142 FORTUNE OCTOBER/NOVEMBER 2021In the ceaseless tide of worry over the pandemic,
it’s easy to forget how far we’ve come. It is noth-
ing short of remarkable how quickly the pharma-
ceutical 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 dis-
tributed. Such is usually
the way with great innova-
tions. But in the case of
COVID vaccines, scientists
and ethicists agree that
unevenness is not good
enough. Not only do inad-
equately vaccinated popu-
lations 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 vac-
cines stand up against it
relatively well, the Delta
variant—and the intense
economic uncertainty sur-
rounding 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 hon-
ored the pharma industry’s
unprecedented collabora-
tion on beating the virus,
this year Fortune is high-
lighting companies that
are racing to expand access
to vaccines, especially in
the Global South.
That list begins with
AstraZeneca and Johnson& Johnson. The tradi-
tional vaccine technolo-
gies on which they have
relied, while potent, have
been slightly less effec-
tive than the messenger
RNA (mRNA) technique
employed by Moderna
and BioNTech/Pfizer.
But significantly, both
AstraZeneca and J&J have
been selling 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.
The COVAX program also
includes Pfizer/BioNTech
and Moderna’s vaccines,
and those made by China’s
Sinopharm and Sinovac,
which have helped fill the
gap created by Western
firms’ production limita-
tions. (The Chinese vac-
cines’ efficacy also appears
to be lower than that of
mRNA vaccines.)
Many vaccine-equity
advocates, including the
WHO, argue that produc-
tion would be best expand-
ed 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 agree-
ment—has been resolutely
opposed by Big Pharma
and the European Union.Fighting the COVID-19 Fight,
Worldwide
The race to create coronavirus vaccines was
only the beginning. These companies are striving to
make sure low-income nations don’t get left out.
BY DAVID MEYER
The Vaccine Makers
GLOBAL61.5% of people in the world’s highest-income countries have received at least one COVID vaccine dose
AS OF SEPT. 22, 2021. SOURCE: UNDP