Almost a year after the start of the first covid-19 vaccination campaigns, the vast majority of vaccines have gone to people in wealthy countries, with no clear way to resolve the disparity.
News this month that an antiviral drug has been shown to be effective against the coronavirus in a large clinical trial has brought new hope of a turning point in the pandemic: a not-so-distant future where a single pill could prevent people infected to die or become seriously ill.
The drug, molnupiravir, manufactured by Merck, is easy to distribute and can be taken at home. The results of the trial showed that it halved the risk of hospitalization and death in people at high risk at the onset of their infections. The company has applied for emergency use authorization from the Food and Drug Administration. A decision could be made in early December.
Unlike vaccine makers Pfizer and Moderna, who have resisted calls for licensing deals to let overseas manufacturers do their injections, Merck will allow generic manufacturers in India to sell the pills for a much lower price in more than 100 countries. poorer. Most countries in sub-Saharan Africa, where immunization rates are as low as 3%, are covered by the agreement.
Access to medicines advocates say Merck’s licensing deal is an encouraging start, but it’s just a small step towards fairness. Merck has started production of the drug, but it’s unclear how much of the generic will be available next year.
The deals leave out many under-vaccinated countries, like Ukraine, which have been hit hard by covid-19. And an antiviral needs to be paired with reliable and affordable testing, which is also limited in many places.
“A drug like this that is stored at room temperature, you can get it even to the most remote parts of the world. It’s fair to say that this drug could prevent hundreds of thousands of hospitalizations and deaths.” , said John Amuasi, an infectious disease. global health expert and specialist at the Kumasi Center for Collaborative Research in Tropical Medicine in Ghana. “But the barrier will be the price. See how long it took for the vaccines to reach Africa.
More than 18 months after the start of the pandemic, covid-19 remains a disease to be endured rather than treated. The few drugs that have shown some benefit – such as monoclonal antibodies – are expensive, complex to administer and, in poor countries, scarce or absent.
The US government bought a large chunk of the supply of antiviral remdesivir last year after early research showed it could speed up recovery from covid-19. Now he is pursuing a similar strategy for molnupiravir: he has a $ 1.2 billion deal to purchase 1.7 million treatments of the drug if it receives FDA clearance.
Merck was criticized two decades ago for selling its anti-HIV drugs at unaffordable prices in Africa. This time, the company recognized the imperative to expand access as early as possible.
The voluntary licenses the company has negotiated with Indian drug makers offer the possibility that governments in poorer countries can purchase molnupiravir for well under $ 20 per five-day course, compared to $ 712 in the US deal.
The eight Indian companies are in clinical trials with their versions of the drug, and four have confirmed to the New York Times that they expect to release the results soon. An industry executive who was not authorized to speak officially said he expected his company to produce the drug for less than $ 10 per course.
Merck is also in talks with the Medicines Patent Pool, a UN-backed nonprofit that works to make medical treatments and technologies accessible.
Charles Gore, director of the organization, said he hoped Merck would agree to a licensing deal that could allow companies in an even wider range of locations to manufacture the drug while Merck sells its own product in the rich countries. Such a deal, he said, would set an important precedent for other companies.
If Merck, Pfizer, or other drugmakers do not ensure wide availability of covid-19 treatments, they could face widespread use of compulsory licensing, in which governments override intellectual property restrictions to allow the manufacture of drugs, often in emergency situations. While Merck will levy a royalty on drugs sold by generic manufacturers and probably also on any deals made through the patent pool, under compulsory licensing, the company has no say in the price of the drug. drug or the amount of the fee.
Merck’s voluntary licenses for molnupiravir are all granted to companies in India, a concentration that could present risks.
Covax, the alliance of organizations backed by the UN that works to deliver vaccines to the poorest countries, relied on the Serum Institute of India to produce the bulk of the injections. But after the virus surged in March, the Indian government banned vaccine exports, and these are only resuming now.
Testing will be an additional challenge. Medications work best if taken when symptoms first appear, and patients need to be sure they have the coronavirus. But testing is scarce in many places: WHO estimates that less than 15% of covid-19 infections are detected in Africa, for example.
But if early antiviral treatment is available globally, it could reduce the spread.