Some existing medicines that may be repurposed to fight Covid-19 could also be manufactured profitably for as little as $1 to $29 per course of treatment, a move that could dramatically widen availability across the globe, according to a new study.
For instance, the researchers calculated that remdesivir, the experimental Gilead Sciences (GILD) drug originally tested for Ebola, could be made for just 93 cents for a day’s supply. And a Roche (RHHBY) drug called Esbriet, which is used to treat idiopathic pulmonary fibrosis, could be made for $1.09 for a day’s supply, according to the analysis, which was published in the Journal of Virus Eradication.
Another example is hydroxychloroquine, the decades-old malaria drug that was repeatedly touted by President Trump. Several tests are under way to test its effectiveness and the researchers calculated it could be made for only 8 cents a day. Other drugs the researchers examined included the antibiotic azithromycin, Roche’s Actemra rheumatoid arthritis medication, and an AbbVie (ABBV) HIV pill. No medicine has yet proved an effective treatment for Covid-19, the disease caused by the novel coronavirus.
The study defined repurposed drugs as existing medicines that are being investigated for new medical indications and off-patent drugs that, in some cases, sell for much more than the cost of production. To reach their conclusions, the researchers relied on prices for active pharmaceutical ingredients, excipients and packaging, among other things, and baked in 10% profit margins for the manufacturers.
“The beauty of the repurposing option is that you can take drugs off the shelf and put them straight to work. We already have the means for manufacturing for many people. What we need to do is massively increase supplies from the factories. It’s a big effort, but if it is done, there’s no reason we couldn’t gain access,” said Andrew Hill, a co-study author and senior visiting research fellow at Liverpool University.
The researchers recommended that treatments proven effective in well-powered clinical trials should be made available worldwide at prices close to production costs; there should be parallel manufacturing by at least three different companies for each product; there should be no patent barriers preventing mass production, and results and databases from all trials should be fully accessible.
The researchers also argued that mechanisms exist to serve as blueprints for both production and distribution. These include the Global Fund to Fight AIDS, Tuberculosis and Malaria, and PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief. These programs allow low- and middle-income countries to access high-quality drugs at affordable prices.
However, the researchers acknowledged that, for newer drugs such as remdesivir and Esbriet, production costs could continue to fall over time through economies of scale. Many drugs may have been discounted off list prices that were used in the analysis.
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The study arrives as the world scrambles for both treatments and a vaccine to combat Covid-19. In the process, though, concern has mounted over the extent to which effective medical products will be sufficiently available, especially to poorer populations. This has prompted a variety of proposals to provide affordable access to both existing products and those being tested. In turn, there has been rising pressure on drug companies to relinquish patent rights.
Recently, Israel approved a license to sidestep the patent on the AbbVie HIV pill, prompting the company to relinquish patent rights and waive restrictions to generic supplies on a global basis. And Roche agreed to release the recipe for a liquid solution that Dutch laboratories need to run a coronavirus test, after initially refusing to do so and causing lawmakers to consider compulsory licensing.
We asked Roche for comment and will update you accordingly.
[UPDATE: Later, a Gilead spokesman wrote to say “we disagree with the findings of this study, which do not accurately reflect the true cost to manufacture remdesivir at scale. Importantly, Gilead has committed to providing all our current supply of remdesivir at no cost for use in clinical trials, compassionate use and expanded access programs, and following potential future regulatory approvals globally. This represents 1.5 million doses, or more than 140,000 treatment courses.”]
Earlier this week, the World Health Organization director general endorsed the idea of creating a voluntary pool to collect patent rights, regulatory test data, and other information that could be shared for developing drugs, vaccines, and diagnostics.
Separately, a group of legal experts, scientists and Creative Commons established the Open Covid Pledge, which is designed to provide a way for universities, companies, and other patent holders to support the development of medicines, vaccines, and other scientific discoveries related to Covid-19 for the duration of the pandemic.
And several academics are kicking around a proposal to create a fund to reward companies that develop Covid-19 products and technologies that are also made available at cost in low- and middle-income countries. “Monopoly pricing can’t work, so we need to create incentives for investors to fully support Covid-related innovation,” Aidan Hollis, an economics professor at the University of Calgary, who studies the pharmaceutical industry, wrote in a recent electronic mailing list.
The latest study won praise from Doctors Without Borders, which argued that patents and monopolies will results in limited supply and potentially unnecessarily high prices.
“This pricing study shows clearly that potential medicines to treat Covid-19 are not at all expensive to produce and could be priced such that anyone who needs treatment should be able to access it. Several of the treatments being (tested) for Covid-19 are currently priced much higher than these estimates show they should be,” said Jessica Burry of the Doctors Without Borders access campaign, in a statement.
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It should probably be noted that the purpose of the study, as admitted in the Conclusion, is to “strengthen price negotiations”. Reading through the paper, it looks like a couple of folks got together and sketched out on the back of a napkin some sort of minimum price to manufacture based on some very simplistic assumptions. Scale up costs aren’t mentioned, for example. Does this sort of thing really qualify as a “scientific” paper?
Repurposing existing low-cost drugs that display somewhat proven applicability for a new disease or contagion, is likely the best way to curb a pandemic on a broad scale. This buys time for the “official” R&D to plod along for a cure. Several types of drugs have cheaper versions, so why not for Covid-10?
Drugs to address pandemic exposure ought to be free for anyone in the population intending to protect itself. Governments should fund the drug, and there should be no affordability discussion on protecting its population from extinction. Whether this is a cheap revival of an old existing good drug, or a new one, should not matter. But obviously, looking at the rate of spread and the number of people infected: if a “cheap fix” works, then that is the way to go.
There is no clear evidence that hydroxychloroquine and the closely related drug chloroquine are effective at treating COVID-19. But there is clear evidence on risks of the drugs, which include everything from headaches, vomiting, and rashes to loss of vision (retinopathy), seizures, hypoglycemia, heart arrhythmias, and deadly heart damage.
Until then I hope I can find where to buy a mask for me and my family.
Thank you so much, just placed an order. The antiviral drug, called favipiravir or Avigan, has been used in Japan to treat influenza, and last month, the drug was approved as an experimental treatment for COVID-19 infections, Pharmaceutical Technology reported.