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New Analysis Reveals Shocking Extent of Unmet Need for Paxlovid in LMICs During COVID-19 Emergency

Washington, D.C. – In an analysis released today, Public Citizen and the Health Global Access Project (Health GAP) found that the number of people with high risk COVID-19 infections in low and middle income countries (LMICs) exceeded procured supply of the World Health Organization’s antiviral of choice – nirmatrelvir/ritonavir, marketed by Pfizer as Paxlovid – by at least eight million courses in 2022. This shortfall late in the COVID-19 emergency left unmet at least 90% of health need for the WHO-preferred treatment in developing countries.

The news comes as Pfizer announced planned U.S. price hikes for Paxlovid, which could further inhibit treatment access, and as the U.S. International Trade Commission (USITC) releases its report on access to COVID-19 diagnostics and therapeutics under World Trade Organization (WTO) intellectual property rules. The USITC report is expected to help guide long-delayed U.S. government deliberations regarding exempting COVID-19 therapeutics and diagnostics from certain WTO procedural requirements, in order to further facilitate LMIC access to medicine.

“At a minimum, ten times more people needed Paxlovid than had any chance to receive it in developing countries, and that almost certainly significantly understates the problem,” said Peter Maybarduk, the director of the Access to Medicines program at Public Citizen. “Health need vastly exceeded the procured supply, by an order of magnitude at least. We have, in part, intellectual property barriers to thank for this, amidst anemic health funding and multiple failures to adequately support the global Covid response. Drug corporations’ high prices, contract secrecy and monopoly supply all suppress demand, and make it harder for resource-starved health agencies to purchase the treatment they need to care for people.”

The analysis suggests that supporting affordable, predictable and diverse sources of supply of future treatments can help spark country demand and meet treatment needs.

Using publicly available supply agreements and data from the World Health Organization, Public Citizen determined that by the end of 2022, only an estimated 916,120 courses of Paxlovid had been procured by LMICs, compared to a minimum population-based need of 9,135,953 courses. It also determined that 780,000 courses were procured through bilateral supply agreements with Pfizer and 135,120 courses were received from the Access to COVID-19 Tools Accelerator (ACT-A). Meanwhile, 1,000 courses were donated through the nascent COVID Treatment Quick Start Consortium. Additional data from Pfizer could help complete an exhaustive account of Paxlovid supply in LMICs during 2022.

At least 9.1 million people aged 65 and over were infected with COVID-19 in LMICs in 2022 according to Airfinity. This very conservative estimate of high risk infections excludes other at-risk populations, such as people living with chronic diseases or experiencing long COVID, meaning that the real number of people who may have benefited from treatment and did not receive it most likely is far higher.

“This analysis emphasizes the urgency of the U.S. immediately voicing its support for and working to achieve an extension of the WTO decision for vaccines for diagnostics and therapeutics, getting counterproductive WTO rules out of the way and contributing to an environment that makes it straightforward for countries to address the health needs of their population,” said Melinda St. Louis, Global Trade Watch director at Public Citizen.

In a letter this week, health groups called on the Biden administration to stand up to the pharmaceutical industry and support an extension of the June 2022 WTO decision to therapeutics and diagnostics.

“By extending the June 2022 WTO Decision to cover therapeutics and diagnostics, companies in LMICs will find it easier to issue compulsory licenses that remove patent barriers and allow expanded export/import to markets ill-served by Big Pharma monopolies,” said Professor Brook K. Baker, Senior Policy Analyst for Health Global Access Project. “Much more needs to be done at the WTO and in WHO Pandemic Accord negotiation to override multiple IP barriers to life-saving tests and treatment, but a decision by the U.S. to ease equitable access via compulsory licenses after a long and unfortunate delay, is a small step in the right direction.”