How Switzerland bought rapid access to Covid vaccines

Switzerland signed contracts for rapid access to vaccines early on in the pandemic. Keystone-SDA

The long-awaited publication of contracts between the Swiss government and vaccine makers has revealed the extent to which Switzerland was willing to go to secure rapid access to Covid vaccines.

Last Thursday, the Swiss government published unredacted contractsExternal link signed with two Covid vaccine manufacturers – Moderna and Novavax – for the first time. The move came in response to a February court ruling that obliged the government to publish the contracts under the Freedom of Information Act after a two-year legal battle.

The release of the contracts marked a significant victory for transparency, following widespread frustration from politicians and media over the Federal Office of Public Health (FOPH)’s refusal to disclose them. While the FOPH had claimed disclosure would hinder Switzerland’s future vaccine negotiations, the court found no evidence that publishing the contracts would harm national interests.

“The secrecy surrounding the FOPH has finally come to an end,” wrote Otto Hostettler, an editor/reporter at BeobachterExternal link, who was a plaintiff in the case against the government. These are some of the first contracts globally to be published in full, shedding light on the prices and terms Switzerland, and likely other wealthy countries, were willing to agree to secure rapid access to Covid vaccines.

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Other Swiss contracts with vaccine manufacturers Pfizer, Janssen, AstraZeneca, and CureVac were published in 2022 with extensive redactions, including the prices. These were not covered by the February court rulings.

How much, how many and how risky?

According to the contracts, Switzerland paid around $1 billion (around CHF920 million in 2021) for Covid-19 vaccines from Moderna and Novavax. The majority ($980 million) of this was paid to Moderna at between $32 and $35 a dose, and $40 for pre-filled syringes. The Novavax vaccines, which the federal government reserved more than a year after Moderna in December 2021, were cheaper. These cost $22 per dose, totalling around $22 million for one million doses.

Contracts with other countries are only partially public, making a comparison difficult. Hostettler reported that the German government paid $32 per dose for Moderna’s vaccine. Other European countries paid slightly less for the same vaccine, while the US paid about half that amount. The Moderna documents state that the price offered to FOPH was “as favourable as the price” offered to other countries that signed deals with Moderna in summer 2020.

Switzerland ordered the first 4.5 million doses of vaccine from Moderna on August 5, 2020, nearly six months before it was approved by the Swiss medicines regulator. Switzerland was also willing to pay a large amount upfront to be on the “priority supply” list. This put it at the front of the queue with a group of countries (other than the US) that signed early contracts.

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By the end of the pandemic, Switzerland had purchased 31 million doses of the then-novel mRNA vaccines. In total, Switzerland ordered 61 million doses from the six vaccine makers for a population of 9 million. This was far beyond the number of doses it ended up using. Some 17 million vaccine doses were administered in Switzerland, and 8 million were donated to other countries.

The contract shows that Moderna prohibited Switzerland from reselling or transferring vaccines outside its territory. A parliamentary committee found that Switzerland destroyed 18.6 million doses of Covid-19 vaccines that had expired. This means that some 60% of doses the government paid for were never used in or outside the country.

Switzerland also agreed to limit the liability of manufacturers in the case of injury. The contracts indicate Moderna would only be liable in cases of intent, negligence, or production defects. For all other risks – especially rare side effects – the government would be responsible for potential claims for damages.

“This isn’t entirely unusual, but it’s quite exceptional on this scale. With conventional vaccines, the manufacturer bears significantly more responsibility,” accordingExternal link to Swiss public television SRF business editor Sven Zaugg. However, different rules apply internationally during a pandemic.

Anne Lévy, the director of the federal health office, defended the vaccine procurement strategy in an interviewExternal link over the weekend. “At the start of the pandemic, competition for supplies was fierce,” Lévy told SonntagsBlick. “It wasn’t clear which company had the best vaccines – imagine if we had bet on the wrong product or ordered too few doses,” she added.

There was a risk that Switzerland, as a small country, wouldn’t have been able to secure a dose either, she said.

Where is global solidarity?

Switzerland was likely not the only country to have negotiated such terms, though this is difficult to verify due to a lack of transparency. In Europe, legal proceedings are still ongoing to publish the contracts with the European Commission in full.

It isn’t unusual or unreasonable for wealthy countries to pay more for drugs. However, health equity experts say the concern is how countries use their wealth as leverage to secure faster access especially when supply is tight. Many wealthy countries ordered far more vaccine doses than their population size.

“Instead of a coherent and cohesive global response, the pandemic has been marked by a chaotic patchwork of responses,” said World Health Organization Director-General Tedros Adhanom Ghebreyesus in a speechExternal link in 2023. “This is because of narrow nationalism. We can only face shared threats with a shared response, based on a shared commitment to solidarity and equity.”

The Swiss government’s deal with Moderna acknowledged that “different financial terms may apply for the sale and delivery of the Moderna vaccine to developing nations”, through NGOs or the WHO. However, during the pandemic, many countries including Switzerland rejected calls from developing countries to waive intellectual property protection that would have boosted supplies.

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In November 2021, only 3% of people in low-income countries were fully vaccinated, compared to over 60% in high-income and upper-middle-income countries. More than half of vaccine doses produced in 2021 were purchased in advance by high-income countries, even though they make up only 13% of the world’s population.

“Rich countries like Switzerland could secure vaccines because they could pay a high price. It was logical that companies like Moderna would favour them,” Gabriela Hertig, a health policy expert at the Swiss NGO Public Eye, told Swissinfo. “Low-income countries also couldn’t provide the kind of liability companies wanted, which made it difficult to get access to vaccines.”

The ability to secure contracts depended on many different factors, Lévy told SonntagsBlick. This includes how quickly a country can conclude a contract, how rapidly and reliably the vaccine can be delivered and the size of the market.

Even as a small country, Switzerland “succeeded in procuring good vaccines early on from various manufacturers in the necessary quantities. This allowed us to bring the pandemic under control,” said Lévy.

Edited by Marc Leutenegger/sb