In this thread, I’ll share what is known about access to #remdesivir, one of the leading therapeutic candidates against #COVID19. Originator company @GileadSciences ($GILD). As an introduction, I suggest you should read this very detailed article. biopharmadive.com/news/coronavir… 1/n
Remdesivir (aka GS-5734) inhibits RNA-dependent RNA polymerase. Broad-spectrum antiviral. Injectable (IV). Wasn’t found as clinically effective for #Ebola as monoclonal antibodies. Here is the formula. The synthesis of GS-5734 is described here. pubs.acs.org/doi/full/10.10… 2/n 
How much of remdesivir is available now ? Unclear. In Feb 2019, when drug was still a promising candidate for #Ebola, Gilead planned to have 25kg + 4x40g of (unfinished) drug substance by 2020, equivalent to 148,000 treatment courses. Unknown if it materialized. 3/n
As results of the trial for #COVID19 are expected in April, @GileadSciences needs to share concrete information on inventory & replenishment of remdesivir asap, not just vague intentions ! Transparency from all actors, including pharma companies, is critical. 4/n
Several manufacturers in China and Taiwan have been able to synthetize generic remdesivir through reverse engineering. BrightGene is one of them. However, outstanding questions on potential intellectual property barriers and true manufacturing scale. 5/n
Compulsory licensing is one of the possible solutions to overcome intellectual property barriers and increase capacity to manufacture remdesivir at affordable cost. 6/n
How much will Gilead charge for a treatment course of remdesivir (if ever drug is found effective against #COVID19) ? Previous @WSJ article mentioned possible price of $260 in China. According to article in @BioPharmaDive, price could be $900-1,000. Gilead, please clarify. 7/n
Remember that R&D of remdesivir has been heavily financed by grants from the public sector, and in-kind contributions by NGOs & WHO & MoHs of African countries. Here is a (non-exhaustive) list of public/philanthropic support for R&D of remdesivir (for #Ebola alone). 8/n
Disclaimer 👆: not easy to track R&D funding. For example, DoD funding in FY2017-18 ($119.1M) was related to a compound named «AV TX Candidate 2»; we believe this is remdesivir, but can’t confirm it. If anyone finds a mistake above, I am happy to rectify it accordingly. 9/n
Generally speaking, we @MSF_access believe that details of publicly funded R&D should be publicly available and transparent. But that’s most often not the case. Let’s hope R&D funding information for #COVID19 will be more transparent, not business as usual. 10/n
Pharma companies usually justify their high prices by the need to recoup their own R&D costs. In the case of remdesivir, a vast portion of the R&D costs has already been covered by public and philanthropic sectors. 11/n
There is no justification for a high price for remdesivir. That would mean that the public pays twice. And we @MSF_access dislike ‘double dipping’, especially during #COVID19 times. 😉msfaccess.org/how-big-pharma… 12/n
