In the ceaseless tide of worry over the pandemic, it’s easy to forget how far we’ve come. It is nothing short of remarkable how quickly the pharmaceutical industry developed not one but several COVID-19 vaccines, and that those lifesaving doses were introduced to the arms of the public just a few months later. Not even a year after the first regulatory approvals, more than 30% of the global populace has been fully vaccinated against COVID-19—a historic and humbling achievement.
Still, that success has been accompanied by an unignorable asterisk. The vaccines’ rollout has been deeply inequitable, with poorer countries left lagging far behind richer counterparts that bought up most of the supply. In the words of the author William Gibson, the future is here but unevenly distributed. Such is usually the way with great innovations. But in the case of COVID vaccines, scientists and ethicists agree that unevenness is not good enough. Not only do inadequately vaccinated populations suffer more harm, they also risk becoming breeding grounds for fast-moving new variants of the virus that might evolve to be vaccine-resistant. Although today’s vaccines stand up against it relatively well, the Delta variant—and the intense economic uncertainty surrounding it—has provided an unwelcome glimpse of that potential future.
That’s the thinking behind our No. 1 entry for the Change the World list. While last year’s list honored the pharma industry’s unprecedented collaboration on beating the virus, this year Fortune is highlighting companies that are racing to expand access to vaccines, especially in the Global South.
61.5%
of people in the world’s highest-income countries have received at least one COVID vaccine dose
3.3%
of people in the world’s lowest-income countries have received at least one dose (AS OF SEPT. 22, 2021. SOURCE: UNDP)
That list begins with AstraZeneca and Johnson & Johnson. The traditional vaccine technologies on which they have relied, while potent, have been slightly less effective than the messenger RNA (mRNA) technique employed by Moderna and BioNTech/Pfizer. But significantly, both AstraZeneca and J&J have been selling all their doses at cost. That has made them pivotal to the efforts of the COVAX initiative, which has so far distributed more than 300 million World Health Organization–approved vaccine doses to the developing world. Pfizer has also delivered millions of doses at not-for-profit prices to low- and lower-middle-income countries, via various channels that include COVAX. The WHO-backed program has also been distributing Moderna’s vaccine and those made by China’s Sinopharm and Sinovac, which have helped fill the gap created by Western firms’ production limitations.
Many vaccine-equity advocates, including the WHO, argue that production would be best expanded and made sustainable by forcing manufacturers to share their intellectual property and technical know-how. One way of doing so—activating the waiver provision in TRIPS, the global intellectual-property-rights agreement—has been resolutely opposed by Big Pharma and the European Union. But the EU’s preferred alternative, of voluntarily getting other manufacturers on board, is gaining traction. Africa’s largest pharmaceutical company, Aspen Pharmacare, has a contract to “fill and finish” J&J vaccine doses in South Africa. Pfizer and BioNTech have similar pacts with the Biovac Institute—also based in South Africa—and with Eurofarma Laboratórios in Brazil. South Africa’s Numolux Group has also signed a Sinovac fill-and-finish pact.
None of these deals yet takes the extra step of allowing a licensee to produce the active vaccine substance itself. The model for that kind of cooperation was set by AstraZeneca and the Serum Institute of India. That contract held great promise for global supply until a terrible pandemic wave in India forced SII to divert exports to its domestic market. Still, the pact could prove vital in the future. SII has also signed up to make Russia’s Sputnik V vaccine, as have firms in countries from Brazil to Belarus, though that vaccine’s inclusion in COVAX remains uncertain.
Step by step, we’re getting to worldwide immunization. And get there we must. In our globalized context, this pandemic demands change around the world for any part of it to become truly safe again.
Editor’s note: This article has been updated to reflect additional details about the distribution of Pfizer/BioNTech vaccines.
A version of this article appears in the October/November 2021 issue of Fortune with the headline, “Fighting the COVID-19 fight, worldwide.”
Dive into stories from Fortune’s print edition:
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- Can new CEO Fidji Simo turn Instacart into more than just a delivery company?
- Are women on a collision course with the COVID ceiling?
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- These 9 powerful women are ones to watch
This story highlights global Vaccine Makers. The group earned the No. 1 spot on Fortune's 2021 Change the World list.
