Thread by @mellabarb

Jan 2023 #Paxlovid costing update:🧵

9 months later, no real news.
❌generic supply is still not widely available
❌Pfizer is refusing to expand licensing
🥴no trial data on how it works in key populations

Updated cost-based estimated generic price: $15
scholar.harvard.edu/melissabarber/…

Here's the top-line summary, using current prices of API traded in global markets.

#Paxlovid is $530 in the US. It has been reported that in China right now, desperate people have been paying as much as $7,000 to get it for their loved ones. 2/
reuters.com/business/healt…

Cost-based estimated generic prices use the price of active pharmaceutical ingredient (API) traded in global markets, and a cost estimation algorithm we developed in earlier research (see gh.bmj.com/content/3/1/e0…)

Costs come down exponentially when there is competition, but.. 3/

...is there competition? Is there enough production capacity to meet need?

Complicated question; complicated answer!

In short, @pfizer is letting us have a little competition. Supply can expand, but only a little. As much as feels comfortable (for Pfizer). 4/

.@pfizer's licenses to the MPP cover 53% of the world’s population.

That's better than nothing, but while this accelerates access, it was never the best option. Pfizer could just say they will not enforce patents on their medicines or vaccines. 5/

I don't describe the MPP licenses or UNICEF donation as corporate social responsibility bc human rights don't come in halves.

There's either a right to health or there isn't. You can't say there's a right, but only for the half that won't turn a profit. 6
speakingofmedicine.plos.org/2022/05/25/a-s…

.@pfizer has excellent public relations professionals, so it's understandable if you thought charity was solving this problem.

But their access program took almost a year to deliver the first doses - just 1000 - delivered 3 weeks ago to Zambia. 7/

dukeghic.org/wp-content/upl…

This is a really sad and unnecessary situation.

China is the largest producer of API globally. There is capacity and know-how. We could have had supply of #Paxlovid as readily available as we have supply of corticosteroids (which are generic). 8/

reuters.com/business/healt…

The shortage in global supply is not a surprise to anyone.

2 years ago S Africa + India proposed the #TRIPSwaiver to allow generic production.

A version so narrow as to be almost useless passed for vax. Rich countries stalled a decision on treatments. 9/
genevahealthfiles.substack.com/p/high-drama-b…

Bangladesh had generic #Paxlovid almost a year ago. They can bc of the LDC exception to patents.

Indian manufacturers were ready months before the first supply started being available. They were delayed bc Pfizer dragged their feet w/samples needed for regulatory approval. 10/

I'd be remiss if I didn't note that while Pfizer's decision to let people die by restricting access is bad, we still don't know how well Paxlovid works in most pop's.

It's the best we've got under ltd info. We cd know more, but Pfizer blocked trials. 11/
dndi.org/press-releases…

Scarcity in clinical data, like scarcity in supply, is an artificial problem.

It's a policy choice (a bad one) wherein one dude elected by some shareholders gets to control global access to a drug that we don't even know who/if it works for. 12/

It's not too late. @pfizer can announce *today* they won't enforce patents. Or at min expand license.

Rich countries w/more supply than they need can share w/ countries in acute need.

@pfizer's shareholders can afford to recognize shared humanity more than 53%. Let's go 💯
13/

We urgently need global cooperation and solidarity for this and the next pandemic, inc:
✅publicly developed & accessible vaccines & cures
✅publicly owned platform trials
✅exercise of compulsory licensing, patent buy-outs, or other means to make monopoly tech available. end/