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Illustration: Shoshana Gordon/Axios

The world still needs more coronavirus vaccines, particularly low-income countries. Pressure is increasing on the Biden administration to close the gap — and the Biden administration, in turn, is pushing Moderna to fill it.

Why it matters: Getting global vaccination rates as high as possible isn't just a humanitarian effort; it also reduces the risk of vaccine-resistant variants emerging.

  • But manufacturing setbacks and the prioritization of people in high-income countries have left the world facing a coronavirus vaccine deficit in the short term and inequities in the longer term.

What they're saying: "The right to make billions of dollars off of an essential medicine that was developed using government funds comes with the obligation to provide access and doses to people in low- and middle-income countries who can’t afford it," a senior Biden administration official told Axios.

  • "That is exactly what we are doing with Covax. And bilateral partnership with middle and low income countries" like Botswana and Peru, Moderna CEO Stéphane Bancel told Axios in response.
  • "And as we speak we are looking to add another [500 million] doses for mid and low income countries," he added.

One hopeful note: Vaccine manufacturing is accelerating, and worldwide production is expected to exceed 12 billion doses by the end of 2021, the International Federation of Pharmaceutical Manufacturers and Associations said yesterday.

  • "The numbers show that the scale up of vaccines is on track to ensure that everybody who needs to be vaccinated can be. We see a turning of the tide," Thomas Cueni, director general of the IFPMA, said in a statement.
  • "We will soon be at the inflection point where overall global supply of high-quality vaccines will be adequate for global needs," said Krishna Udayakumar, director of the Duke Global Health Innovation Center. "One critical issue right now is inequitable allocation of those doses."

The big picture: Nearly half of the world's population has received at least one dose of a coronavirus vaccine, per NYT.

  • But as of now, more than three-quarters of doses have been administered in high- or upper-middle-income countries.
  • It's also become clear that some vaccines work better than others, prompting concerns about low-income countries receiving less effective vaccines.

State of play: Some of the manufacturers of more effective vaccines — primarily American companies — are falling short of production expectations or selling primarily to high-income countries.

  • In March, Johnson & Johnson, Novavax and AstraZeneca were projecting they'd make a combined 6 billion doses by the end of the year. But all three have fallen short and now project a combined 2.6 billion doses, according to Udayakumar.
  • Novavax — which projected an output of 2 billion doses in 2021 — hasn't yet been approved for use anywhere in the world because of manufacturing difficulties, and J&J's production has also been curtailed by manufacturing setbacks.

These delays, combined with a ban on vaccine exports from India earlier this year, have been a blow to COVAX, the organization created to help get vaccines to lower-income countries.

  • "Those three vaccines are the ones that COVAX has been most reliant on for early access, which explains part of the supply challenges for COVAX and for low- and middle-income countries more broadly," Udayakumar said.

Meanwhile, the mRNA vaccines have emerged as the world's most effective vaccines, and activists say that the U.S. government should be more aggressive in its efforts to scale up production of these vaccines.

  • Moderna — which has received billions of dollars from the U.S. government — is facing particularly intense criticism for selling its vaccine nearly exclusively to rich countries.
  • The administration is currently in talks with the company about selling substantial quantities of doses at a not-for-profit price to go to low-income countries, which Pfizer has already agreed to do.

Between the lines: The vaccine deficit will undoubtedly grow if vaccine manufacturers continue to miss their production targets. But wealthy countries' booster efforts could also stretch supplies.

  • And the quality of vaccines matters. China has produced half of the global vaccine supply to date, but its vaccines aren't as effective as those made in the U.S. and Europe.
  • "They are quite literally better than nothing. They're just not very good by American standards or by European standards," said Cornell virologist John Moore.

Go deeper

19 hours ago - Health

Pfizer could have vaccine data for children under five by end of 2021, CEO says

A health care worker administers a dose of the Pfizer-BioNTech COVID vaccine to a child at a Salvation Army vaccination clinic in Philadelphia on Nov. 12. Photo: Hannah Beier/Bloomberg via Getty Images

Pfizer could have data on COVID-19 vaccine efficacy for children under five by the end of the year, CEO Albert Bourla said on Friday in an interview with NBC News.

Why it matters: Omicron has raised concerns that young children are becoming more vulnerable to the virus. Tshwane, the epicenter of South Africa's Omicron outbreak, has seen a high number of hospital admissions for children under two in the last few weeks, though scientists have not confirmed a link to the variant, Reuters reports.

Updated Dec 1, 2021 - Axios Events

Watch: A conversation on America's manufacturing future

On Wednesday, December 1st, Axios markets reporter Courtenay Brown and business reporter Hope King explored how new technologies and sustainability commitments are setting a new standard for domestic industrial manufacturing, featuring Sen. Debbie Stabenow (D-Mich.) and Siemens USA president and CEO Barbara Humpton.

Sen. Debbie Stabenow explained how government leaders and the manufacturing sector are responding to the current supply chain crisis and reinforced the important role domestic manufacturing plays in fostering economic growth and national security.

  • On the supply chain crisis and chip manufacturing: “We’re seeing a little bit of improvement happening, but we’ve got a long ways to go because when you shut down this type of operation and then work on getting it up and going again, it’s not like turning on a switch...there’s a lot of safety testing and standards that have to be met to make these.”
  • On the importance of domestic manufacturing: “Manufacturing, as it moves and changes in more advanced manufacturing and technology, is a very important part of our economy to be successful and to provide good paying jobs, it’s also part of our national defense and is part of what is important for us in terms of leading the world.”

Barbara Humpton described the issues plaguing supply chains, how companies are adapting to improve production timelines, and how manufacturers are thinking about the transition to renewable energy.

  • On the urgency of the supply chain crisis for global economies: “The supply chain obviously is a critical issue for all of us. From the first disruptions we saw due to COVID to all of the really crazy things that happened in 2021, the supply chain has really risen as the issue right now for our economies all around the world.”
  • On the transition to renewable energy: “I know there are plenty of advocates who would love to see us make an immediate switch to all renewable energy, but let’s face it, we’re going to be in a decade when we need to be transitioning from fossil fuels to other alternatives. While we’re working our way through that transition, we can find lots of greener, more effective, more efficient sources of fuel, more efficient ways to use clean natural gas, for instance, in order to support our industries.”

Axios SVP of Product & Technology Melanie Colton hosted a View from the Top segment with SAFE Commanding Heights executive director Dr. Jeffrey Jeb Nadaner, who discussed how the U.S. can reestablish itself as a leader in manufacturing.

  • “One of the issues we have today is how do we restore that manufacturing base? The good news is that we have the technology, we have the people. It’s a question of having the right policies and the right incentives by the U.S. government to make a favorable business climate for industry to want to build those fabrication plants in the U.S. once again.”

Thank you SAFE for sponsoring this event.

Axios AM Deep Dive: Pandemic eating

Illustration: Sarah Grillo/Axios

A food revolution began pre-pandemic and COVID has only accelerated that. See how America's food industry is transforming, from farm to your table.