The Washington PostDemocracy Dies in Darkness

Opinion Pfizer and Moderna’s mRNA vaccines are our best chance to end this pandemic. Break up their duopoly.

Syringes of the Pfizer-BioNTech coronavirus vaccine at a vaccination site in Sale, Morocco, on Oct. 5. (Fadel Senna/Agence France-Presse/Getty Images)

Tom Frieden, a physician, is president and chief executive of Resolve to Save Lives, an initiative of the global public health organization Vital Strategies, and former director of the Centers for Disease Control and Prevention (2009-2017).

Drug companies claim they are on track to produce a glut of coronavirus vaccines globally by 2022. Don’t believe them. Failure to ramp up production now could cost lives and prolong the pandemic. The best way to avoid that is to break up the duopoly that Moderna and Pfizer maintain over mRNA vaccines.

There are about 7.1 billion people over age 5 in the world; vaccinating 80 percent with a two-vaccine series would require more than 11 billion doses. More than 6.5 billion doses have been delivered. Simple math suggests that “only” another 4.5 billion or so doses are needed, and, with a billion doses produced per month, this need will be met by early next year.

This is wrong for at least five reasons. First, people who received less-effective vaccines or vaccines whose protection wanes, especially against variants, will need booster shots. About half of the more than 6.5 billion doses already given globally have been relatively less effective Sinopharm and Sinovac vaccines from China. This may increase the need for effective vaccines by 3 billion to 6 billion doses or more in 2022 alone.

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Second, as uncontrolled spread continues, new variants could emerge that partially or completely evade vaccines. This could require more boosters or re-vaccination — potentially another 11 billion doses.

Third, manufacturers have consistently missed their production targets. The analytics company Airfinity reports that other than Chinese firms, which have generally met the targets they announced, vaccine manufacturers missed their 2020 targets by 96 percent and are missing their 2021 targets by about half.

Fourth, production of the mRNA vaccines is lagging. These vaccines are, at present, our most powerful tool to end the pandemic. They’re easier to tweak for variants, quicker to produce and less likely to suffer production delays than other vaccines.

Moderna and Pfizer produced 347 million doses in August. At this rate, it would take them nearly three years to produce 11 billion doses, and by then, additional boosters or tweaked vaccines may well be needed.

Finally, vaccines continue to be sold to countries based on ability to pay, not need. With nearly 1 billion doses distributed between them, Pfizer and Moderna have both delivered a minuscule percentage of their doses to low-income countries. Of the more than 6.5 billion doses administered globally, fewer than 4 percent have gone to people in low-income countries. Not only is this morally indefensible, it assures the pandemic will be needlessly extended and that millions more may die.

It’s certainly possible that the Chinese vaccines, as well as those from Johnson & Johnson, Novavax, AstraZeneca and others, will be produced in sufficient quantities and provide robust protection against current and future variants. It’s also possible that new vaccine-resistant variants won’t emerge. But these are high-stakes — and unnecessary — gambles. Building capacity to produce more mRNA vaccines faster is our insurance against both production delays and variants.

Both Moderna and Pfizer deserve credit for responding quickly, testing their vaccines in large clinical trials with tens of thousands of participants and providing data for regulatory approval. But the plain truth, whatever they claim, is that despite their progress increasing production, they cannot produce the quantity of vaccine needed in time. The only responsible way forward is for them to transfer their vaccine technology to other companies that can rapidly increase production.

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A three-pronged approach could step up production. First, increase production of the Moderna vaccine by the pharmaceutical company Lonza, which already has some production capacity in at least 10 countries, including the United States. Second, establish an additional U.S. production hub, potentially at a site with a pharmaceutical production track record in an area that needs an economic boost. Third, create a new hub in another country, such as South Korea, to quickly manufacture billions of doses. Other hubs in other regions of the world could be developed subsequently.

Moderna claims it will take 12 to 18 months to transfer its technology. This is false. It took about six months to get the Lonza facilities producing vaccines and should take less time now.

Taxpayers supported these vaccines at almost every step of development. Taxpayer money also bought and distributed millions of doses. In exchange, the public has every right to expect companies to behave responsibly. Since they haven’t, the federal government must use all its tools, including legal action, to get them to transfer this urgently needed technology.

Technology transfer isn’t charity. Intellectual property can be protected, the companies can be appropriately indemnified, and they can receive royalties of billions of dollars for vaccines produced under their license. They could even have their existing markets protected. But they must stop hiding the quality and production details that other companies need to scale up production.

This could be a win-win. By transferring this technology, the world will be safer, millions of lives will be saved, and both companies will get more revenue. If they fail to do so, Pfizer, Moderna and the U.S. government will be responsible for the consequences.