — which uses a new technology known as messenger RNA — and to plan
a safety study. To manufacture the doses for that trial, the company
received $900,000 from the nonprofit Coalition for Epidemic Preparedness

The nonprofit group said Moderna had agreed to its “equitable access
principles.” That meant, according to the coalition, that the vaccine would
be “first available to populations when and where they are needed and at
prices that are affordable to the populations at risk, especially low- and
middle-income countries or to public sector entities that procure on their

Moderna agreed in May to provide up to 34 million vaccine doses this year,
plus up to 466 million doses in 2022, to Covax, the struggling United
Nations-backed program to vaccinate the world’s poor. The company has not
yet shipped any of those doses, according to a Covax spokesman, although
Covax has distributed tens of millions of Moderna doses donated by the
United States.

Mr. Bancel said that many more doses would have gone to Covax this year had
the two parties reached a supply deal in 2020. Aurélia Nguyen, a Covax
official, denied that, saying, “It became clear early on that the best we
could expect was minimal doses in 2021.”

Late last year, the Tunisian government was hoping to order Moderna doses.
Dr. Hechmi Louzir, who led Tunisia’s vaccine procurement efforts, didn’t
know how to contact Moderna to begin talks and asked the U.S. Embassy in
Tunisia for help, he said. Officials there contacted Moderna, he said, but
nothing came of it.

“We were very interested in Moderna,” Dr. Louzir said. “We tried.”

In Thailand, where about 32 percent of people are fully vaccinated, a
government spokeswoman said the government was paying Moderna about $28 per
dose for one million shots that are designated for vulnerable people.
Deliveries from that order will start next year.

In Botswana, the health minister told Parliament in July that the
government had ordered 500,000 shots from Moderna, at nearly $29 per dose —
enough to fully vaccinate about 10 percent of the population. (That would
roughly double the number of Botswanans who are fully vaccinated.) A
spokesman for the Health Ministry said that the doses were expected to
start arriving in August, but that none had yet arrived.

Colombia ordered 10 million shots from Moderna. The government budgeted
about $30 per dose, a price that may include the cost of transportation and
other logistics, according to Finance Ministry documents. The country’s
health minister, Dr. Fernando Ruiz, said Moderna’s vaccine was the most
expensive among the Covid shots that Colombia had ordered.

There were some initial delays, Dr. Ruiz said: The first deliveries,
expected in early June, came in August. About 2.3 million had arrived as of

Reporting was contributed by Noah Weiland, Mitra Taj, Elian Peltier, Jason
Gutierrez, Daniel Politi, Flávia Milhorance and Muktita Suhartono.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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