Last week, the New York Times published a letter to the editor by Moderna co-founder and chairman Noubar Afeyan in which he criticized the recent Times headline, "Moderna, Racing for Profits, Keeps Covid Vaccine Out of Reach of Poor." Calling it “biased” and “sensational,” he argued, “Moderna has made great efforts to distribute vaccines throughout the world as fast — and as fairly — as it possibly can.
So has Moderna really done all it possibly can to that end? Let’s look at the facts.
Vaccine Sales and Distribution
According to science analytics firm Airfinity, Moderna has produced and delivered over 442 million doses to date. Where did they end up?
Over 430 million doses went to high-income countries — 97% of the total, a greater share than any other vaccine manufacturer — leaving about 6 million to upper-middle-income countries, 5.5 million to lower-middle-income countries, and zero to low-income countries.
Meanwhile, according to the Times: “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.”
While there’s little transparency around vaccine pricing generally, it’s been reported multiple times over the last 12 months that Moderna’s vaccine, on average, is the most expensive. In August 2020, the company said it would sell at $32 to $37 per dose, significantly higher than other vaccines. (The Pfizer-BioNTech vaccine, in contrast, was going for around $20 per dose last November, according to CNBC.) While the US initially paid $15 to $16.50 per dose, the Times reported that Botswana, Thailand, and Colombia — all upper-middle-income countries — are paying $27 to $30 per dose.
Pharmaceutical companies have discretion around whom they agree to sell doses to, at what price, and when; and they have a corporate responsibility — especially in a historic pandemic — to distribute vaccines equitably and at cost for lower-income countries.
Distribution via COVAX
The global COVID-19 vaccine distribution initiative COVAX was launched in June 2020 and struck its first deal in August 2020 with the Serum Institute of India to access the AstraZeneca and Novavax vaccines. In December, COVAX announced another deal, this one with AstraZeneca directly, as well as a memorandum of understanding with Johnson & Johnson that later became a committed purchase agreement.
In January 2021, COVAX announced an agreement with Pfizer (albeit for only 40 million doses). Then in the months following, COVAX received and distributed the first doses from these agreements, including to the poorest countries (and even more would have flowed if India, facing a crisis, had not banned exports back in the spring).
It was not until May 2021 that Moderna agreed to a deal with COVAX, at that point the last major vaccine manufacturer to do so. However, Global Citizen criticized the deal, which was presented as being for 500 million doses despite the fact only 34 million doses were to be provided in late 2021 and the rest not coming until 2022.
According to the Times report, Moderna CEO Stéphane 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.”
It was also around that same point, the Times reported, that the African Union was negotiating with Moderna, but the talks fell apart because Moderna could not provide doses before 2022; as shown in its distribution numbers to date, the doses had nearly all been allocated to high-income countries.
As of yet, Moderna has still not provided a single dose directly to COVAX as part of its purchase order, or confirmed when deliveries will begin.
Sharing Technology to Increase Vaccine Supply and Access
In a recent open letter, Bancel wrote, “From the beginning our goal has been to help protect as many people as possible around the globe ... As a small company, we are still limited in our capacity to help and focused on scaling our manufacturing.”
Moderna may have been a small company before the pandemic, but it’s certainly not now. In its second quarterly earnings report for 2021, Moderna projected vaccine sales this year to reach around $20 billion. According to a recent report from Amnesty International, higher prices mean it will earn over $47 billion by the end of 2022.
This puts the Moderna vaccine in the company of the highest selling medical products last year, and it has vaulted two of its founders, including Afeyan, as well as an early investor into the Forbes 400 list of the richest people in the US.
Should a company of such value be “limited in our capacity to help” and therefore have no choice but to remain “focused on scaling our manufacturing”?
So far, Moderna has only transferred its technology — the process of licensing and training another manufacturer to make the product — to a limited number of partners in North America, Europe, and South Korea, toward creating its own exclusive manufacturing network.
That’s why Global Citizen and other organizations have been calling on Moderna to transfer its technology non-exclusively to manufacturers in developing countries, especially through Africa’s mRNA technology transfer hub. The hub aims to expand the continent’s vaccine access, and companies like Moderna would still benefit financially through royalties if they participated.
Yet Moderna so far has not taken that step, leaving the hub to try and reverse-engineer its vaccine, which could take years. Instead, amid the recent public pressure, Moderna announced plans to build its own mRNA vaccine production plant somewhere in Africa (they did not specify a country) within two to four years. But action is needed now, and the hub and other initiatives like the World Health Organization’s COVID-19 Technology Access Pool provide immediate pathways to help address the current crisis.
As Dr. Tom Frieden, a former head of the US Centers for Disease Control and Prevention, pointed out, in 2020, it only took Moderna six months to transfer technology to Lonza, a Swiss company in its manufacturing network, and should take less time now.
Martin Friede, the leading World Health Organization official working with the Africa mRNA hub, said this type of plant would have limited impact because it won't be a teaching center.
"But also — and this is very important," he added, "we need to make sure that it is owned by the Africans, and that the Africans are empowered." Otherwise there's no guarantee that in the event of another global supply crunch, the doses wouldn't be shipped to the US or Europe.
But Afeyan says Moderna has no plans to share its vaccine recipe because, per the company’s own determination, “the most reliable way to make high-quality vaccines in an efficient way is going to be if we make them.”
The US government wants Moderna to increase its own manufacturing and transfer its technology to others. According to the Times, the Biden administration has been pressing Moderna to license its technology to manufacturers that could make doses for foreign markets, emphasizing the $10 billion in taxpayer money Moderna received from the US government to support research and development, clinical trials, at-risk manufacturing, and advance purchase. The US government also co-developed the vaccine through the National Institutes of Health and owns a key patent in the formula.
Dr. David Kessler, the Biden administration’s chief science officer for the COVID-19 response, said to MSNBC’s Rachel Maddow: “We need Moderna to provide substantial doses at not-for-profit price to low-income countries. We need them to do it now. And we need the companies to create manufacturing capacity in Africa. Having real manufacturing capacity on the African continent will make a real difference in access for many people who do not have access to these vaccines.”
It’s fair to ask why a company that's accumulated massive wealth and has the capacity to develop a number of other new vaccines can’t also find the capacity to share its COVID-19 technology to help meet the global need.
In Moderna CEO Stéphane Bancel’s open letter, he recalled Moderna’s announcement in October 2020 that it would not enforce its COVID-19 related patents during the pandemic, adding, “we never wanted our patents to be a barrier to others bringing forward mRNA vaccines.”
In reference to that, co-founder and chairman Noubar Afeyan told the Associated Press, “We didn’t have to do that ... We think that was the responsible thing to do ... We want that to be helping the world.”
It hasn’t been.
To illustrate, imagine Bancel’s statement above were reversed positively, in a way that would have helped by focusing squarely on Moderna’s vaccine, not others: We always wanted our patents and other intellectual property (IP) to enable others to produce and distribute the vaccine Moderna developed.
Of course that wasn’t the plan. Patents alone don’t provide all the knowledge needed to make a vaccine and bring it to market. There’s also copyright, manufacturing know-how, trade secrets, and clinical trial data.
Petro Terblanche, managing director of Afrigen Biologics, one of the companies working with the Africa mRNA hub to reverse-engineer Moderna’s vaccine, said regarding its patent, “It’s written very carefully and cleverly to not disclose absolutely everything.”
Moderna basically said as much in May 2021. After the US government declared support for an IP waiver on vaccines, Bancel was quoted as saying, “If someone wants to start from scratch, they would have to figure out how to make mRNA, which is not in our patents.”
In other words, don’t expect our patents to help.
Additionally, when the company made its patent promise last year, it said "to eliminate any perceived IP barriers to vaccine development during the pandemic period, upon request we are also willing to license our intellectual property for COVID-19 vaccines to others for the post pandemic period."
This provided an early glimpse into what we’ve now seen play out. Moderna said it was only willing to license its technology for the “post pandemic period,” not during the pandemic when the world needs it most.
All Possible Measures to End the Pandemic
In the Times piece, Bancel was quoted saying “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. Clearly that’s not the case.
Both Bancel and Afeyan have underscored investments Moderna is making to scale up its manufacturing capacity so that it can deliver another 1 billion doses to low-income countries in 2022. That’s great, but it’s a leap of logic to say it’s “either/or” between this and sharing technology and IP with others.
The company can do both, pursuing all possible pathways to maximize global vaccine production and, critically, access. Sadly, what’s plainly driving its decisions is profit.
Moderna’s mRNA vaccine is an incredibly powerful tool to save lives and stop the spread of COVID-19. But we can’t celebrate life-saving inventions that only help the fortunate few. Hopefully the intensifying pressure on Moderna leads the company to accept change and embrace partnership and solidarity for the global good. It’s late, but it’s not too late.