As the COVID-19 pandemic continues to rage around the globe, killing thousands daily and pushing as many as 176 million people into extreme poverty, governments and companies are scrambling to develop a safe and effective vaccine. While roughly 165 vaccines are in development globally, only ten have advanced past early stage safety trials to phase three clinical trials.

Among the front-runners in the United States is Moderna’s mRNA-based vaccine, which was initially developed by scientists at the National Institutes of Health (NIH), University of Texas at Austin, University of North Carolina at Chapel Hill, and Vanderbilt University. Working with Moderna scientists, researchers identified a vaccine candidate based on the structure of the viral spike protein and were able to show that the potential antidote protects against viral infection in animal models. In a highly accelerated timeline, Moderna began NIH-sponsored human trials to establish safety in small cohorts, and on July 27 launched phase three trials that will enroll thirty thousand people across the United States.

It’s still unclear how effective the Moderna vaccine will be. But one thing is already apparent: the company’s executives intend to profit handsomely.

Moderna is currently charging up to $74 a treatment (two doses, priced at $32 to $37 each), well above the target prices announced by several other companies with potential vaccines, including AstraZeneca and Johnson & Johnson, who have told Congress they will not seek to make a profit from vaccine sales.

The US government managed to secure a discount earlier this month, signing a $1.5 billion contract with Moderna for one hundred million doses with the option of purchasing another four hundred million. Other countries, and Americans who don’t get the vaccine through the government, will have to negotiate separately.

Moderna’s stock price has ballooned over 350 percent in the last six months in anticipation of the windfall, and insiders have already started cashing in. CEO Stéphane Bancel, chief medical officer Tal Zaks, and other executives have sold nearly $100 million in stock this year. Investment funds like Flagship Ventures have sold over $68 million in shares. Brigham and Women’s Hospital president Elizabeth Nabel, who was forced to resign from Moderna’s board over conflict of interest concerns, sold at least $6.5 million in stock, even as the hospital runs clinical trials for Moderna and freezes wages and benefits for thousands of employees. Other Boston-area biopharma elites stand to make a fortune as well. MIT professor Bob Langer and Harvard professor Timothy Springer are among the largest shareholders, each holding a stake in Moderna worth about $1 billion.

If Moderna’s vaccine gets the green light, the American public will have paid Moderna twice: once to develop the vaccine and again to sell it.

A staggering $955 million in public money is underwriting Moderna’s work toward a COVID-19 vaccine. This massive public intervention, on behalf of a company that has yet to bring a product to market, has covered 100 percent of the vaccine’s development costs since at least April and provided Moderna’s public research funding for mRNA technology dating back to at least 2013. The government’s investment is so significant that the National Institutes of Health claims joint ownership of key intellectual property underpinning the vaccine.

Yet despite the vast sums of government money showered on Moderna, the biotech company is seeking exclusive patent rights — which would enable it to maximize the vaccine’s cost and control distribution worldwide.

Others are scrambling to get a piece of Moderna’s pie. Arbutus Biopharma is patent trolling Moderna, claiming rights to some of the intellectual property underlying the vaccine. A recent legal victory for Arbutus, which could theoretically halt advances toward the vaccine but will likely just be used as leverage to extract a licensing fee, caused Moderna’s stock to drop by almost 10 percent.

This legal wrangling will do nothing but slow the fight against the virus. As progressive activist and ALS patient Ady Barkan has warned, “patent monopolies have fueled the current drug pricing crisis, and they may block access to any future COVID-19 vaccine.”

Barkan’s solution is simple: “Vaccines belong to the people.” And groups like Universities Allied for Essential Medicines agree. Their members urge governments to force nonexclusive licensing and allow generic production.

Defenders of the current system, such as former Association of University Technology Managers president Fred Reinhart, insist that lowering prices or breaking patent monopolies would put the brakes on future investment in drug development and trigger a collapse of America’s “innovation ecosystem.”

But that’s just plain wrong. It misrepresents who is responsible for innovation and ignores the history of successful price reduction campaigns in pharmaceutical development. America’s medical innovation is the result of more than a century of accumulated scientific knowledge, dedicated workers, world-class education, and substantial government funding — not policies that feather the nest of pharmaceutical companies.

In fact, rather than promoting innovation, profit-driven investing is directly implicated in many failures to develop new drugs, especially when they would benefit low-income or marginalized people. This failure can be seen most acutely in the pharmaceutical industry’s abandonment of antibiotic resistance research. Even venture capitalists admit that market failure is largely responsible for the dearth of novel antibiotics, which leads to millions of preventable deaths.

And then there’s the current crisis: for years, private industry refused to work on a coronavirus vaccine, despite scientists’ pleas after the SARS epidemic in 2003. Although researchers, like Peter Hotez at Texas Children’s Hospital, had promising candidates that warded off deadly strains of coronavirus in animal models, they “just could not generate much interest” in funding human trials.

Looking further back, we know from some of humanity’s worst epidemics that high prices and exclusionary licensing put treatment out of reach for many and can lead to countless preventable deaths.

The HIV/AIDS epidemic of the late 1980s and early 1990s is perhaps the most tragic example. When the first effective treatments, AZT and d4T, were developed, they were exclusively licensed and went on the market as the most expensive drugs in history. Largely due to these barriers, most people on earth with HIV/AIDS did not receive the treatment.

Eventually, thanks to the efforts of activists, Yale University and Bristol-Myers Squibb released their exclusive patent rights for generic manufacturing, causing d4T’s price to plummet nearly fifty-fold. This nonexclusive licensing — the same type Moderna and the government could elect for the COVID-19 vaccine — yielded an affordable, widely used drug that saved millions of lives.

Moderna’s leaders have the power to make these changes overnight. They should begin by signing the “Open COVID Pledge” and joining the World Health Organization’s COVID-19 technology access pool, both of which commit COVID-19–related knowledge and intellectual property to the public sphere.

Government agencies funding the work can also choose to exercise “march-in” rights to force nonexclusive licensing, a power granted under the 1980 Bayh-Dole Act in cases where “health or safety needs… are not reasonably satisfied” by the company receiving public support. In either case, the choice to open the technology and set prices at cost can be made without reservation or interference.

The American public has paid for the development of Moderna’s vaccine. We should expect some ownership — not to profiteer, but to end the COVID-19 pandemic as quickly and equitably as possible. We should demand that the vaccine be fairly priced, available to all, and free at the point-of-delivery. We should insist that technology and results of development and testing be made public for worldwide scrutiny and use.

The choice is simple — prioritize shareholders and executives or put human life over private profit in the defining health crisis of our generation.