Just a quarter of Pfizer's COVID-19 treatment orders will go to developing countries

Rich countries have secured almost three times as many courses of a World Health Organisation (WHO)-recommended COVID-19 medicine, Pfizer's Paxlovid, according to new analysis from Oxfam and the People's Vaccine Alliance.

Using new data from Airfinity, they found that just a quarter of orders for the treatment will go to low- and middle-income countries, despite the fact they make up 84 per cent of the world's population and have a much greater need as far fewer people are vaccinated against COVID, unlike rich nations which are largely protected.

On the eve of crunch talks at the World Trade Organization (WTO) over intellectual property rules for COVID-19 treatments and tests, the organisations are warning that we are seeing the same worrying trend of inequity that we saw with COVID vaccines.

Pfizer's monopoly also means that some middle-income countries could be paying ten times more for Paxlovid than a generic equivalent, with reports of them being quoted as much as $250 per course. This is despite the fact that other lower-income countries will have access to a Clinton Health Initiative (CHAI) deal with Pfizer and undisclosed generic companies, which means they could access the treatment for just $25 a course.

Dr. Catherine Kobutungi, Executive Director of the African Population and Health Research Center said: "When vaccines were our main medical tool to fight COVID-19, big pharmaceutical companies prioritized maximizing their profits by selling doses to the richest countries. Millions died while people in low- and middle-income countries were sent to the back of the vaccine queue. And now, we are witnessing a repetition of the same inequity with COVID-19 treatments and tests."

"Oral antiviral treatments are easy to administer. They reduce hospitalization and cut deaths. And they may reduce the likelihood of long COVID. Yet, right now, they're nearly exclusively accessible to people in the richest countries. The fact is that if you are a vulnerable person with COVID-19 in a high-income country, you will probably have access to treatments that can help you survive. If you live in a lower-income country, you probably won't. It's grotesque inequality and it kills", she added.

The WHO recommends using Paxlovid to cut COVID-19 hospitalization and death rates, and has called for equitable global access to COVID-19 medicines as part of a strategy to combat long COVID. A recent, non-reviewed study suggests that Paxlovid may lower the risk of patients developing long COVID.

There are hundreds of other potential COVID-19 medicines in the development pipeline, including at least 77 in late-stage clinical trials that could be more effective and have a wider scope of use. However, intellectual property rules are giving a small number of companies a monopoly on supply, allocation, and price, meaning low- and middle-income countries are unlikely to have affordable access to these medicines either.

Because far fewer people in low-income countries are vaccinated than in rich countries, they are more vulnerable to hospitalization and death from COVID-19. These countries have already experienced the highest death toll in the pandemic, a trend that could continue without access to treatments like Paxlovid.

Jennifer Reid, Senior Health and Vaccine Equity Advisor at Oxfam, said: "After the inequity they faced with the vaccine rollout, developing countries are now experiencing access and affordability issues for COVID treatments. It is a disgrace that those who need them the most are receiving the least and that patent laws are handing Pfizer a long monopoly on this lifesaving medicine.

"Addressing both acute and long COVID is essential - and the WHO has been clear that countries need treatments like Paxlovid to cut deaths and hospitalizations. But the patents minefield is a massive barrier preventing many developing countries from getting the medicines and tests they need now and in the future to save lives."

In June, after a year and a half of negotiations, the WTO rejected proposals to waive intellectual property rules for all COVID-19 medical technologies, adopting a far more limited text that only covers vaccines. Ahead of talks taking place tomorrow in Geneva, civil society organizations are urging WTO member states to immediately agree to an extension to include treatments and tests, which would allow developing countries to produce for their own populations and export for others in need, ensuring essential tools are accessible and affordable.

Mohga Kamal Yanni, Policy Co-Lead for the People's Vaccine Alliance, said: "Decades ago, governments allowed pharmaceutical companies to control the price, allocation, and supply of lifesaving HIV medicines - and millions of people died without affordable access. Now, the same thing is happening again with COVID-19 vaccines and medicines. Companies have been allowed to decide who lives and who dies. WTO member states must ensure that public health takes precedence over commercial interest."