Advocacy Group Urges Pfizer to Combat Paxlovid Inequality

Public health experts on Monday urged Pfizer to prioritize the equitable distribution of its highly effective Covid-19 treatment and warned the pharmaceutical giant that if it refuses to provide a timely and adequate supply of its lifesaving antiviral pill to low-income nations, it will replicate the injustice of global vaccine apartheid.

"No African country has yet to purchase the treatment at all."

"We are gravely concerned that inequalities in access to Covid-19 treatments will soon resemble, if not exceed, gaps in vaccine access seen around the world," wrote Peter Maybarduk, director of the Access to Medicines program at Public Citizen, in a letter addressed to Pfizer chairman and chief executive officer Albert Bourla.

"We urge you to choose a better path for your oral antiviral treatment, Paxlovid, by significantly ramping up supply to developing countries," Maybarduk added. "Help end the pandemic this year around the world--not just in a handful of rich countries."

Paxlovid is expected to play a key role in reducing coronavirus mortality after a clinical trial found that the pill decreased hospitalizations in high-risk patients by nearly 90%.

One recent analysis estimated that over half of the global population at increased risk of severe Covid-19 resides in Africa, Asia, and Latin America and the Caribbean. But according to a tracker compiled by Knowledge Ecology International, "Pfizer has entered into Paxlovid supply agreements almost exclusively with countries based in North America and Europe," wrote Maybarduk. "No African country has yet to purchase the treatment at all."

Maybarduk toldReuters that "this is going to be one of the top access to medicines issues of the coming year. It's going to be a tremendously discouraging repeat of vaccine inequity, at least initially, and many of us will be working to mitigate that."

Zain Rizvi, a researcher with Public Citizen's Access to Medicines program, echoed his colleague on Twitter.

"We have been here before," he said, citing data from last month showing that Pfizer was on track to deliver 60% percent of its vaccine doses to wealthy countries that represent just 16% of the world population.

Almost 10 billion Covid-19 vaccine doses have been administered globally to date. While more than 70% of people in high-income nations have been fully inoculated, just 9.6% of people in low-income countries have received at least one shot due to dose hoarding by wealthy governments and knowledge hoarding by pharmaceutical corporations, whose profit-driven refusal to share publicly funded vaccine formulas has generated artificial scarcity.

Pfizer, for its part, has raked in billions of dollars in profits while selling less than 1% of its jabs to low-income nations and rejecting demands to share its vaccine recipe with other drug manufacturers to ramp up global production.

"The same mistake cannot be repeated for treatments," Maybarduk stressed in his letter to Bourla, whose company is expected to bring in more than $100 billion in revenue this year, with over half coming from sales of its Covid-19 vaccine and Paxlovid.

Pfizer says it can produce enough Paxlovid for just 120 million patients in 2022--less than half of the 250 million people the pharmaceutical giant recently predicted may need the pill this year.

"Pfizer is not prepared to meet global need," Maybarduk said in a statement. "Millions of people in developing countries are likely to suffer through a Covid treatment shortage that mirrors the gross vaccine inequity of the past year. Generics can make a major difference, but not for many months yet, and Pfizer is erecting patent barriers in middle-income countries that have suffered terrible pandemics."

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Pfizer has granted a royalty-free license for Paxlovid to the United Nations-backed Medicines Patent Pool (MPP). This agreement allows generic drugmakers to produce the pill to boost supply in 95 countries, a move that experts have described as a clear but inadequate departure from Big Pharma's monopolization of Covid-19 vaccine knowledge and technology.

A Pfizer investor document obtained by Public Citizen, meanwhile, states that MPP-licensed generic pills--projected to treat 95 million patients--are not likely to "come on board" until 2023. This suggests that in addition to being denied equal access to vaccines, people living in impoverished nations will be forced to wait at least one year for a robust supply of Covid-19 treatments.

"This is unacceptable," wrote Maybarduk, whose letter outlines three ways that Pfizer can "step up" this year:

First, it can set aside at least two-thirds of its 2022 supply for developing countries at a reasonable price, and make transparent its allocation criteria, pricing, and delivery schedules;

Second, it can accelerate the entry of generic manufacturers licensed under the Medicines Patent Pool by providing deeper technical assistance and sharing regulatory information; and

Third, it can expand the scope of the Medicines Patent Pool license to allow the generic producers to supply more countries.

Taking these steps, he said, will "prevent needless deaths, ease the pain of medical apartheid, and shorten the pandemic."

Nearly 5.6 million people and counting have died from Covid-19, including over four million since India and South Africa first introduced their widely supported motion to temporarily waive the World Trade Organization's (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement.

Suspending coronavirus-related patent protections for the duration of the pandemic would enable qualified manufacturers to boost the worldwide supply of tests, treatments, and vaccines, but pharmaceutical corporations and a handful of rich nations continue to stonewall the proposal.