The U.S. must ramp up vaccine production to end the global pandemic: A conversation with Rob Weissman
On the July 2021 RESULTS National Webinar we dove into a timely new global campaign—working to ensure equitable Covid-19 vaccine access globally.
Joanne Carter opened the global section of the webinar with our call to action: “The question driving our campaign is, are we going to leave billions of people behind in this time of crisis, or are we going to step up?”
Next, John Fawcett invited attendees to think about how their lives have been positively impacted by access to vaccines in the United States. He also shared the latest updates on global vaccination: “In sub-Saharan Africa, less than 1 percent of the population is fully vaccinated. That is taking a toll, not just in terms of the direct impact of Covid-19, but also on levels of poverty. Whether we look at [vaccinations] by geography or by income level this disparity is immense, and it is growing.”
Then, John was joined by Rob Weissman, President of Public Citizen, to discuss how the world got to this point of massive global vaccine inequity, the role of Congress and the Biden administration to check monopoly power on vaccines to increase access, and the need for action now to save millions of lives.
Rob also shared a plan being proposed by Public Citizen and other advocacy organizations to scale up vaccine manufacturing. The plan calls for a $25 billion investment by the U.S. government which would make 8 billion doses of vaccine available for low- and middle-income countries within one year.
John and Rob’s conversation is below and has been edited for brevity and clarity. A recording of the full interview is here.
John Fawcett: In December, we were celebrating the first Covid-19 vaccines within a year of the pathogen being identified. At this point, heading through the summer into the fall, we're debating booster shots for adults or vaccinating young children. But in many countries around the world, particularly in sub-Saharan Africa and South Asia, they don't even have enough doses for doctors or nurses. How did we get from that moment of celebration to this point six months later?
Rob Weissman: It's hard not to be infuriated because we have prior experience that should have prepared us for this. Moreover lots of people, not just at Public Citizen, saw this unfolding during the period of vaccine development and said, “We have to be ready to scale up manufacturing the moment the first effective vaccines are approved for use.” And it didn't happen.
Instead in the U.S. we've enabled two drug companies to exert monopoly control over mRNA vaccines, the most effective vaccines, even though all of the foundational work in this area is publicly supported. And we're just watching and waiting and hoping that miracles are going to happen and they're not going to happen. The rest of the world is going to wait a long time to be vaccinated on the current course that we’re on.
John Fawcett: Estimates are that on the current course there will not be enough doses for low-income countries to theoretically reach herd immunity until 2023 or 2024. This course also assumes a whole bunch of things go well, which is not necessarily our experience to date. What are the tools that the United States has to increase the supply of vaccines? And how is Public Citizen proposing the U.S. use these tools to ramp up production?
Rob Weissman: I think the starting point is to think about it the way RESULTS does and say, "Let's forget about what the law is and all that kind of stuff—what should we do?" And the answer is, we should make enough vaccine for everybody in the world as fast as possible.
We think the US Government has the tools right now to make that happen, without any new laws being passed. It would take money, so we need to get some additional appropriations and global commitments. But if there is no cooperation from the drug manufacturers that have the monopoly control, the government has authority to compel sharing of both the intellectual property of the patents, and the manufacturing know-how, with new manufacturers in order to create more facilities. The government has this authority under the Defense Production Act and Section 1498 which deals with the use of patent inventions for government use.
We don't think that, at the end of the day, the U.S. government would need to use those authorities. We think that the Biden administration should go to the company and say, “We have to end this pandemic immediately and you can't make enough doses fast enough, so we need you to share with other manufacturers.” Our belief is that companies would cooperate if President Biden said that, using his moral authority that’s backed up by legal authority, if necessary.
Public Citizen has elaborated a plan to talk about how we can [achieve this objective]. We look to having 14 new manufacturing sites with 55 production lines that could produce an additional 8 billion doses of the mRNA vaccines. Production would start in six months and the full 8 billion doses manufactured within another six months. So from day zero to one year we could have enough vaccine to get two doses [per person] to all low- and middle-income countries, aside from China. We think the existing capacity is enough [to produce vaccines] for China and the rich countries.
We’ve [estimated this plan will cost] $25 billion, which is small compared to the cost of inaction. What we're lacking is the political will to get it done—so that’s what we're pushing for right now and excited to be partnering with you on.
John Fawcett: You mentioned the public investment that made these vaccines possible. Could you say more about how taxpayer funding has helped enable these vaccines to be available?
Rob Weissman: We've done a lot of careful looking at this after SARS, which is in the same family coronaviruses as Covid-19. The National institutes of Health started investing in coronavirus research and private sector didn't—it’s not a surprise, it's how things work. NIH and other government entities spent about $700 million in the period after 2002 on coronavirus research that is the framework for everything that comes afterwards. The private sector did basically zero. If you look at all the patents around the spike protein they’re based on NIH original research. The particular product that Moderna company has the key underlying patent for is co-owned with NIH. We actually think it should be called the NIH-Moderna vaccine, not the Moderna vaccine. So the patented invention was developed with government support and then, in the case of Moderna, they opted in for Operation Warp Speed funding to do the clinical tests, that means 100 percent of their development costs came from the Federal Government.
Pfizer's a different story, they did not opt into Operation Warp Speed, but their product is licensed from a German company called BioNTech and BioNTech itself relied on German government funding to get to their original invention. So, if you look at this space government support—public support—drove both all the underlying research and lots of the development. Then we're further subsidizing the companies because we're paying them—not the most they could charge, but not their cost for each vaccine. Moderna’s stock is soaring and Pfizer's doing great.
So these companies and their executives are making lots of money off the pandemic but they're holding the vaccine recipe, and the know-how about how to make the vaccine really close, they're not willing to share it.
John Fawcett: I've heard that there are concerns or objections to what Public Citizen and many others are proposing about ramping up supply through compelling companies to share this technology. We’re seeing projections from the pharmaceutical industry that we're on the verge of having a glut of vaccines essentially—that with production scaling up we're going to have billions by the end of the year. And the other side of that is setting up new production capacity, transferring this technology teaching people the recipe, it's simply going to take too long, given the crisis that we're in. What are your responses to that?
Rob Weissman: The industry has been pretty slow to scale up production. [In order to achieve] the projections that say we'll have enough [doses] by the end of 2022 everything has to go beautifully right in ways that it already has not. So there's no reason to suspect we will make up for mistakes that have already happened and then nothing else will happen. They're far behind in their production, in United States with Johnson and Johnson, they are way behind their production, and the AstraZeneca vaccine way behind those.
The idea that would be enough [vaccine doses] relies on production from the Chinese and Russian vaccines which don't have approval from high quality regulators and there's a lot of evidence to suggest they're not highly efficacious to deal with the Delta variant of Covid-19. So they may be better than nothing, but not really what you want to give to people.
Those assumptions also assume that we won't be siphoning off the projected supply for booster shots, which seems like a really bad assumption. And it imagines new manufacturers coming online, who are already behind the schedule that was projected. We've seen them time and time again fall behind.
A lot of you know, the Gavi, Gates Foundation, United Nations collaboration, called COVAX, is way behind its projections for what it would have distributed already in low- and middle-income countries. And it keeps falling further behind. I checked this morning and they've delivered about 100 million doses. They're claiming they're going to get to 2 billion by the end of the year and there's no way. Everything we've seen so far suggests that they're not going to make it and that those projections are wildly optimistic.
On the other side, could we scale up manufacturing if we wanted to? The answer is absolutely yes! How do we know that? Well for one thing, no one ever made the mRNA vaccines anywhere before and a company has figured out how to do it. So if they figured it out how to do it, they can teach other people how to do it and, in fact, they have. They have, within their monopoly control, created new facilities and showed licensed contractors how to make it, even within three months. So we're highly optimistic. We think that six-month period for the startup of new manufacturing is conservative. It probably could be done even faster than what we said… about six months is almost certain.
John Fawcett: On COVAX in particular, just to underscore the supply challenge, now COVAX is essentially fully financed in terms of financial pledges but there's no vaccine to buy. They can’t [purchase vaccine] when current and future supplies are tied up in contracts with countries like the United States and many others.
What has engagement with Capitol Hill looked like so far on this? Are there members of Congress that have supported this initiative and what should Congress be doing?
Rob Weissman: There's a lot brewing on the Hill. I think the most urgent and important thing is an effort to get this funding included in the reconciliation bill. We estimate [the cost of the plan at $25 billion]. We want the US [to contribute the full amount] and not worry about finding funding from anywhere else.
You’re the masters of appropriations, and $25 billion is a ton of money in the appropriations process, but it is not a ton of money in the context of a [multi-trillion dollar] reconciliation bill. We see a real opportunity right now to get an included. The first piece, as you guys know better than me, is to have it built into the top line numbers in the budget resolution.
We're engaged and focusing much more on the Senate side than on the House side right now. It seems like the Senate is going to really drive this process. We’ve talked to 25 offices or more—not as much as RESULTS would hit, but we’re done a lot of it. Senator Sanders is key. He’s sympathetic but there ar competing priorities, so [his office] needs to be hearing from other folks to make sure that they find a way to get it included. Senators Merkley and Warren are champions on this. Tina smith's office, and she herself, are really excited about it…We've had conversations more with Democrats than Republicans, but with the majority of members on the health committees, budget committees, and a big chunk of foreign relations committees.
John Fawcett: A lot of your career has been on fighting battles on access to medicines and holding corporations and our decision makers accountable to make sure that lifesaving medication, vaccines, and treatments are available to the folks that need them. How do you think about this effort around global vaccination as it relates to the longer-term battles around access to medicine? How do we use this moment not just confront the existing global pandemic, but also start to get at [longer term solutions]—whether its manufacturing capacity or the way we think about intellectual property—to ensure that in this era of pandemics that we are in, we're not caught as flat footed as we have been in the last year and a half.
Rob Weissman: I’m a little hesitant to answer [the first part of] that question because I feel like this is such an acute crisis that the difference between action and inaction is easily a million lives, and probably a lot more that. If we solve the problem and get people vaccinated but do it in ways that don't deal with better sharing of information and more global equity, I'm still going to be pretty happy because we're going to have a lot of people who didn't die needless deaths. I don't want to subordinate the true emergency we're facing to the bigger structural issues.
That said, I think there's layers to this. The first is the private monopoly control of information and knowledge and whether we're going to permit that or require some sharing. In the case of Global AIDS, which Joanne was referencing, the issue wasn't supply, it was price. Companies were charging too much, but they were able to do that for the same reason, they had monopoly control. Here we have a problem with supply where prices are a secondary consideration, not irrelevant, but just not that important comparatively. And again it's due to the monopoly control so dealing with these monopoly issues are one of the big things. The ideas we're talking about to facilitate sharing of technology, whether or not the companies are inclined to do it, that speaks to putting some limits on the exercise of monopoly power.
Another thing that's newly arising, and sort of distinct from the old fights, is that vaccines aren’t the same thing as drugs. They're similar but different, this mRNA technology has enormous promise. So, if we could have facilities that were set up around the world of mRNA manufacturing sites with some kind of regional public control (which is one of the ideas being discussed at the World Health Organization right now), then you could really have countries or regions developing things to respond to locally emerging needs in a really fast way under their own control. That would just be enormous both for redressing global inequity, but also to have a fast response to emerging health problems that was bottom up. So both the research agenda and the development agenda, [would be] driven by what was happening [locally]… Researchers and public health experts [could identify] problems and then [have] a local facility that could develop products to meet those local problems. That would turn the whole model of global research and development right now upside down. It would be transformative.
John Fawcett: From your perspective, what should the President and Congress be doing right now?
Rob Weissman: The disappointing thing is the President has been great—but great in the domestic context—and talking about all of government response, for responding like it's a war situation, and actually delivering. It's been amazing how fast we turned [this vaccine technology] around and how it's actually liberated us. But that has been totally absent from thinking about [vaccine access] as a global issue. It's changed a little bit in the last few weeks, I think because of pressure. [Policymakers] have been reluctant to talk about global issues because they didn't want anyone to think that they were more worried about people overseas than domestically, which is quite unfortunate.
Even now in the United States, at the G-7, maybe with the exception of the WHO, we don't see from world leaders that kind of passion, recognition of a global emergency, and then treating [the Covid-19 pandemic] like it's a global emergency. Because if [they] said it's a global emergency and [they] have the solutions at hand, then [they] would just do the solutions! So we're missing that, and I think what our advocacy has to do is force that on them…to take this thing seriously, share this technology, and get everybody vaccinated…
We have to bring the passion so that they bring the passion. We have a plan to do it—there could be other ways to do it, it doesn't really matter—but there has to be a commitment to a global solution to this, and it right now it doesn't exist.
I know that's what you guys deal with every day. You’ve been doing so much, I know what you've been doing, how much in an amazing period of time, and winning some incredible victories. I hope that you get refueled not just by time off, but by recognizing how transformative your work is. This little collective of RESULTS advocates just makes enormous things happen with spectacular results. I hope you're able to bring it to bear in this fight. I think, together, we can make a gigantic difference, and I fear very much what happens if we don't all lean in on it.
John Fawcett: That's a great note to wrap up on. We’re jumping in here with Public Citizen and many others. We will have a slew of resources coming your way, including an Action Alert to tell the President that the United States has to lead this global effort to boost the supply of Covid-19 vaccines, using the tools he has.
We also need to tell Congress! We’ll have subsequent actions and materials around that. But the US needs to allocate the funding for this to happen. It's not that big of a price tag given what's at stake, but some action from Congress, would both enable The White House to do that and also put some additional pressure on them to really take the lead.
Lots more to come on that we are excited to be jumping in on this it, it could not be more critical. Not only for Covid-19 itself and ending the pandemic, but for all of the other things that we have helped achieve in the world and want to achieve in the future around health poverty, education, etc. Thank you all very, very much for joining today.