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The global COVID-19 treatment divide
Ann Danaiya Usher
Experts warn of huge global inequities in access to new treatments for COVID-19. Ann Danaiya Usher reports.
The brutal logic that has divided the world into vaccine haves and have-nots is now being repeated as game-changing COVID-19 drugs like Pfizer's oral antiviral Paxlovid (nirmatrelvir–ritonavir) enter the market. “The global community is sleepwalking into yet another great divergence when it comes to medical technologies”, says Zain Rizvi, lawyer at the Washington-based advocacy organisation Public Citizen. “We have lived through more than a year of vaccine apartheid. And now we are poised at this moment to see huge inequalities in treatment access.”
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2 years after the emergence of COVID-19, there is finally a drug that appears to stop the disease early in its tracks. On Nov 5, 2021, Pfizer announced the results of the phase 2/3 trial of its new oral antiviral treatment Paxlovid: hospitalisation of high-risk patients was reduced by 89% when administered in the first few days after symptoms appeared. Paxlovid is a course of pills taken at home over several days. Because this regimen places little demand on health personnel and avoids the need for medical oxygen support and other interventions, it offers huge advantages for countries with weak health systems.
Pfizer plans to produce 120 million courses of Paxlovid in 2022. High-income countries (HICs) have already purchased the first 30 million courses expected to be available by July, 2022, with the USA claiming the lion's share, according to research by Knowledge Ecology International. Pfizer is reportedly talking to 100 countries about sales of the remaining 90 million courses. However, barring a decision by Pfizer to set aside a portion of its production, this treatment is likely to remain out of reach for most people in low-income and middle-income countries (LMICs) for at least a year.
“This was bound to happen”, says Catherine Kyobutungi, director of the African Public Health Research Centre in Nairobi, Kenya. “Given how the world has behaved with diagnostics and vaccines, you could not expect anything different with therapeutics.”
Furthermore, because Paxlovid must be taken soon after the onset of symptoms, testing is a prerequisite for use. But COVID-19 tests are scarce in low-income countries. Of more than 3 billion tests performed worldwide, only 0·4% were done in low-income countries, according to the FIND SARS-Cov-2 test tracker. A global roll-out of this new medicine would therefore require a simultaneous massive increase in access to diagnostics.
Until last autumn, only a few drugs had proven effective against COVID-19: anti-inflammatories, such as dexamethasone, and monoclonal antibodies. These are treatments for patients with severe symptoms that must be administered in hospital. Paxlovid has caught the interest of global health advocates because it targets mild COVID-19 and is easy to take. “We know from the past 2 years that COVID is crashing health systems, not only in terms of crowding hospitals and exhausting doctors and nurses, but also draining resources for other illnesses”, says Yuanqiong Hu, senior legal adviser specialising in intellectual property at the Médecins Sans Frontières (MSF) Access Campaign. “Having a treatment available to manage milder symptoms of COVID would be super important to preserve health systems going forward.”
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