ROCHESTER, Minn. -- Should the makers of COVID-19 vaccine be compelled to share their methods with the world?
Leading vaccine doctors won't say.
President Joe Biden supports waiving patent protections for the vaccines, which have brought down hospitalizations and death but remain in the hands of a few companies lacking capacity to produce them on a global scale.
Though wealthy nations have high rates of vaccination, dozens of poor countries remain below 5% vaccination rates, rapidly dividing the planet into a world of COVID-19 haves and have-nots, and notably by color.
Beyond inequity, critics say this creates a false sense of security for Americans now receiving third doses.
The longer poor nations of color go without, they argue, the greater the likelihood that a vaccine-resistant variant will make its way into the U.S. health care system, undoing all progress.
As Mayo Clinic's Dr. Greg Poland said recently, "this is a we, not me situation," one in which the fate of distant others affects that of patients here within the U.S.
It's why earlier this week, a group of U.S. senators, led by Sen. Elizabeth Warren, signed a letter urging Biden to release patent protections on the Moderna vaccine, which received billions of dollars in federal aid to get to market.
They were joined in calling for sharing of intellectual property by Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention.
In a Washington Post piece published Tuesday, Oct. 12, Frieden said the fact that just 4% of the world's 6.5 billion doses of COVID-19 vaccine have gone to poor countries was "morally indefensible," and that it could cause millions of added deaths.
"The only responsible way forward," Frieden wrote of drug giants Pfizer and Moderna, "is for them to transfer their vaccine technology to other companies that can rapidly increase production."
He added that this can be done without erasing their patent rights or royalties.
Doctors who speak up, and others who remain silent
What do influential vaccinologists believe about sharing vaccine technology?
Poland, Mayo's face of vaccine messaging and a global authority in the research and development of the medicines, won't say. He declined comment through a spokesperson.
Mayo's Robert Nellis cited a separation within Mayo between opining on medical practice and public policy, saying that "Mayo generally does not comment on government policy or positions."
Nor would Dr. Paul Offit lend his support to sharing IP. A pediatrician at Children's Hospital in Philadelphia and past member of the CDC's advisory committee on vaccines, the prominent American vaccine authority suggested the question of technology transfer was better directed to a medical ethicist.
Other doctors argue that ethics and policy are uniquely a part of stopping the spread of COVID-19.
"I am an advocate of physicians bringing their professional expertise to bear on these important decisions and policy decisions," said Dr. Nathan Chomilo, a pediatrician with HealthPartners, and the Senior Equity Advisor to the Commissioner of the Minnesota Department of Health.
"Particularly those who have expertise in vaccine development, distribution, and who hold prominent places in this conversation," he added. "It really is important for them to be taking this up ... to bring professional expertise to bear on this civic discussion."
Chomilo supports the release of vaccine technology by citing an Aug. 10 letter to the White House signed by 175 medical experts, scientists and civil society leaders, including deans of five leading public health, nursing, and medical schools.
No Mayo clinicians are listed as signers to that letter.
"The United States should explore all legal options," it read, "to compel mRNA manufacturing originators to share technology and voluntarily license their technology to contract manufacturers around the world, including mRNA manufacturing hubs."
"There's a global pandemic," Chomilo says. "There's a conversation to be had about how do the structures that were set in place during nonpandemic times need to change ... in order to address this threat. Then if they wish folks can go back to what was working before it."
"They talk about a wartime effort. In a wartime effort, you do what's necessary. You don't just stop and say we've done our part ... It's not going to be easy in the way our society is structured to get folks to agree to technology transfer, but I think it's definitely necessary."
Christian ethics and pandemic medicine
In recent remarks to the media, Mayo's Poland suggested that getting vaccinated, social distancing and wearing masks constitutes a show of Christian ethics.
He cited a popular passage written by reformation figure Martin Luther when the Black Death returned in 1527 to Wittenburg, Germany.
"'I shall avoid places and persons where my presence is not needed,'" the vaccinologist quoted from the famous letter. "That's social distancing. Interesting morality there."
"'If everyone would help ward off contagion as best he can,'" he continued from the 500-year-old passage, "'then the death toll would indeed be moderate. But if some are so foolish as to not take precautions -- now we would say (that means) masking, distancing and vaccines-- and aggravate the contagion, then many will die.'"
Today, the head of the church started by Martin Luther supports the sharing of vaccine technology.
“We cannot abdicate our responsibilities to our sisters and brothers by imagining that the market can be left to resolve the crisis," read a letter signed last spring by 150 faith leaders, including Lutheran World Federation General Secretary Rev. Dr. Martin Junge.
"We have a moral obligation to reach everyone, in every country.”
The letter was written in support of The Access to COVID-19 Tools (ACT) Accelerator, a World Health Organization proposal that "recognizes and aims to address the requirement for information sharing -- whether about technology, intellectual property or manufacturing," to combat the pandemic.