Moderna this week moved to address vaccine-inequality criticisms by promising to never enforce its patents against potential COVID-19 vaccine manufacturers in 92 low- and middle-income countries.

The U.S. firm also said it would establish an mRNA vaccine plant in Kenya and push to develop vaccines for more than a dozen diseases that aren’t COVID-19—currently the only ailment for which Moderna has a product.

Vaccine equity advocates, who are trying to turn around a situation where less than 18% of Africans have received even one COVID jab, are not impressed.

“Moderna is clearly feeling the pressure from the millions of people challenging their lucrative monopoly, but their billionaire CEO [Stéphane Bancel] shouldn’t get to choose who lives and who dies in this pandemic,” thundered People’s Vaccine Alliance policy adviser Julia Kosgei.

“This is the absolute minimum we should expect,” complained Nick Dearden, director of the NGO Global Justice Now.

Here’s how Moderna’s promises fall short in the eyes of these campaigners—and how those developing new mRNA vaccines plan to push past the pledge’s limitations.

Patent pledge

Moderna’s pledge to never enforce its COVID-vaccine patents in non-rich countries really is a significant step. Until now, the drugmaker has only said it wouldn’t enforce its patents against other companies during the pandemic.

With the end of the pandemic perhaps being in sight, Moderna had to make a decision one way or the other, and now it’s done just that, splitting the ways it will respond to patent issues in rich countries and the rest of the world.

But the list of the 92 countries—all of which are getting vaccines through the COVAX financing mechanism for developing nations—has some notable exceptions such as South Africa and Brazil, which are countries that have the capacity to produce serious quantities of vaccines.

South Africa is particularly important because it’s where the World Health Organization last year set up an mRNA vaccine technology-transfer hub, which bore fruit a month ago when the Cape Town–based biotech Afrigen revealed a prototype mRNA vaccine for COVID-19 that is based on Moderna’s sequence.

In the ensuing weeks, the WHO announced plans to share the technology with potential manufacturers everywhere from Pakistan and Vietnam to Serbia and Senegal. However, the vaccine’s development will be slowed by the fact that Moderna has refused to cooperate with the WHO hub in providing technical expertise; the WHO has estimated this means it will take at least three years to get the vaccine finished and approved, rather than 12 to 18 months.

Moderna told Politico that the WHO’s South African hub would be party to the pledge, even though South Africa isn’t on its list. That would certainly go some way to giving the WHO and its partners some legal certainty about the future—albeit only relating to COVID vaccines and not to other potential mRNA vaccines for things like tuberculosis and HIV, which the WHO hopes to develop.

However, Bancel told the publication that Moderna wouldn’t work with Afrigen and other hub participants, because that wouldn’t be “a good use of our time.” He also described the hub as a “nice to have, not a must have.”

“Incredibly unhelpful”

Dearden described this as “incredibly unhelpful” on Moderna’s part. “The systems are all set up for Moderna to share their technology with the mRNA hub,” he told Fortune on March 9. “They have the systems in place with the WHO to share this technology around the world, [but] Moderna wants to do everything possible to control this technology.”

“If Moderna really cared about vaccine access for low- and middle-income countries, they would share their vaccine blueprints with the WHO’s COVID-19 technology access pool, cooperate with the WHO mRNA hub in South Africa, and revoke the patents they have filed in that country,” Kosgei said in a statement.

However, professor Petro Terblanche, Afrigen’s managing director, told Fortune that Moderna’s failure to transfer technology to the WHO hub had turned out to be a blessing in disguise, because such a deal may have restricted the team to only making COVID vaccines using Moderna’s blueprints.

“In hindsight we are quite grateful that never happened,” she said. “It allowed the group of South African scientists and partners to really innovate and to break out of the box of the technology transfer and build a platform.

“We already are putting programs together to look at HIV, Ebola, and dengue fever,” Terblanche said, adding that it would be unsustainable to develop the mRNA technology for COVID alone. “This is designed to be a multiproduct platform, and this is what we want to transfer to these low- and middle-income countries,” she said.

Terblanche welcomed Moderna’s decision not to enforce its patents in the 92 countries. “That those countries are unlikely to be the front-runners in adopting this technology doesn’t matter,” she said. “It just says, ‘We are prepared to provide that freedom.’ Moderna, thank you, this is much more than we had a year ago.”

Partnerships

Also included in Moderna’s announcement was an invitation to researchers around the world to join Moderna’s new “mRNA Access” program. There, they could codevelop mRNA drugs for existing “neglected diseases” and “explore novel vaccine designs against prototype viral families in preparation for Disease X”—a term the WHO uses to refer to a future pandemic we currently can’t anticipate.

Dearden said Moderna will benefit by co-patenting the resulting inventions and intends to maintain “monopoly control” over the technology. (Moderna had not responded to a request for comment at the time of publication.)

However, the NGO chief conceded that the program wouldn’t be counterproductive, as long as it isn’t “enough to convince those scientists and governments and manufacturers in the Global South to go, ‘Well, we can give up on our independent efforts now and just go with this solution.’

“I don’t think it’s going to convince anybody, particularly given their hostility to the scientists at Afrigen,” he added. “Moderna are clearly worried about being perceived to be on the wrong side of history here, I think with good reason.”

“The message from the mRNA hub to Moderna is we really welcome these announcements, and we’re really excited about the opportunities it brings to Africa and to our partners, and we will walk the road,” said Terblanche. “But I tell you this, we’re going to keep going. We’re going to take a vaccine to market for COVID-19, but we’re also going to do other vaccines using our mRNA platform because this platform provides a tool to low- and middle-income countries to expedite.

“We’re going to go full blast, with many partners. Our invitation to Moderna is: Work with us.”