In view of the stagnating German vaccination campaign, it is easy to forget that there is still a shortage of Covid vaccines in parts of the world. Currently, just under 15 percent in poor countries have received at least one injection. The unequal distribution of vaccines was repeatedly criticized and improvements were repeatedly praised. And yet the development seems to be repeating itself at the moment with Paxlovid, the drug that represents one of the greater hopes for the treatment of Covid-19. Poorer countries are currently at a disadvantage when purchasing the drug, which is taken in tablet form and can reduce the risk of severe Covid courses by up to 89 percent.
To date, about a dozen wealthy countries have ordered the drug from the US manufacturer Pfizer for a total of 28.5 million people, according to data from Duke University in the United States. This corresponds to a quarter of Pfizer’s planned annual production. The USA is there with 20 million packs, Great Britain with 2.75 million and Germany ordered tablets for a million inhabitants weeks before the EU approval. Health Minister Karl Lauterbach (SPD) said they were “particularly suitable for the treatment of unvaccinated risk patients”.
There are particularly many such people in the poorest countries. However, not one of these countries is on the Paxlovid order list. So far, their residents can at best benefit from Pfizer’s commitment to give Paxlovid to the children’s charity Unicef in the course of the year. The delivery should include “up to four million” packs – intended for young patients in 95 countries. This quantity should not cover the demand.
Not even research is possible with the drug in poorer countries
Poorer countries are disadvantaged to such an extent that they apparently cannot even hope for drugs for trials. According to the Drugs for Neglected Diseases Initiative (DNDI), an international research organization that works with scientific institutions around the world, Pfizer blocks research in less affluent countries.
The initiative had asked for tablets for about 1,000 to 2,000 patients in order to subject the drug to further tests. Specifically, it should be examined to what extent a major disadvantage of the preparation, which is particularly evident in poorer countries, can be avoided. Paxlovid should be taken as soon as possible after infection, but no later than five days after the onset of symptoms. This is difficult to achieve in regions where diagnostic resources are also scarce. Data from the DNDI indicate that more than half of Covid patients can only seek treatment after the fifth day of illness. The initiative therefore wanted to test whether the time window could be opened further by combining it with other drugs. But nothing seems to come of it at first.
“It’s hard to understand why people refuse to cooperate in the midst of a global pandemic,” says DNDI staff member Nathalie Strub-Wourgaft, who is responsible for Covid-19 research at the organization. She also warned of a “dangerous precedent” given that there are many other promising antiviral drugs in the pipeline that need follow-up research so they can be optimally used in poorer countries.
Márcio da Fonseca, infection specialist at Doctors Without Borders, also emphasizes that research is needed in as many different environments as possible. The factors that influence health and disease can differ significantly between poorer and richer regions. Therefore, different treatment strategies need to be evaluated, including timing, possible drug combinations, and for which patients the therapy is most appropriate in practice. He demands: “The profit interests of private companies must not prevent the necessary research work from being carried out, especially since this is associated with the risk of more suffering and death.”
Pfizer apparently makes the production of cheap generics more difficult
At the same time, the DNDI criticized the fact that Pfizer also made it difficult to provide cheap imitation drugs. The company had agreed that other companies could also produce the drug. But according to DNDI, some of these manufacturers are having trouble getting Paxlovid as a reference drug. You need this to prove that your preparations correspond to the original.
Márcio da Fonseca urged the company to provide samples of Paxlovid: “And this must be done urgently: some forecasts suggest that otherwise this drug will not be available to people in low- and middle-income countries until 2023, which is unacceptable. “
Pfizer did not comment specifically on the allegations, but said that the company is aware of the important role additional data and information can play in governments’ pandemic management. “We are committed to well-controlled, hypothesis-driven clinical trials that can provide data that are accepted by global regulatory authorities and thus deliver the highest benefit for patients,” the company said when asked. “Further studies on Paxlovid are already underway or are currently being examined.”