[Some poorer countries are paying
more and waiting longer for the company’s vaccine than the wealthy — if they
have access at all.]
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.
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 vaccine.
“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.
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.
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 deals.”
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’ orders.
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 world.”
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 Innovations.
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
behalf.”
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 Friday.