On Oct. 13, 2021, the LPE Project and the Global Health Justice Partnership sponsored a panel discussion about How to Vaccinate the World. In the following excerpt, which has been lightly edited for length and clarity, the panelists discuss the development of mRNA vaccine manufacturing capacity in Africa. At the core of the conversation are the questions of whether the U.S. government has done enough to encourage pharmaceutical companies to transfer their vaccine technology to countries that need it, what such technology transfer would entail, and how such efforts fit into broader strategies for increasing vaccine access across the world. A video of the complete discussion is available here.
Fatima Hassan (founder of the Health Justice Initiative): Let’s talk about Moderna. It has not delivered vaccines to a single low-income country. We have waited the whole year, but it has not agreed to participate voluntarily in the WHO mRNA hub that has been set up in South Africa down the road from me. We now have to copy and replicate that [mRNA] technology, and it may take us three years, an untenable situation. Moderna refuses to submit its dossier here in South Africa and refuses to supply many African countries. It decides which countries it actually wants to support. We need the Biden administration to step in there.
Pfizer has not agreed to participate in the WHO mRNA hub that has been set up in South Africa either. It has given Biovac a “fill and finish” license. And that capacity may be about a hundred million doses—it will only cover 50 million people of a population, on the [African] continent, of 1.3 billion. And even that may only come online in 2022. So those “fill and finish” licenses are not sustainable either, because they rely on the voluntary cooperation of these companies. . . .
If we’re going to turn the tide—if we’re going to talk about real political leadership—we have three companies that are headquartered in the US, and the Biden administration has to march in. We can do that by sharing technology with available existing capacity or investing in additional capacity. And like I said, people are getting sick and dying. Whether these hubs are in the U.S. or whether they’re in Latin America or Africa is immaterial. The point is we need to ramp up global manufacturing capacity to actually serve the rest of the world.
David Kessler (Chief Science Officer of the White House COVID-19 Response Team): Again, I don’t want to delve into the technicalities of which authorities are best here. I mean we could probably take the next hour and [moderator] Amy [Kapczynski], you, and Zain could go through them.
I think there is no doubt that we have a short-term problem that needs to be addressed, and I think that Moderna and J & J can and must step in on that short-term issue. There are the longer-term solutions that I think will take several years, but we need to start now. I do believe in and I’m a strong proponent of the importance of building pharmaceutical mRNA capacity on the African continent. The reality is, and I’ve seen it just from the United States perspective, that when you have a manufacturing plant in your country or on your continent that is making vaccines, it’s much easier to make an argument that you don’t have to stand in line behind everyone else in the world. So getting pharmaceutical manufacturing capability in those countries that have less access is absolutely important. We expect that companies like Moderna will enter into arrangements with local pharmaceutical companies on the African continent to do that—we think it is absolutely critical.
Now I do point out—and you can all help me because you know—that we don’t have a great track record of doing this. It’s very hard. If you look at HIV drugs, the generic drugs tended to be made in India. We’ve not built capacity. So I’m not saying that there’s not a lot of work ahead, but I think it is absolutely essential to begin now, recognizing that it will take several years to build capacity on the African continent, and we are committed to seeing that happen.
James Krellenstein (co-founder of Prep4all): Can I just add a quick interjection? David, let’s just get a little real here. I mean, by the end of this conversation, this hour-and-a-half long panel, you know 900 people will have died from COVID-19 globally. Over 10,000 people every day are dying right now, and we know basically almost 100% of those deaths are preventable if there were vaccine access. The thing that scares me about this conversation, just to be frank, is that building new capacity can be done quickly—we’ve done it with mRNA and it takes six months—but six months is still six months. And we’ve been talking about this for longer than six months at this point. We’ve been talking about this since December and January and February.
We can’t just rely on Moderna and say, “Well, is Moderna actually committing to that production capacity?” I haven’t seen a firm commitment from the company that they’re actually building to the capacity we need them to. And at this point we can’t take their word for it. We need to guarantee that there will be capacity when we need it, and we haven’t been doing that for nine months, and thousands and thousands of people are dying every day as a result. And it’s threatening our national security as well, right?
David Kessler: I agree with everything you said, but I think we do have to just put things into two major categories and recognize that there is getting doses now, over the next 6-to-12 months, and for that there is capacity, there is enormous capacity at Merck and J & J. There is very substantial capacity at Merck. Those companies have to step up to the plate and deliver doses now, over the next six to twelve months. They have the capacity to do that.
Then there is the question of building further capacity, and I think we have to recognize that that’s going to take longer. That’s my only point.
Zain Rizvi (Law & Policy Researcher at Public Citizen): A few points there. I think, one, it’s true that the companies should have been allocating their doses to the low- and middle-income countries at a reasonable price, and it’s true that this should have been done months ago. This is not even the bare minimum. This is something that is so obvious that it baffles me that it wasn’t done on day one of the Biden administration’s agenda. We need access for global vaccines. We need to end the pandemic. I think all of us agree that that certainly needs to be done.
What we’re also talking about is that we need much more capacity, because we just have so much uncertainty about the course of the pandemic. We have seen how the pandemic continues and continues and continues without access to vaccines. And we have, frankly, seen from developing countries themselves huge demands placed. You have, for example, the South African government, which has been a real champion working with the World Health Organization, trying to set up this mRNA hub. Right now, at this moment, down the street from Fatima, there are manufacturers and there are scientists that are working to reproduce the Moderna COVID-19 vaccine. They’re going to spend months trying to experiment to get to the knowledge that Moderna already has. Are we going to let them waste that time in a pandemic? It is unconscionable that the U.S. government is not doing more to support those hubs and to make the requisite investments.
We’ve seen some positive steps from the administration—I want to acknowledge those. We have seen, for example, even Congress allocating $2 billion for global and domestic vaccine manufacturing through the [Energy and Commerce Committee initial markup].
Now we need the Biden administration to step up because, at the end of the day, James, me, Fatima, Amy—we’re not sitting across from the heads of Moderna and Pfizer. We can’t tell them what to do. Covax can’t tell them what to do. The head of the World Health Organization can’t tell them what to do. There is a singular unique power that the U.S. government has, and the U.S. government has alone. This is the moment, and the question is, will the Biden administration rise to the occasion.
David Kessler: We’ve already told them what they have to do.
Fatima Hassan: But they’re not going to do it, right? I think we just won’t know what’s coming down the line, because Zain is right: I have no power over the CEOs of Moderna, Pfizer, and Johnson and Johnson. In fact, when we write letters to them, they don’t even have the decency to respond. We handed over petitions to Johnson and Johnson. They took them through a security gate. They didn’t have the decency to come out in person to accept the memorandum from us. This is the kind of power we’re dealing with when it comes to pharmaceutical companies.
I just want to say three things about Moderna and to really, really urge Dr. Kessler to actually get to the point of taking more firm action against them. I hear you saying that you’ve given them an ultimatum, and hopefully they’ll see the light.
The Moderna CEO is about to be celebrated with an award, and so too the Pfizer CEO. We will make our opposition to that known. But they’ve now said—in October 2021, months into this pandemic—after a lot of criticism, and after the protest that James and a number of other activists led outside the CEO of Moderna’s house—that they will set up a plant in Africa. When they’ll do so, where in Africa—a large continent!—and why not in the mRNA hub, are all questions that are not being answered. It’s a great PR statement that they’re going to commit to a hub, that they’re going to invest in manufacturing capacity in Africa, but there are no details.
They are registering patents in South Africa right now, while they have said that they’re not going to enforce patents during this pandemic. So clearly there is a game plan for Moderna. They know exactly what they are doing. They looked at the different scenarios, and they are going to decide for themselves when this pandemic is over, so that they can start enforcing the patents and still extract as much profit and control out of this pandemic as possible. So there isn’t this genuine voluntary cooperation to actually share knowledge in the middle of a pandemic.