Experts and campaigners are alarmed both by the US unilateral action on remdesivir and the wider implications, for instance in the event of a vaccine becoming available. The Trump administration has already shown that it is prepared to outbid and outmanoeuvre all other countries to secure the medical supplies it needs for the US.
“They’ve got access to most of the drug supply [of remdesivir], so there’s nothing for Europe,” said Dr Andrew Hill, senior visiting research fellow at Liverpool University.
Remdesivir, the first drug approved by licensing authorities in the US to treat Covid-19, is made by Gilead and has been shown to help people recover faster from the disease. The first 140,000 doses, supplied to drug trials around the world, have been used up. The Trump administration has now bought more than 500,000 doses, which is all of Gilead’s production for July and 90% of August and September.
“President Trump has struck an amazing deal to ensure Americans have access to the first authorised therapeutic for Covid-19,” said the US health and human services secretary, Alex Azar. “To the extent possible, we want to ensure that any American patient who needs remdesivir can get it. The Trump administration is doing everything in our power to learn more about life-saving therapeutics for Covid-19 and secure access to these options for the American people.”
The drug, which was invented for Ebola but failed to work, is under patent to Gilead, which means no other company in wealthy countries can make it. The cost is around $3,200 per treatment of six doses, according to the US government statement.
The deal was announced as it became clear that the pandemic in the US is spiralling out of control. Anthony Fauci, the country’s leading public health expert and director of the National Institute of Allergy and Infectious Diseases, told the Senate the US was sliding backwards.
“We are going in the wrong direction,” said Fauci. Last week the US saw a new daily record of 40,000 new coronavirus cases in one day. “I would not be surprised if we go up to 100,000 a day if this does not turn around,” he said. He could not provide an estimated death toll, but said: “It is going to be very disturbing, I guarantee you that.”
The US has recorded more than 2.5 million confirmed cases of Covid-19. Some states lifted restrictions only to have to clamp down again. On Monday, the governor of Arizona ordered bars, cinemas, gyms and water parks to shut down for a month, weeks after they reopened. Texas, Florida and California, all seeing rises in cases, have also reimposed restrictions.
Buying up the world’s supply of remdesivir is not just a reaction to the increasing spread and death toll. The US has taken an “America first” attitude throughout the global pandemic.
In May, French manufacturer Sanofi said the US would get first access to its Covid vaccine if it works. Its CEO, Paul Hudson, was quoted as saying: “The US government has the right to the largest pre-order because it’s invested in taking the risk,” and, he added, the US expected that “if we’ve helped you manufacture the doses at risk, we expect to get the doses first”. Later it backtracked under pressure from the French government.
Canadian prime minister Justin Trudeau warned there could be unintended negative consequences if the US continued to outbid its allies. “We know it is in both of our interests to work collaboratively and cooperatively to keep our citizens safe,” he said. The Trump administration has also invoked the Defense Production Act to block some medical goods made in the US from being sent abroad.
Nothing looks likely to prevent the US cornering the market in remdesivir, however. “This is the first major approved drug, and where is the mechanism for access?” said Dr Hill. “Once again we’re at the back of the queue.”
The drug has been watched eagerly for the last five months, said Hill, yet there was no mechanism to ensure a supply outside the US. “Imagine this was a vaccine,” he said. “That would be a firestorm. But perhaps this is a taste of things to come.”
Remdesivir would get people out of hospital more quickly, reducing the burden on the NHS, and might improve survival, said Hill, although that has not yet been shown in trials, as it has with the other successful treatment, the steroid dexamethasone. There has been no attempt to buy up the world’s stocks of dexamethasone because there is no need – the drug is 60 years old, cheap and easily available everywhere.
Hill said there was a way for the UK to secure supplies of this and other drugs during the pandemic, through what is known as a compulsory licence, which overrides the intellectual property rights of the company. That would allow the UK government to buy from generic companies in Bangladesh or India, where Gilead’s patent is not recognised.
The UK has always upheld patents, backing the argument of pharma companies that they need their 20-year monopoly to recoup the money they put into research and development. But other countries have shown an interest in compulsory licensing. “It is a question of what countries are prepared to do if this becomes a problem,” said Hill.