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Illustration: Sarah Grillo/Axios

Moderna said Thursday that starting in 2021, it could manufacture "possibly up to 1 billion doses per year" of its experimental coronavirus vaccine with the help of a contract manufacturer.

Yes, but: 1 billion vaccine doses may sound like a lot, but government and public health leaders would inevitably still have to make hard choices about who should get the vaccine first.

By the numbers: 500 million people could get vaccinated from 1 billion vaccine doses, based on Moderna's tests of one person getting two 100-microgram shots.

  • There are 7.8 billion people on Earth, meaning Moderna's vaccine could initially cover 6% of the global population.

This scenario assumes the vaccine clears all clinical hurdles and is deemed safe and effective — which are major unknowns right now — and that it eventually gets FDA and other international governmental approvals.

  • This scenario also assumes 1 billion doses can actually be made within a year, which many experts believe is difficult to do.

The burning questions: That production level not only falls short of immediate need, but all 1 billion doses also will not come out at the same time. It's leading ethicists to consider the following:

  • Which clinics, hospitals and other facilities will get it?
  • Will health care workers, older people in places like nursing homes and others with compromised immune systems be prioritized? If so, who comes after?
  • If there are new coronavirus outbreaks, should those locales get an influx of the vaccine?
  • What if the vaccine costs a couple hundred dollars, like other vaccines? Will everyone be able to get it regardless of insurance coverage or ability to pay?
  • Since Moderna is based in the U.S., will the U.S. prioritize itself over other countries, and will it cut deals with other countries?

Between the lines: It's naive to think the most affluent people won't try to get it immediately.

  • "The very rich … will do anything to get it, and there will be a black market," said Arthur Caplan, a bioethicist at New York University, adding he's "200% sure" that would occur given what happened when ventilators were in short supply.

The bottom line: Even with other coronavirus vaccines rapidly moving through clinical trials, billions of people simply won't have access to a vaccine by 2021.

  • And if history is any indication, the poor and minorities will be at the back of the line unless equitable national and global policies are put into place.

Go deeper: How the U.S. might distribute a coronavirus vaccine

Go deeper

Rep. Brooks: We need to better prepare for pandemics

Axios' Margaret Talev (L) and Rep. Susan Brooks (R). Photo: Axios

Insufficient stockpiles and a lack of personal protective equipment during the COVID-19 pandemic should serve as a warning for America on future preparedness, Rep. Susan Brooks (R-Ind.) said at an Axios virtual event on Friday.

What they're saying: "Congress had been beefing up for years — the appropriations for preparedness — it certainly was not enough, and we recognize that," Brooks said.

Sep 18, 2020 - Health

Rep. Khanna: COVID-19 could change the perception of public health care

Rep. Khanna and Axios' Margaret Talev

The universal experience of COVID-19 could change how opponents view Medicare for All, Rep. Ro Khanna (D-Calif.) said at an Axios virtual event on Friday.

What they're saying: "The pandemic has reminded us of our shared humanity with other American citizens. It's no longer possible to think, 'Oh, we're not part of those who get sick.' Now almost everyone knows, unfortunately, someone who has been hospitalized, someone who had a serious bout with COVID," Khanna said.

Sep 18, 2020 - Health

CDC again recommends coronavirus testing for asymptomatic people

CDC director Robert Redfield testifies at a Senate Appropriations subcommittee hearing on Sept. 16. Photo: Anna Moneymaker-Pool/Getty Images

The Centers for Disease Control and Prevention updated its previously revised guidance for coronavirus testing on Friday to say that testing asymptomatic people who were exposed to COVID-19 is recommended for treatment and contact tracing.

Why it matters: The CDC's modification in August to recommend against testing for asymptomatic people was not written by scientists and posted despite their "serious objections," New York Times first reported. CNN confirmed that the agency's update was published outside the agency's "normal review process."