Mongolia, a country of grassy hills, vast deserts and endless skies, has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadow of its powerful neighbors, Russia and China.
But during a pandemic, being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.
At a time when most countries are scrambling for coronavirus vaccines, Mongolia now has enough to fully vaccinate its entire adult population, in large part thanks to deals with both China and Russia. Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”
Mongolia’s success in procuring the vaccines in the span of a few months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots, hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries.
deep skepticism over their homegrown vaccines.
Mongolia is a buffer between eastern Russia, which is resource rich and mostly unpopulated, and China, which is crowded and hungry for resources. While Russia and China are often aligned on the global stage, they have a history of conflict and are wary of each others’ interests in Mongolia. Those suspicions can be seen in their vaccine diplomacy.
arrived this week. Mongolia’s most recent agreement with China’s Sinopharm Group, which is state-owned, was made days before the company received emergency authorization from the World Health Organization.
Mongolia was late to the global clamber for Covid-19 vaccines. For nearly a year officials boasted that there were no local cases. Then came an outbreak in November. Two months later, political crisis precipitated by the mishandling of the virus led to the sudden resignation of the prime minister. The prospect of continued coronavirus restrictions threatened to throw the country into further political turmoil.
The new prime minister, Oyun-Erdene Luvsannamsrai, pledged to restart the economy, which had suffered from lockdowns and border closures, particularly in the south, where Mongolian truck drivers ferry coal across the border to China’s steel mills. But these plans were complicated by surging cases, with the daily count going from hundreds a day to thousands.
“We were quite desperate,” said Bolormaa Enkhbat, an economic and development policy adviser to Mr. Luvsannamsrai.
Vero Cell vaccine. Soon after, China donated 300,000 doses of its Sinopharm vaccine to Mongolia, citing a “profound traditional friendship” as motivation.
Opening up more of the border between China and Mongolia was also a part of the vaccine discussions, Chinese and Mongolian officials said in Chinese state media. Mongolia needs China to buy its coal — exports to the country make up nearly a quarter of Mongolia’s annual economic growth. The revenues helped to pad Mongolia’s budget by a quarter last year.
After a month of back and forth, the Mongolian government struck a deal in March with Russia’s Gamaleya Research Institute, too, for one million doses of the Sputnik vaccine. Days later, Mongolia finalized an agreement to buy 330,000 additional doses of the Sinopharm vaccine.
Ulaanbaatar, Mongolia’s capital, 97 percent of the adult population has received a first dose and more than half are fully vaccinated, according to government statistics. Across the country, more than three quarters of Mongolians have already received one shot.
China has shut its border and stopped purchasing Mongolian coal.
Mongolians have also expressed a preference for Russia’s Sputnik vaccine. To get the population to take the Sinopharm shot, the government has offered each citizen 50,000 tugriks — about $18 — to get fully vaccinated. The average monthly salary in 2020 was $460.
The terms and pricing of the Sinopharm and Sputnik deals were not made public, and Mongolia’s foreign ministry declined to comment on pricing. Representatives for the Gamaleya Research Institute and Sinopharm did not respond to requests for comment.
While some global health experts have questioned whether Sinopharm will be able to continue to deliver on its commitments overseas, it has delivered all of the doses Mongolia ordered. China has said it can make as many as five billion doses by the end of the year, though officials have warned that the country is struggling to make enough shots for its citizens.
a third booster shot sooner than expected.
China, for its part, may be playing a long game, said Julian Dierkes, an associate professor at the University of British Columbia who specializes in Mongolian politics. Though many Mongolians may still not trust China, the Mongolian government will remember how it made its vaccines available at a critical moment.
“We could coin a phrase here: ‘The opportunity of smallness,’” he said.
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In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.
But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.
Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.
But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.
dangerous new variants emerge, requiring booster shots and reformulated vaccines, demand could dramatically increase, intensifying the imperative for every country to lock up supply for its own people.
The only way around the zero-sum competition for doses is to greatly expand the global supply of vaccines. On that point, nearly everyone agrees.
But what is the fastest way to make that happen? On that question, divisions remain stark, undermining collective efforts to end the pandemic.
Some health experts argue that the only way to avert catastrophe is to force drug giants to relax their grip on their secrets and enlist many more manufacturers in making vaccines. In place of the existing arrangement — in which drug companies set up partnerships on their terms, while setting the prices of their vaccines — world leaders could compel or persuade the industry to cooperate with more companies to yield additional doses at rates affordable to poor countries.
Those advocating such intervention have focused on two primary approaches: waiving patents to allow many more manufacturers to copy existing vaccines, and requiring the pharmaceutical companies to transfer their technology — that is, help other manufacturers learn to replicate their products.
more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.
But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.
Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.
“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”
Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.
The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”
halting vaccine exports a month ago. Now, as a wave of death ravages the largely unvaccinated Indian population, the government is drawing fire at home for having let go of doses.
poses universal risks by allowing variants to take hold, forcing the world into an endless cycle of pharmaceutical catch-up.
“It needs to be global leaders functioning as a unit, to say that vaccine is a form of global security,” said Dr. Rebecca Weintraub, a global health expert at Harvard Medical School. She suggested that the G7, the group of leading economies, could lead such a campaign and finance it when the members convene in England next month.
Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.
History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.
Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.
“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”
Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.
The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.
stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.
Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.
“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.
Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.
But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.
With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.
“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”
Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.
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In delivering vaccines, pharmaceutical companies aided by monumental government investments have given humanity a miraculous shot at liberation from the worst pandemic in a century.
But wealthy countries have captured an overwhelming share of the benefit. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population.
Vaccine manufacturers assert that a fix is already at hand as they aggressively expand production lines and contract with counterparts around the world to yield billions of additional doses. Each month, 400 million to 500 million doses of the vaccines from Moderna, Pfizer and Johnson & Johnson are now being produced, according to an American official with knowledge of global supply.
But the world is nowhere close to having enough. About 11 billion shots are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. Yet, so far, only a small fraction of that has been produced. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.
more than 100 countries in asking the W.T.O. to partially set aside vaccine patents.
But the European Union has signaled its intent to oppose waivers and support only voluntary tech transfers, essentially taking the same position as the pharmaceutical industry, whose aggressive lobbying has heavily shaped the rules in its favor.
Some experts warn that revoking intellectual property rules could disrupt the industry, slowing its efforts to deliver vaccines — like reorganizing the fire department amid an inferno.
“We need them to scale up and deliver,” said Simon J. Evenett, an expert on trade and economic development at the University of St. Gallen in Switzerland. “We have this huge production ramp up. Nothing should get in the way to threaten it.”
Others counter that trusting the pharmaceutical industry to provide the world with vaccines helped create the current chasm between vaccine haves and have-nots.
The world should not put poorer countries “in this position of essentially having to go begging, or waiting for donations of small amounts of vaccine,” said Dr. Chris Beyrer, senior scientific liaison to the Covid-19 Prevention Network. “The model of charity is, I think, an unacceptable model.”
Pfizer expects to sell $26 billion worth of Covid vaccines this year; Moderna forecasts that its sales of Covid vaccines will exceed $19 billion for 2021.
History also challenges industry claims that blanket global patent rights are a requirement for the creation of new medicines. Until the mid-1990s, drug makers could patent their products only in the wealthiest markets, while negotiating licenses that allowed companies in other parts of the world to make generic versions.
Even in that era, drug companies continued to innovate. And they continued to prosper even with the later waivers on H.I.V. drugs.
“At the time, it rattled a lot of people, like ‘How could you do that? It’s going to destroy the pharmaceutical industry,’” recalled Dr. Anthony S. Fauci, President Biden’s chief medical adviser for the pandemic. “It didn’t destroy them at all. They continue to make billions of dollars.”
Leaders in the wealthiest Western nations have endorsed more equitable distribution of vaccines for this latest scourge. But the imperative to ensure ample supplies for their own nations has won out as the virus killed hundreds of thousands of their own people, devastated economies, and sowed despair.
The drug companies have also promised more support for poorer nations. AstraZeneca’s vaccine has been the primary supply for Covax, and the company says it has sold its doses at a nonprofit price.
stumbled, falling short of production targets. And producing the new class of mRNA vaccines, like those from Pfizer-BioNTech and Moderna, is complicated.
Where pharmaceutical companies have struck deals with partners, the pace of production has frequently disappointed.
“Even with voluntary licensing and technology transfer, it’s not easy to make complex vaccines,” said Dr. Krishna Udayakumar, director of the Duke Global Health Innovation Center.
Much of the global capacity for vaccine manufacturing is already being used to produce other lifesaving inoculations, he added.
But other health experts accuse major pharmaceutical companies of exaggerating the manufacturing challenges to protect their monopoly power, and implying that developing countries lack the acumen to master sophisticated techniques is “an offensive and a racist notion,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University.
With no clear path forward, Ms. Okonjo-Iweala, the W.T.O. director-general, expressed hope that the Indian and South African patent-waiver proposal can be a starting point for dialogue.
“I believe we can come to a pragmatic outcome,” she said. “The disparity is just too much.”
Peter S. Goodman reported from London, Apoorva Mandavilli from New York, Rebecca Robbins from Bellingham, Wash., and Matina Stevis-Gridneff from Brussels. Noah Weiland contributed reporting from New York.
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