Merck covid pill: Asian countries rush to buy Molnupravir, but poor countries may lose it

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Experts say that while the pill may seem promising, they are worried that some people will use it as an alternative to vaccines, which still provide better protection.

While low-income countries have been accused of hoarding doses by rich countries, they warn that last year’s vaccine catch could make Asia’s race see it again.

“(Molnupiravir) really has the power to change the game a little bit – it has the potential,” said Rachel Cohen, North American Managing Director for Nonprofit Drugs, an initiative for neglected diseases.

“We need to make sure we do not repeat history – we do not fall into the same patterns or repeat the same mistakes we saw in Govt vaccines.”

What is Molnupravir?

Molnupravir is considered a positive step because it provides a way to treat Govit-19 – patients do not need to be hospitalized.

The pill works like this: Once a patient is diagnosed with Covit-19, they can start the course of molnupravir. It consists of four 200 mg capsules, twice a day, for five days – a total of 40 tablets.

Sanjay Senanayake, an epidemiologist and medical associate professor at the Australian National University School of Medicine, said that unlike immunosuppressive vaccines, molnupravir disrupts the virus’ response. “In a way, the virus makes children unhealthy,” he said.

Merck headquarters in Kenilworth, New Jersey on January 25, 2021.
Interim Phase 3 results of a trial of more than 700 unvaccinated patients published earlier this month show that the risk of hospitalization or death can be reduced by approximately 50% compared with patients who have taken placebo. All participants were given a pill or placebo within five days of the onset of symptoms – and within 29 days, none of those taking the pill died, compared with eight who took the pill. Full data for the molnupiravir test have not yet been released and data have not yet been reviewed or released.
Wendy Holman, CEO of Ridgeback Biotechnics, a company that specializes in growth, said in a statement that the results were encouraging – and that the drug “had a profound effect on controlling the infection.”

“Antiviral treatments that can be taken at home are very necessary to get those with Covit-19 out of the hospital,” he said.

Experts agree that the drug is promising. Instead of waiting to see if patients become seriously ill, Cohen said, from the Medicines initiative for neglected diseases that can be treated straight after the virus is diagnosed.

Unlike other Govit-19 treatments, Molnupravir can be taken at home and hospital resources can be released to the most ill patients.

“Getting the tablet is very simple,” Senanayake said. “This is a game changer.”

What does Govit mean for pill vaccines

Experts say vaccines are still the best protection – after all, they can reduce the risk of getting COV-19 per person.

But even in the Asia-Pacific, vaccination rates in many countries have improved after a slow start, with millions of people not yet vaccinated because they are not qualified, or they cannot access the footage.

And the tablet comes inside.

“There are many who can’t get vaccinated,” said Niall Weidt, an associate professor at the School of Pharmacy at the University of Sydney. “This drug will be a leading solution for the sick.”

New Zealand and Australia are coveted success stories. Why are they lagging behind in releasing vaccines?

But wheat and other experts are concerned that the pill may make it harder for some people to get vaccinated, which increases the vaccine reluctance found in many countries, including Australia.

Research shows that people prefer to swallow drugs rather than being injected, Weed said.

“If you had told me a year and a half ago that people would refuse a vaccine for a disease that would destroy this planet, I would have thought you were crazy,” he said. “People are always more likely to think that this drug is a better solution than vaccination.”

But experts say this pill is not a substitute for vaccines.

Senanayake says the approach is the same as how we treat the flu – there is a flu vaccine, but there are also antiviral drugs to treat those who are sick.

Cohen says the pill does not mean there is less urgency in increasing equivalent access to vaccines.

“Vaccine equality is the defining challenge of our time. But you can never fight an infectious disease with a single tool,” he said. “We really need a full arsenal of health technologies.”

Why Asia-Pacific countries buy Govit pill

According to Airfinity data, 10 countries or regions are in talks or have signed agreements for the tablet – eight of which are in Asia-Pacific.

Some of those countries may try to avoid past mistakes when slow orders lead to delayed vaccine releases.

“I think we need to make sure we are ahead of the game when it comes to these other new developments,” Senanayake said.

“There are a few middle-income countries out there that I think shouldn’t fall into the same trap they left when high-income countries hoarded all the vaccines,” Cohen added.

It is not clear how much each of these countries will pay for the pills.

The United States has agreed to pay $ 1.2 billion for 1.7 million courses if the tablet is approved. The government pays about $ 700 per course. Analysts Melissa Barber and Dzintars Gotham found that it costs about $ 18 to produce a course of molnupiravir based on the cost of raw materials.
Gotham, who researches access to drugs, said it was common for pharmaceutical companies to impose a large markup on drugs, but said he was surprised by the high cost as US funding contributed to the development of the tablet.
On October 5, 2021, a woman received the Pfizer vaccine in the Kua Musang district of Klantan Province, Malaysia.

Merck did not confirm whether those estimates were accurate, but said in a statement to CNN that the calculations did not take into account research and development.

“We have not yet established its price as Molnupravir is not approved for use,” the company said. “We have entered into an advance purchase agreement with the US Government, and that price is a substantial amount specified for Molnubra and does not represent a list price for the United States or any other country.”

In a statement in June, Merck said it plans to use a fixed pricing approach to various countries and has entered into licensing agreements with generic manufacturers to expedite the availability of the tablet in 104 low- and middle-income countries.

Inequality

Low-income countries may be at a disadvantage when using the pill.

Once a drug is approved for use, countries must decide whether to give it to anyone with symptoms or whether a positive test is needed before they receive it.

But it requires access to testing. In some countries it may be an issue, Cohen said. The interim results of the pill are for those given within five days of the onset of symptoms – and in some countries, getting a test sooner can be a problem.

Rich nations hoard Govt-19 vaccines and overtake developing ones, warns People's Vaccine Alliance
Boundaries nonprofit doctors hailed the drug as “potential life-saving care” for people living in unvaccinated and disease-prone areas.

First, the question is how they can access it.

Although the drug is simple to prepare, according to Lena Mengane, the South Asian head of the group’s access campaign, Merck controls the patent and can determine which countries should supply the drug at what price.

He renewed calls for patent rebates abolishing intellectual property rights for countries around the world to produce versions of drugs – which would save many more lives. Prior to the outbreak, activists urged the government to waive the Govt-19 vaccine, but the demand was thwarted by a small number of governments, including the United Kingdom.

Cohen said health tools and technologies should be considered a common good – and the situation raised questions about how we can ensure that those benefits are shared equally.

“We are concerned that this will lead to a kind of therapeutic nationalism,” he said. “What we are most concerned about is that equal access to antivirals can be a challenge, especially in low- and middle-income countries.”

Senanayake once again said that rich countries run the risk of receiving more than their fair share.

“By Govt, you have to be selfless to be selfish,” he said. “Otherwise, if you protect your own small nest, your own small country, a new variant of the vaccine could develop if it occurs in other countries.”

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