In search of Covid pills, poor nations fear a repeat of the AIDS crisis

The cost to UNICEF of Paxlovid – including Pfizer’s insistence that UNICEF keep what it pays confidential – remains a sticking point, said Dr. Philip Duneton, which manages the therapeutic arm of the WHO consortium. In announcing its “strong recommendation” for Paxlovid, WHO took the unusual step of publicly blaming Pfizer for a “lack of transparency”, which makes it difficult to know which countries have the drugs and what they are paying for.

“We need to have better visibility in terms of price,” said Dr. Duneton said.

Manufacturers often prefer the details of their sales agreements to be secret so as not to weaken their hand with other potential buyers. Pfizer chief executive Albert Bourla reported last week that Paxlovid has been a “key growth engine” for the company, using a “tiered tariff approach” in which low- and middle-income countries -low will get Paxlovid at a price not – for the profit price.

In response to a New York Times investigation, Pfizer released a statement saying it was “deeply disappointed with the sentiment expressed by our partners,” adding, “We have listened in good faith and responded to many of their concerns.”

Both Pfizer and Merck have also taken steps to make inexpensive generic versions of their pills available, by signing up license agreements with the Medicines Patent Pool, created during the global AIDS crisis to bring low-cost drugs to low- and middle-income nations. It took years and bitter struggles between activists and companies to reach such agreements for HIV drugs.

But the Covid antiviral deals don’t apply to many middle-income nations, including much of Latin America and parts of North Africa and Asia. The result, experts say, is that both poor and rich nations will have access, but countries in between will have to negotiate with companies or force drug makers to give up their intellectual property.

So far, 36 companies from 12 countries have signed up to produce generic Paxlovid. Companies in India are already producing generic versions of both Paxlovid and molnupiravir. The expectation is that both drugs will eventually be available in about 100 low- and middle-income countries, covering roughly half of the world’s population. Companies will not receive royalties from sales while the WHO declaration on the pandemic as a global health emergency remains in effect.

“Given the severity of the pandemic and the fact that vaccines had a very erratic penetration rate, we felt this was a very important contribution the company could make,” said Paul Schaper, Executive Director for Global Public Policy. by Merck.