A nurse conducts tests for a COVID-19 vaccine at the Desmond Tutu Foundation HIV Youth Center in Masiphumelele, South Africa, on December 4, 2020. (Joao Silva / The New York Times)

Moderna, whose vaccine appears to be the best defense against COVID-19 in the world, has been giving its doses almost exclusively to wealthy nations. As a result, the poorest countries have had to wait while the drugmaker makes billions of dollars in profits.

After developing an innovative vaccine with the scientific and financial support of the US government, Moderna has shipped a larger proportion of its dose to wealthy countries, more than any other vaccine manufacturer, according to Airfinity, a scientific data analysis company that is tracking vaccine shipments.

Approximately 1 million doses of Moderna’s vaccine have gone to countries that the World Bank classifies as low-income. Instead, 8.4 million doses of Pfizer’s vaccine and about 25 million single-dose Johnson & Johnson vaccines have gone to those countries.

Of the handful of middle-income countries that have agreed to buy the Moderna doses, most still haven’t received any, and at least three had to pay more than the United States or the European Union, according to government officials in those countries.

Thailand and Colombia are paying high prices. Doses from Botswana have been delayed. Tunisia could not even contact Moderna.

Unlike Pfizer, Johnson & Johnson, and AstraZeneca, which have diverse portfolios of drugs and other products, Moderna only sells the anti-COVID vaccine. The future of the Massachusetts company depends on the commercial success of its vaccine.

“They are behaving as if they have absolutely no responsibility beyond maximizing the return on their investment,” said Tom Frieden, former director of the Centers for Disease Control and Prevention.

Executives at Moderna have said they are doing everything in their power to make as many doses as possible as quickly as they can, but their production capacity remains limited. All the doses that will be produced this year are to fulfill orders already made from governments such as those of the European Union.

Either way, the Biden administration has grown increasingly frustrated with Moderna for failing to make its vaccine available to poorer countries as well, two senior officials in his administration mentioned. The government has been pressuring Moderna executives to increase production at US plants and to license the company’s technology to foreign manufacturers that can make doses for international markets.

Moderna is having to defend itself against accusations that it is giving priority to rich countries.

On Friday, after The New York Times sent detailed questions about the small number of poor countries that have had access to Moderna’s vaccine, the company announced that it is “currently investing” in order to increase its production and be able to deliver 1 billion doses to low-income countries in 2022. The drugmaker also indicated last week that it would open a factory in Africa, without specifying when.

Moderna executives have been talking to the Biden administration about selling doses cheaply to the federal government, which in turn would donate them to poorer countries, as Pfizer agreed to do, according to the two top officials. Negotiations are ongoing.

In an interview on Friday, Moderna CEO Stéphane Bancel mentioned that “it is sad” that his company’s vaccine had not reached more people in poor countries, but that the situation was out of his control.

He claimed that Moderna last year tried and failed to get governments to contribute money to expand the company’s low production capacity, and that it You decide how much to charge based on factors such as the number of doses ordered and the wealth of a country. (A Moderna spokeswoman disputed Airfinity’s estimate that the company had supplied 900,000 doses to low-income countries, but did not provide another figure.)

Almost a year after Western countries began the fast-paced race to vaccinate their populations, the focus of attention has shifted in recent months to severe vaccine shortages in many parts of the world. Dozens of the poorest countries, mostly in Africa and the Middle East, had vaccinated less than 10 percent of their population as of September 30.

In August, for example, Johnson & Johnson faced rebuke from the director general of the World Health Organization and public health activists after The New York Times reported that doses of its vaccine produced in South Africa were being exported to richer countries.

Officials in the Biden administration are especially frustrated by what they think is a lack of cooperation from Moderna, as the US government provided the company with critical assistance.

Scientists from the National Institutes of Health worked with the company to develop the vaccine. The United States provided $ 1.3 billion for clinical trials and other research. In addition, in August 2020, the government agreed to pre-order $ 1.5 billion worth of vaccines, ensuring that Moderna would have a market for what was an untested product.

Although the Moderna and Pfizer vaccines were found to be similar in efficacy in clinical trials last year, more recent studies suggest that Moderna’s vaccine is superior, offering longer lasting protection and easier to transport and store.

The vaccine Moderna “is practically the best quality vaccine”, said Karen Andersen, industry analyst at Morningstar. “They’re in a position where they probably don’t need to sacrifice too much when it comes to pricing a lot of their deals.”

Only a few governments have disclosed how much they pay for Moderna doses. The United States paid between $ 15 and $ 16.50 for each dose, in addition to the $ 1.3 billion the government gave Moderna to develop its vaccine. The European Union has paid between $ 22.60 and $ 25.50 for its doses of Moderna.

Botswana, Thailand and Colombia, which the World Bank classifies as upper-middle-income countries, have said they are paying between $ 27 and $ 30 for each dose of Modern.

Moderna’s COVID vaccine has been transformative for the company and its leaders. The company said it expects its vaccine to generate at least $ 20 billion in revenue this year, which would be one of the most lucrative medical products in history. Andersen, the Morningstar analyst, estimated that the company’s earnings from the vaccine could reach $ 14 billion. In 2019, Moderna reported total revenue of $ 60 million.

Moderna’s market value has nearly tripled this year to over $ 120 billion. Two of its founders, as well as an early investor, were featured on Forbes magazine’s list of the 400 richest people in America this month.

Faced with the spread of the coronavirus in early 2020, Moderna rushed to develop its vaccine, which uses a new technology known as messenger RNA, and to plan a safety study. In order to manufacture the doses for that test, the company received $ 900,000 from the nonprofit Coalition for Innovations in Epidemic Preparedness.

The nonprofit organization said that at the time Moderna had accepted its “principles of equitable access.” That meant, according to the coalition, that the vaccine would be “available first to populations when and where it is needed and at affordable prices to populations at risk, especially in low- and middle-income countries, or to public sector entities. that they acquire them for said populations ”.

Moderna agreed in May to supply up to 34 million doses of its vaccine this year and up to 466 million doses in 2022 to Covax, the troubled United Nations-backed program to vaccinate the world’s poor. The company has yet to ship any of those doses, according to a Covax spokesperson, but the program has managed to distribute tens of millions of doses of Moderna that the US government has donated to it.

Bancel said that many more doses would have reached Covax this year if the two parties had reached a supply agreement in 2020. Aurélia Nguyen, a Covax official, denied that saying: “It was clear from the beginning that the best we could hope for they were minimum doses in 2021 ”.

© 2021 The New York Times Company

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