Paxlovid’s charges to UNICEF — including Pfizer’s insistence that UNICEF keep secret how much it pays — remains a sticking point, said Dr. Philippe Duneton, who leads the therapeutic arm of the WHO consortium. By announcing its “strong recommendation” for Paxlovid, the WHO took the highly unusual step of publicly berating Pfizer for a “lack of transparency,” making it difficult to know which countries have the drug and what they are paying for.

“We need to have better visibility in terms of price,” said Dr. duneton.

Manufacturers often prefer that the details of their sales agreements be kept secret so as not to weaken their hand with other potential buyers. Pfizer’s CEO Albert Bourla reported last week that Paxlovid had been a “major growth engine” for the company, which uses “tiered pricing” where low- and lower-middle-income countries get Paxlovid at a not-for-profit price.

In response to a question from bohobarmadrid, Pfizer released a statement saying it was “deeply disappointed by our partners’ sentiment”, adding: “We have heard and responded in good faith to many of their to care.”

Both Pfizer and Merck have also taken steps to make low-cost generic versions of their pills available, signing licensing agreements with the Medicines Patent Pool, which was created during the global AIDS crisis to bring low-cost drugs to low- and middle-income countries. . It took years, and bitter fighting between activists and companies, to reach such agreements on HIV drugs.

But the agreements for Covid antivirals do not apply to many middle-income countries, including much of Latin America and parts of North Africa and Asia. The result, experts say, is that both poor and rich countries will have access, but countries in the middle will have to negotiate with the companies — or force the drug makers to transfer their intellectual property.

So far, 36 companies from 12 countries have signed up to make generic Paxlovid. Companies in India already make generic versions of both Paxlovid and molnupiravir. Both drugs are expected to eventually be available in about 100 low- and middle-income countries, covering about half of the world’s population. The companies will not receive any royalties from sales as long as the WHO’s declaration of the pandemic as a global health emergency remains in effect.

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

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