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In search of Covid Pills, Poor Nations Fear Repeat of AIDS Crisis

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The associated fee to UNICEF of Paxlovid — including Pfizer’s insistence that UNICEF keep how much it pays confidential — stays a sticking point, said Dr. Philippe Duneton, who runs the therapeutics arm of the W.H.O. consortium. In announcing its “strong suggestion” for Paxlovid, the W.H.O. took the highly unusual step of publicly scolding Pfizer for a “lack of transparency,” which makes it difficult to know which countries have the drug and what they’re paying.

“We’d like to have higher visibility by way of price,” Dr. Duneton said.

Manufacturers often prefer that the small print of their sales agreements be secret in order to not weaken their hand with other potential buyers. Pfizer’s chief executive, Albert Bourla, reported last week that Paxlovid had been a “key growth driver” for the corporate, which is using a “tiered pricing approach” wherein low- and lower-middle-income countries will get Paxlovid at a not-for-profit price.

In response to an inquiry from The Latest York Times, Pfizer issued an announcement saying that it was “deeply dissatisfied by the sentiment expressed by our partners,” adding, “We have now in good faith heard and responded to a lot of their concerns.”

Each Pfizer and Merck have also taken steps to make inexpensive generic versions of their pills available, signing licensing agreements with the Medicines Patent Pool, which was created in the course of the global AIDS crisis to bring drugs to low- and middle-income nations at low price. It took years, and bitter fights between activists and firms, to achieve such agreements for H.I.V. drugs.

However the agreements for Covid antivirals don’t apply to many middle-income nations, including much of Latin America and parts of northern Africa and Asia. The result, experts say, is that each poor and wealthy nations could have access, but countries in the center could have to barter with the businesses — or force the drugmakers to show over their mental property.

To this point, 36 firms from 12 countries have signed as much as make generic Paxlovid. Corporations in India are already making generic versions of each Paxlovid and molnupiravir. The expectation is that each drugs will ultimately be available in about 100 low- and middle-income countries, covering about half the world’s population. The businesses won’t receive royalties from the sales while the W.H.O.’s declaration of the pandemic as a worldwide health emergency stays in effect.

“Given the severity of the pandemic and given the undeniable fact that vaccines had a really uneven penetration rate, we felt that this was an important contribution the corporate could make,” said Paul Schaper, executive director for global public policy at Merck.

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