Pfizer will allow its Covid pill to be made and marketed cheaply only in impoverished countries

The company has announced a deal that could significantly expand access to the Covid-19 drug, although it excludes several countries that have been strongly sa truck by the pandemic.

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Pfizer announced a contract on Tuesday that will allow its promising drug Covid-19 to be manufactured and supplied at low cost to 95 impoverished countries that represent more than half of the world’s population.

The pact follows a similar deal Merck struck last month, and the partnerships together have the potential to dramatically increase the global manufacture of two core antiviral drugs that could change the trajectory of the pandemic by preventing serious illnesses caused by the coronavirus.

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“The fact that we now have two manufacturer’s licenses anywhere for these two drugs is a huge step forward, and this contrasts sharply with the restrictive licenses for vaccines so far,” said James Love, Executive Director of Knowledge Ecology International, an organization that studies availability of medical products.

Pfizer will transfer a royalty-free license for the pill to the Medicines Patent Pool, a United Nations-backed nonprofit, under the terms of the agreement, which will allow manufacturers to license.

They will receive the drug formula from Pfizer and can sell it in 95 poor countries, mostly in Africa and Asia, once regulators in those countries approve the drug. A similar deal was signed with Merck to have its Covid antiviral tablet, molnupiravir, manufactured and supplied at low cost in 105 developing countries.

Nonetheless, there are many questions as to whether this measure will be adequate to ensure a sufficient supply of drugs for countries that still lack Covid vaccines.

The Pfizer deal, like the Merck deal, excludes several impoverished countries that have been hit hard by the virus.

Brazil, which has one of the highest pandemic death rates in the world, along with Cuba, Iraq, Libya and Jamaica, will have to buy pills directly from Pfizer, most likely at a higher price than what generics will charge, and those countries risk being cut off from supply.

The two treaties exclude China and Russia, two middle-income countries with a combined population of 1.5 billion people. Brazil is also excluded.

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Nonetheless, Pfizer’s approach to its drug is radically different from its approach to vaccination against Covid. The company has distributed more than two billion doses of the vaccine internationally, but only about 167 million of these have gone to poor countries, which are home to around four billion people.

It hasn’t licensed any manufacturer to make its Covid vaccine, which is expected to generate $ 36 billion in revenue this year.

The Pfizer pill, which will be offered in wealthy countries under the brand name Paxlovid, has been shown to be very effective in preventing serious illness when given to high-risk, unvaccinated research volunteers soon after. they started showing symptoms of Covid in a pivotal clinical experience.

The drug is desperately needed in areas where few people have had the opportunity to get vaccinated. And because it’s a pill that can be taken at home, it will be considerably easier to dispense than intravenous therapy.

“This will be especially critical for low- and middle-income countries because it’s easy to follow, only lasts five days, and maybe quite cheap to create,” said Charles Gore, executive director of the Medicines Patent Pool.

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However, Felipe Carvalho, the coordinator of Médecins Sans Frontières’ access to medicines campaign in Brazil, expressed disappointment that his country was excluded from the deal. “It is inexcusable that a high burden country like Brazil is once again left behind in terms of access to treatment,” he said.

Even though his country is upper-middle-income, he says three-quarters of Brazilians depend on the public health system and few can afford expensive procedures.

Merck would allow its pill, molnupiravir, to be manufactured and supplied at a reduced cost in 105 developing countries.

Despite their promise, the impact of Pfizer and Merck tablets will depend on patient access to affordable and straightforward Covid testing.

To be successful, drugs must be administered within days of onset of symptoms, which experts say will be difficult in wealthy countries and even more difficult in countries where people have less reliable access to medical specialists. health.

The drug from Pfizer may have the following advantages over the drug from Merck: According to the results of the trials, it appears to be more effective and the method by which it prevents the replication of the coronavirus appears to be safer, especially for use in patients. pregnant women and women at risk of becoming pregnant.

These reasons are expected to increase the worldwide demand for the Pfizer pill.

The drug from Pfizer may have the following advantages over the drug from Merck: According to the results of the trials, it appears to be more effective and the method by which it prevents the replication of the coronavirus appears to be safer, especially for use in patients. pregnant women and women at risk of becoming pregnant.

These reasons are expected to increase the worldwide demand for the Pfizer pill.

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Australia and the UK have already secured part of Pfizer’s supply of tablets. No supply contract has yet been announced in the United States, where Pfizer is expected to apply for an emergency clearance soon.

Mr Gore said more than 20 companies have contacted the patent pool to express interest in a license to manufacture the drugs from Pfizer, and production could begin in the first quarter of next year.

However, availability will also be determined by how quickly regulators and the World Health Organization approve the drug, he said.

Pfizer therapy is designed to be taken at home as a five-day regimen of 30 tablets. Ten of the pills contain a modest dose of ritonavir, an HIV medicine, intended to slow down the breakdown of Pfizer’s pill so that it stays active in the body longer.

Ritonavir is manufactured by generic manufacturers around the world, however the effectiveness of Covid treatment depends on the availability of the drug. Pfizer spokesperson Kit Longley said the company did not anticipate any problems with the supply of ritonavir.

When the drugs Merck and Pfizer both become generic, clinicians will be able to use them together as treatment, potentially preventing even more people from entering overcrowded hospitals.

Mr Gore referred to previous experiences with other viruses, such as HIV and hepatitis C, in which antivirals were more effective when used in combination.

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