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The availability of new COVID-19 treatments will help low-income countries

A MARTINEZ, HOST:

While people in the U.S. are waiting for their COVID-19 booster shots, most people in low-income countries are still waiting on their first doses. But the outlook is more promising when it comes to new treatments against the disease. Yesterday, Pfizer announced a licensing deal that could massively expand access to its new pill against COVID. It follows a similar arrangement signed by Merck.

With us now to discuss this is NPR global health correspondent Nurith Aizenman. Now, Nurith, first of all, how big of a role could these antiviral treatments play in the fight against the pandemic in low- and middle-income countries?

NURITH AIZENMAN, BYLINE: Potentially huge - so these treatments consist of a series of pills that are taken over several days. And they're aimed at people who are at particular risk from COVID. They're elderly. They have medical conditions. And both companies point to studies showing that if an unvaccinated person takes the pills early on, while they're still at home, it really cuts their chances of being hospitalized and of dying. That's usable anywhere, but it's especially helpful in countries where most people aren't vaccinated. They don't have that protection. And right now in low-income countries, about 97% of the population is still in that unvaccinated category. Of course, the treatments can only be a game changer if there's enough supply.

MARTINEZ: Oh, no - supply chain issues raising its ugly head.

AIZENMAN: Yeah, Pfizer and Merck can only produce so much of their drugs themselves. And a large amount of that supply is already being earmarked for sale to the U.S. and other rich countries. But there are reports that the Biden administration alone is buying millions of doses to be used for Americans. It's a key strategy to deal with the United States' unvaccinated population. But there are a lot of generic drugmakers around the world. And these new licensing deals are supposed to make it possible for the generic companies to start pumping out versions of the treatments.

MARTINEZ: So how much more supply will these agreements generate?

AIZENMAN: A lot - basically, first, Merck, and, as of yesterday, Pfizer have signed licensing deals with this United Nations-backed group called the Medicines Patent Pool, or MPP. And the MPP will be able to grant sublicenses to generic manufacturers, who are allowed to sell the drugs in roughly a hundred low- and middle-income countries that, taken together, account for about half of the world's population.

I spoke with MPP's executive director, Charles Gore. He told me that more than a hundred generic companies have already applied to make the Merck treatment. And they're expecting similar numbers to apply to make the Pfizer one.

CHARLES GORE: So that's - I mean, that's, you know, insane amount. We've never had (laughter) those kind of - that number of applications before. So there's no question that there's huge interest from generic companies to manufacture.

AIZENMAN: And he says this extra supply will also have the effect of driving down prices to just above the cost of production.

MARTINEZ: Driving down prices - by how much are we talking about?

AIZENMAN: To give you an idea, the U.S. has agreed to pay roughly $700 for each course of Merck's treatment, courses the generics are likely to be charging the countries they sell to in the $20 range, maybe even $10 for a course of treatment. But there are some caveats. Several key middle-income countries, like Brazil, which has had one of the worst COVID outbreaks, are not on the list of countries that can buy these generics. Also, it's going to take time for these manufacturers to ramp up production. Gore says it could be as long as a year before they're producing a meaningful amount.

MARTINEZ: Is it going to reach low- and middle-income countries in time, though?

AIZENMAN: Yeah, the timing is not ideal. Both companies say they will offer some of their own supply to lower-income countries at lower prices. But again, it's not looking like there will be that much. And also, last spring, while Merck was still developing their drug, they did sign licensing deals directly with several generic companies in India. So officials at Merck say they hope that head start might speed things up. But Pfizer didn't take that step.

So by the time treatments arrive, many low-income countries may have substantially upped their vaccination rates. Still, some may still be struggling with the logistics or with hesitancy. Also, a lot of these countries have very limited hospital capacity. And it doesn't necessarily take that many people infected with COVID to overrun their health systems. So treatments that keep people out of the hospital could still make a big difference a year from now.

MARTINEZ: That's NPR's Nurith Aizenman. Thank you very much.

AIZENMAN: You're welcome. Transcript provided by NPR, Copyright NPR.