SA bullied by makers of Covid vaccines

• Moderna and Pfizer held all the aces, latest documents show

Government officials pushed back against many of the terms demanded by Covid-19 vaccine manufacturer Pfizer but were ultimately forced to pay a premium and bear the risk of any delays or harm caused by the jabs, according to the latest tranche of documents scrutinised by health activists.

The Health Justice Initiative (HJI) on Tuesday released fresh details of SA’s previously secret Covid-19 vaccine deals based on a second set of records provided by the health department to the advocacy group in the wake of a high court ruling in 2023.

Its analysis showed SA’s negotiations with Moderna and Pfizer heavily favoured multinational corporations over the public interest, it said.

“The findings are even more concerning, given the planned introduction of National Health Insurance (NHI), which will also involve mass state-private sector negotiations for medicines and vaccines,” it said.

The NHI Act was signed into law by President Cyril Ramaphosa last week and includes measures to establish a government-controlled fund to buy services and commodities provided by the scheme.

In August 2023 the health department provided the HJI with documents covering its contracts with vaccine manufactures Pfizer, Johnson & Johnson (J&J) and the Serum Institute of India (SII), and the international vaccine sharing mechanism Covax, which the HJI previously said showed the companies had held SA to ransom.

The department provided a second set of records to the HJI in September and November 2023, which the HJI said on Tuesday revealed further evidence of the extent to which SA was strong-armed into contracts with unfavourable terms.

This time its analysis, conducted with the assistance of US-based Public Citizen, has homed in on negotiations with Pfizer and Moderna, the two companies that led the way in developing mRNA vaccines.

“These companies’ attempts to extract excessively high prices are now documented for the whole world to see,” said HJI founder Fatima Hassan.

“We hope this disclosure will have a bearing on last-ditch efforts in Geneva to negotiate a fair, equitable and transparent pandemic accord. The absurd power CEOs have in pandemics has to be addressed with urgency,” she said.

Negotiators from the World Health Organisation’s member states are still in talks about a pandemic treaty they hope will be adopted at the World Health Assembly later this month.

SA never entered into a final agreement with Moderna, which according to the HJI sought a price as high as $42 per dose, a 15-year ban on the disclosure of confidential information and a prohibition on using any of the confidential information that was disclosed in any future challenge to Moderna’s patents.

The records of the negotiations with Pfizer, which agreed to provide SA with at least 30million doses at $10 each — a 32.5% premium on the price it charged the EU — show officials

tried to include contract provisions that would mitigate Pfizer’s control and enable a degree of transparency with parliament and the auditor-general in line with domestic legislation.

Officials sought to insert terms that would hold Pfizer accountable for late or incomplete deliveries, narrow its indemnification requirements and allow SA to sell or donate excess doses to other countries.

SA entered into its vaccine negotiations at a time of global scarcity, when governments with domestic manufacturing capacity prioritised their own citizens, leaving African nations that relied entirely on imports struggling to find supplies. Both Western governments and India initially restricted exports. It was forced to pay a premium on the prices charged in many other jurisdictions, including the first batch of vaccines it procured: it agreed to pay the SII $5.35 for a dose of AstraZeneca’s shot, more than 2.5 times the price the EU paid AstraZeneca directly.

University of KwaZulu-Natal senior lecturer in pharmacology Andy Gray said it was not clear how medicines and other health technologies would be priced under NHI. “Simply stating that the fund will ‘set’ prices obscures the legal challenges to that process,” he said.

While the NHI fund had the potential to bring more pressure to bear on prices than the state tender system, it could not rely on a limited bidding process with one winner per item tendered, he said.

“It needs to maintain competition in the longer term, by moving from a procurement to a reimbursement model, with a maximum reimbursement price per pharmacological category,” Gray said.

FINDINGS ARE PARTICULARLY CONCERNING, GIVEN THE PLANNED INTRODUCTION OF NHI, SAY HEALTH ACTIVISTS