[Ip-health] Washington Post: Moderna agreed to ‘equitable access’ for its coronavirus vaccine, but most of its doses are going to wealthy countries

Thiru Balasubramaniam thiru at keionline.org
Mon Feb 22 07:24:41 PST 2021

Moderna agreed to ‘equitable access’ for its coronavirus vaccine, but most
of its doses are going to wealthy countries

By Emily Rauhala

Feb. 13, 2021 at 9:00 a.m. EST


In January 2020, a nonprofit with a mission to develop and equitably
distribute vaccines invested $900,000 in a

promising but untested bit of technology: Moderna’s coronavirus vaccine.

Announcing the grant, the Coalition for Epidemic Preparedness Innovations
(CEPI) touted an alignment of values,

namely a shared commitment to global public health. Documents suggest
U.S.-based Moderna agreed to uphold the

group’s “equitable access principles” — the idea that vaccines should be
distributed according to need and at affordable


But more than year later, with the pandemic still raging, Moderna’s
successful vaccine is anything but accessible. The

company has sold most of the early doses to rich countries. Poorer
countries have been almost entirely shut out.

Moderna “seems to have refused to allocate or sell any of their supply
beyond the wealthiest countries, the most

profitable markets,” said Suerie Moon, co-director of the Global Health
Center at the Graduate Institute of

International and Development Studies in Geneva.

Asked about the $900,000 grant, equitable access provisions and calls to
make the Moderna vaccine widely available,

company spokeswoman Colleen Hussey referred The Washington Post to a more
than three-month-old news release

about third quarter financial results, which noted that discussions with
Covax — an initiative to equitably distribute

vaccines around the world — were “ongoing.”

Moderna is certainly not the only coronavirus vaccine maker to enter into
deals with rich countries. Just 16 percent of

the world’s population have snapped up 60 percent of doses, according to an
estimate from researchers at Duke


But Moderna’s record stands out because none of its doses are yet earmarked
for what the World Bank classifies as

low-income nations.

Most of its competitors — Pfizer, AstraZeneca, Sanofi and Johnson & Johnson
— have already made commitments to

Covax, an effort co-led by its early backer, CEPI, as well as the World
Health Organization and Gavi, the Vaccine


CEPI said it is still in talks with Moderna about supplying Covax but did
not provide details on where things stand. The

WHO, which co-leads Covax and advocates for vaccine access, referred The
Post to Gavi, which referred The Post to


Moderna, meanwhile, is selling the vast majority of its early doses to
high-income buyers, including the United States,

the European Union and Canada, where immunization campaigns are already

It is also working with the Philippines, a lower-middle-income country, and
with upper-middle-income countries such

as Colombia and potentially Mexico, according to tracking by researchers at
Duke University and Airfinity, a research

firm. But because those countries are further back in line, it may take
time for their doses to arrive.

Advocates for global health are frustrated by the disparities.

“It is being rolled out in rich countries even though an institution
committed to equitable access funded it — it’s

outrageous, it’s tragic,” said Zain Rizvi, an expert on access to medicine
at Public Citizen, a watchdog group.

Part of the issue is supply. Wealthy countries could afford to take risks
and cut early deals on unproven technology.

Only some of their vaccine bets have paid off. But as a result, they have
secured a disproportionate share of projected

2021 supply — leaving the rest of the world to wait.

Then there is the problem of price. Along with Pfizer-BioNTech’s offering,
Moderna’s vaccine is among the most

expensive of the multiple vaccines purchased by the United States and by
the E.U. But Pfizer, which has a similar

vaccine on offer, agreed last month to supply Covax with up to 40 million
doses at a “not-for-profit” rate.

Moderna — whose surging stock price has generated wealth for executives and
investors — has yet to announce a

similar plan, despite the role CEPI played in its development.

CEPI’s investment in Moderna came at a critical moment. The deal was
announced Jan. 23, 2020, less than two weeks

after Chinese researchers first posted the novel coronavirus’s genetic
sequence to an online database and a week before

the WHO declared a public health emergency of international concern.

Announcing the deal, Moderna’s chief executive, Stéphane Bancel, thanked
both CEPI and the National Institutes of

Health, which played an important role in the vaccine’s development.

“Advances in global public health require the collective effort of
public-private partnerships,” he said, according to a

news release. “No organization can act alone.”

Rachel Grant, a spokeswoman for CEPI, which is headquartered in Oslo, said
the foundation’s “early stage catalytic

funding of Moderna was critical to get the project off the ground.”

But CEPI and Moderna did not reach an agreement for second-stage funding.
The relationship did not go further,

Grant said, because the company’s funding needs were met elsewhere — by
what would become the Trump

administration’s Operation Warp Speed.

Moderna got multiple infusions from the U.S. government. By December, it
had received $4.1 billion for vaccine

development, clinical trials and manufacturing, according to the Department
of Health and Human Services. On

Thursday, President Biden announced he would be exercising an option to buy
100 million more doses of the Moderna


Unlike China and Russia, which have tried to use potential vaccines to
bolster their soft power abroad, the Trump

White House was singularly focused on domestic supply. President Donald
Trump opted out of Covax, citing his feud

with the WHO.

The Biden administration has tried to patch things up with the Geneva-based
organization, and Secretary of State

Antony Blinken has talked about helping “make sure that others around the
world who want [a vaccine] have access to

it.” Still, the United States remains focused on vaccinating Americans and
has not announced any plans to share,

whether bilaterally or through Covax.

Public health experts have tried to sound the alarm. Scientists warn that
leaving low-income countries waiting for

adequate vaccine supply will prolong the pandemic. Economists caution that
“vaccine nationalism” could cost the

world more than a $1 trillion dollars a year in GDP.

A coalition called the People’s Vaccine Campaign of South Africa recently
called on the U.S. government to push

Moderna, specifically, to make its coronavirus vaccine more accessible
outside the United States.

“The US government helped research and pay for the development of the
NIH-Moderna vaccine, yet, as things stand,

the company Moderna has unilaterally decided that very few nations will
benefit from it,” they said in a release.

“We therefore implore you — enforce your rights in this instance and ensure
that Moderna and other companies

supported by the US government abide by its obligations. Your actions will
undoubtedly help to save millions of lives in

our country and elsewhere in the global South.”

Even while public health organizations call for an end to vaccine
nationalism, some seem wary of pushing the

companies controlling vaccine supply. Advocates wonder why those tasked
with promoting global public health have

not called more forcefully for drug companies to disclose the terms of
their vaccine contracts, for instance, or urged

vaccine makers to transfer know-how to parts of the world in desperate need
of vaccine.

In a recent report on Covax, Public Citizen’s Rizvi urged CEPI to press
Moderna on equitable access. CEPI should

publish its contracts with the drugmaker and publicly push for more
equitable distribution, the report argued.

Asked whether CEPI would do so, Grant said CEPI’s board has full access to
its agreements but that they contain

“detailed confidential and financial information, which is proprietary” and
therefore the organization does not have the

right to publish them in full.

She said some of their agreements are with publicly traded companies who
must file with the U.S. Securities and

Exchange Commission but noted that contracts are often “redacted to protect
technical and business confidential


Covax “remains in active discussions with Moderna regarding the procurement
of the vaccine for global allocation,”

Grant said, “And we hope that they will commit to support our mission to
ensure global equitable access to covid-19

vaccines along with the other manufacturers in the Covax portfolio.

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

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