The Washington PostDemocracy Dies in Darkness

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

Health workers prepare doses of the Moderna coronavirus vaccine at a walk-up site in San Francisco. (David Paul Morris/Bloomberg News)

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 prices.

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.

Washington Post vaccine tracker

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 University.

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

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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 Alliance.

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 CEPI.

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 underway.

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.

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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 vaccine.

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.

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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.”

South Africa suspends Oxford-AstraZeneca vaccine rollout

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 information.”

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.”

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Coronavirus: What you need to know

End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.

Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.

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