WILL TREATMENTS BE AS ELUSIVE FOR POOR NATIONS AS VACCINES?

Nearly a year after the first COVID-19 vaccination campaigns began, the vast majority of the shots have gone to people in wealthy nations, with no clear path toward resolving the disparity.

News this month that an antiviral medication had proved effective against the coronavirus in a large clinical trial has brought new hope of a turning point in the pandemic: a not-too-distant future when a simple pill could keep infected people from dying or falling severely ill.

The drug, molnupiravir, made by Merck, is easy to distribute and can be taken at home. The trial results showed it halved the risk of hospitalization and death among high-risk people early in their infections. The company has applied for emergency use authorization from the Food and Drug Administration; a decision could come in early December.

Unlike vaccine manufacturers Pfizer and Moderna, which have resisted calls for license agreements to let overseas manufacturers make their shots, Merck will allow generic manufacturers in India to sell the pills at a far lower price in more than 100 poorer countries. Most nations in sub-Saharan Africa, where vaccination rates are as low as 3 percent, are covered by the deal.

Drug access advocates say the Merck licensing deal is an encouraging start but only a small step toward equity. Merck has begun production of the drug, but it is unclear how much of the generic product will be available next year. The agreements leave out many undervaccinated nations, such as Ukraine, that have been hit hard by COVID-19. And an antiviral must be combined with reliable, affordable testing, which is also limited in many places.

Several other drugmakers, including Pfizer, are expected to announce efficacy data from trials of similar medications; the companies said it was too soon to comment on whether they would enter similar agreements.

All this means that treatments could remain largely with nations able to pay for early access, as they have done with vaccines.

“A drug like this that is kept at room temperature, you could get it to even the remotest parts of the world. It’s fair to say that this drug could prevent hundreds of thousands of hospitalizations and deaths,” said John Amuasi, an infectious disease expert and global health at the Kumasi Center for Collaborative Research in Tropical Medicine in Ghana. “But the barrier is going to be price. Look at how long it has taken for vaccines to reach Africa. My worry is that we are steadily on course to do the same with the drugs.”

More than 18 months into the pandemic, COVID-19 remains an illness largely to be endured rather than treated. The few medicines that have shown some benefit — such as monoclonal antibodies — are costly, complex to administer and, in poor nations, scarce or absent. Yet without widespread vaccination, those populations remain vulnerable to COVID-19 and need affordable medicines.

The U.S. government bought much of the supply of the antiviral remdesivir last year after early research showed it might speed recovery from COVID-19. Now it is pursuing a similar strategy for molnupiravir: It has a $1.2 billion agreement to purchase 1.7 million courses of the drug if it receives FDA authorization. That is 20 percent of what the company says it can produce this year.