CAPE TOWN – Moderna tried to extract a huge price for its COVID-19 vaccine from the South African government at the height of the pandemic, according to the local NGO, Health Justice Initiative (HJI), in revelations made public this week.

The US-based pharma company wanted to charge $42 per vaccine in mid-2021 when vaccines were scarce, reducing this to $32.30 in the third quarter and $28.50 by the fourth quarter.

In comparison, Pfizer offered its vaccines for $10 per dose over the same period – which, although less than a quarter of Moderna’s ask, was still higher than the price paid by the European Union.

Moderna also expected South Africa to pay to transport the vaccine from its European offices, and demanded broad indemnification clauses and a 15-year confidentiality agreement, according to HJI.

Ultimately, South Africa did not procure vaccines from Moderna.

HJI resorted to the High Court in South Africa to get the correspondence between its government and drug companies during the pandemic, and released a second round of analysis of the documents this week, following a previous analysis in September 2023.

HJI director Fatima Hassan said that their analysis of the negotiation documents, done with the help of the nonprofit consumer advocacy organisation Public Citizen, “reveals a pattern of bullying and attempts to extract one-sided terms, especially by pharma giants Moderna and Pfizer all while they profiteered from a global health emergency”. 

“What these documents make clear is that corporations can and will exploit the conditions of public health emergencies to coerce governments, particularly those in low-and middle-income countries, into accepting unreasonable agreements on the supply of life-saving medicines,” said Jishian Ravinthiran, a researcher with Public Citizen, addressing a media briefing this week.

“International efforts to address future global health emergencies, like the pandemic accord, must include robust provisions and safeguards to rein in these corporate interests and ensure the rapid, equitable supply of vital countermeasures for everyone.”

Pfizer pursued secrecy

Pfizer wanted a 10-year non-disclosure agreement, but the negotiation documents show South African officials did try to include provisions to “mitigate the unfettered power and control Pfizer sought to exercise over the supply agreement, but that was largely unsuccessful in the end”, said HJI. 

Pfizer rejected provisions that would have permitted the disclosure of confidential information in emergency circumstances and for bolstering transparency and trust in the vaccination programme. 

This is despite South African government officials referring the World Health Assembly’s (WHA) resolution about the transparency of markets for medicines, vaccines, and other health products, and warning that these provisions may hamper oversight from lawmakers and the country’s Auditor General.

“The totality of the agreements signed and the negotiation records show that these companies shamelessly wanted secrecy, and no transparency and that they profiteered at the public’s expense during the pandemic,” said Hassan. 

The report concludes that contractual bullying by monopolistic pharma corporations undermined South Africa’s vaccination programme to the detriment of its people. It calls for mandating transparency around procuring lifesaving vaccines and medicines using public funds in any health emergency.

Voluntary mechanisms fall short

Prof Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at the O’Neill Institute at Georgetown University in the US, said that the South African example was a lesson for those negotiating a pandemic agreement in Geneva at present.

“There has been a lot of talk [in the negotiations] about how we can use voluntary mechanisms in the middle of a pandemic to secure access; that countries will share their technology and that the best we should do is just secure a certain percent of vaccine doses for the World Health Organisation because that is what will secure equity,” said Kavanagh.

“But here we have a G20 member unable to secure equity. What do you think was happening in low and middle-income countries that have far less power than South Africa?”

He added that the evidence gathered from the South Africa negotiations shows that vaccine production had to be decentralised to LMICs, although with tech and knowledge transfer.

“Until we do that, no low and middle income country is going to have enough power to actually get equitable access. That is something that needs to be at the negotiating table in Geneva.”

Need to ‘do better in future’

Public Citizen’s Peter Maybarduk said that similar “extraordinary deference to drug companies” had emerged in Brazil and Colombia where “contracts or fragments of contracts have come to light over the years”.

He described the “extraordinary secrecy” as a major problem: “Fragmenting the world down into many health agencies, who do not know what the other is exactly negotiating and what terms are being set, very much reduces public power, transparency, and the ability of health agencies to make informed decisions, let alone the collective action that’s really necessary to have a global health response.

“Ideally, we’d want health agencies the world over coordinating and understanding where [vaccine] doses are going, when, on what terms, so that we can get as many vaccines to as many people as possible in as short a time as possible,” added Maybarduk.

“Instead, we have a commercial practice being managed by companies under extraordinary secrecy with long-term bars on disclosure. We’re going to have to do better in the future.”

Maybarduk said that the pandemic agreement provides some options for improvement, including conditions on public research and development grants that underpin much pharmaceutical investment.

“But we’re going to need national action as well and some concerted collective action to set different expectations for vaccine contracts and contracting during public health emergencies.”