The gift that keeps giving for big pharma is C ovid-19. The past two years have seen it make huge profits from Covid vaccines, while also opposing wider sharing of the technology required to make them. Covid antiviral treatment pills are a new money-spinner. We are caught in the same inequality traps we were caught in with the global vaccine roll out.
Paxlovid and molnupiravir are the new antiviral pills from Pfizer and Merck. As with the vaccines that came before them, both corporations have made it their business to decide who gets to make generic versions through the medical patent system, a crucial, life-saving question for millions around the world.
Business looks promising. Pfizer alone expects to make as much as $22 billion from its new pill this year, on top of $37 billion it made from the vaccine in 2021.
The new medication isn't cheap. Paxlovid costs about $530 for a five-day course. molnupiravir, which is approved for use in the UK, costs $700. The cost of production for molnupiravir is $17.74.
The familiar alarm bells should be ringing. Demand for antiviral drugs will quickly surpass supply, according to experts. The World Health Organization produced a report in January that warned of a high risk of shortages of Paxlovid for low- and lower-middle-income countries until generic versions became more widely available. The analysis done by Airfinity suggests that it could be as late as early 2023. Lower-income nations are faced with the possibility of a "wild west" scenario for life-saving pills after an inconsistent global vaccine roll-out.
The Medicines Patent Pool (MPP) is a group of generic manufacturers who can produce cheaper versions of their drugs. Access to generic versions are within reach of only half the world's population, but even with these deals in place, they remain firmly in control.
A number of countries, including Argentina, Brazil, Thailand, Russia, Colombia, Peru, Turkey and Mexico, have been excluded from such licences and are left to try to cut deals for the most expensive products. The companies refuse to make affordable generics available to everyone because they don't want to offend rich countries.
This is a mirror of the vaccine supply earlier in the Pandemic when rich nations bought up too much vaccine. More than $10 billion has been put up by the US for Pfizer's Paxlovid, more than the entire GDP of Sierra Leone. Competition is not even a possibility for less wealthy nations.
The patent strategy of the company is to extend its monopoly on molnupiravir beyond the standard 20-year protection. Since developing the pill, it has sought at least 53 patent applications to tie it up in legal red tape and remain firmly in control of who gets to make it and where. In the US and Japan, it has received emergency approval, and in the UK it has been given the go-ahead.
In nations within the MPP, where the pills are allowed to be made by select manufacturers, a low cost is not guaranteed. A generic version of the pill that costs $18 for a course of treatment has been made by Dr. Reddy's Laboratories in India. The costs won't be reflected everywhere. In Bangladesh, the generic version of Pfizer's pill will cost more than $170 for a course of treatment, which is prohibitive for a large number of people. Firms have control over the final price because they restrict which manufacturers can make a generic version. When the number of manufacturers was increased without these limits, the price of the treatment for hepatitis C, sofosbuvir, dropped.
Those in the global north have tacitly begun to accept some things. Rich nations first, buying up more than they need, while the poor are forced to scramble to outbid each other over what is left, or just wait until they are affordable. The supply crisis is not real. If we had access to the knowhow of Pfizer and Merck, we could easily make more of their drugs in a wide range of developing countries. We need patents and other intellectual property barriers to be waived so we can quickly supply all countries of the world.
We are doubling down on a two-tier world, where rich nations have easy access to both preventative measures and treatments, and poorer nations don't. It's vital that we don't sleepwalk into giving corporations too much control over who gets to live and who gets to die, all balanced on what they deem an acceptable bottom line.
The International Treatment Preparedness Coalition has a medicine access advocate.
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