Thread by @DrTomFrieden

Pfizer and Moderna deserve credit for responding quickly to the most disruptive health crisis in a century and producing great vaccines. But failure to transfer technology will tarnish their reputations, prolong the pandemic, and could result in millions of deaths. 1/thread

mRNA vaccines are extremely safe, remarkably effective, & have saved hundreds of thousands of lives. They are our most powerful tool to end the pandemic. They’re easier to tweak for variants, quicker to produce, and less likely to suffer production problems than other vaccines.2/

mRNA vaccines appear to be even safer than other vaccines - which are very safe - and even more effective. mRNA vaccine production is our insurance policy against new, dangerous variants and against production delays with other vaccines. 3/

To their credit, both Pfizer and Moderna worked quickly—without cutting corners—to test the vaccines in large clinical trials with tens of thousands of participants and to provide data for regulatory approval. They also scaled up production with great effort. 4/

Vaccines have now been given to hundreds of millions globally. Since the vaccines have been rolled out, the companies have tracked their safety and effectiveness closely, providing clear documentation of safety and efficacy. 5/

So, what’s wrong with this picture? Despite these accomplishments, Pfizer and Moderna have made fundamental missteps that must be corrected or their reputation for this work will be irreparably tarnished, and, more importantly, millions of lives will be put at risk. 6/

First, Pfizer and Moderna have focused on selling expensive doses to rich countries and have done nothing or next-to-nothing to scale up production to meet the global need. 7/

This has led to the shocking and unacceptable situation we’re in now. More than 6 billion doses have been administered globally—less than 4% to people in low-income countries. 8/

Not only is this a moral failure, it’s also epidemiologically perilous—fewer people vaccinated globally means higher risk new variants will emerge that are more contagious or escape our immunity, either from vaccines or infection or both. 9/

Pfizer and Moderna have also acted inappropriately in many other ways that have undermined public trust. 10/

First, companies shouldn’t tout their products before FDA approval. A responsible executive cares more about public confidence in their product than shareholder expectations. Predictions like this are inappropriate: bit.ly/2XZkO2v 11/

Second, statements by Pfizer and Moderna have minimized the significant challenges we face addressing the global gap in vaccine supply. The companies are spreading the myth that we’ll face a “glut” of vaccines in 2022. This is false. 12/

The world is facing a huge shortage—vaccine supply is nowhere near enough to meet the need. Some non-mRNA vaccines aren’t very effective against some variants and many vaccines being globally aren’t very effective and their protection may not last long. 13/

Also, we may need more initial doses (e.g., 3-dose series for mRNA, 2-dose for J&J) of some vaccines. And we may need boosters periodically. What’s more, if new, vaccine-resistant variants emerge, the mRNA vaccines would be crucial in the next phase of pandemic control. 14/

The implication is clear: We need to be able to produce billions more mRNA doses than we can make now. Unless we change the model, we’re years away from this. The only solution is to act beyond the narrow interests of two companies and break the duopoly on mRNA manufacturing. 15/

At the rate Moderna and Pfizer are currently producing vaccine doses, it would take until 2023 for them to meet the global need. We need more vaccine, sooner. 16/

Third, Pfizer’s CEO has implied that Africa won’t be able to use vaccines effectively. Nonsense. There’s less vaccine hesitancy in much of Africa, and Africa has rolled out vaccination programs effectively for years. 17/

Sure, if mismatched types of leftover vaccines are suddenly dumped on countries with limited planning and short expiry dates, there will be problems. But with predictable supply of approved vaccines and reasonable funding for vaccine programs, they’ll do an excellent job. 18/

Fourth, and there’s no polite way to say this, they’re lying about how long it will take to transfer technology, claiming it will take 12-18 months for a new company to start making their vaccines. It took Lonza less than 6 months to make Moderna's vaccine. 19/

Fifth, they’re using blackmail to frighten the U.S. government, saying that if they are forced to share technology, they won’t meet the needs of the U.S. market. This is war-profiteering, plain and simple. 20/

Pfizer and Moderna have failed to recognize the public investment they’ve benefited from. In the case of Moderna, the US taxpayers paid for their invention. Both companies have already made billions in profit. 21/

Public money supported basic research, intellectual property creation, clinical trials, vaccine distribution, education of doctors/other clinicians, & promoted uptake by patients through extensive information campaigns. Taxpayer money bought and distributed millions of doses. 22/

The plain truth: Pfizer and Moderna cannot meet the global need for their vaccines. They must therefore transfer their technology to support production globally to meet this need. That means working alongside governments to transfer their technology. 23/

This isn’t charity. Their intellectual property can be protected. They can be appropriately indemnified. They can receive royalties of billions of dollars for vaccines produced under their license. They could even have their existing markets protected. 24/

But they must stop hiding the quality and production details other companies need to scale production. 25/

If they transfer technology, it’s a win-win. The world will be safer, millions of lives will be saved, and Pfizer and Moderna will get more revenue. 26/

If they fail to transfer technology, millions of people could die from Covid avoidably, more dangerous variants could emerge, and Pfizer and Moderna will be responsible for these deaths.

27/end of thread but let’s hope not end of story