A recent article published in CodeBlue (“Malaysia Not Rich, Affordable Remdesivir Needed, MPs Tell Gilead”, 20 May 2020) along with an open letter by the Malaysian Health Coalition (MHC) and the Drugs for Neglected Diseases Initiative (DNDi) has highlighted once again how people living in low- and middle-income countries like Malaysia are frequently denied access to affordable, life-saving medicines.
By excluding Malaysia from its voluntary licensing agreements, the pharmaceutical manufacturer Gilead denies Malaysians from obtaining affordable generic versions of Remdesivir, a potential treatment for Covid-19, and forces Malaysians to pay whatever price Gilead decides to set for it.
This raises two questions: What price will Gilead set for Remdesivir, and why shouldn’t Gilead set a high price for this drug?
A recently published article in Politico (“Remdesivir helps coronavirus patients — but at what cost?”, 6 May 2020) revealed that while Gilead has not come to a decision on what the final price tag on Remdesivir will be, Wall Street analysts have begun suggesting that the drug could be priced between USD5,000 to USD10,000 for a 10-day course of the treatment, allowing the company to make between USD5 billion to USD10 billion over the course of three years. A more conservative estimate by the Institute for Clinical and Economic Review (ICER) suggests that Remdesivir could be priced at USD4,500.
These are all prices that most Malaysians will not be able to afford. There is also no good reason for Remdesivir to be excessively priced.
For starters, there is currently a lack of evidence that Remdesivir prevents or reduces death from Covid-19; we only know that it shortens the time patients need to recover from the disease. Based on this, ICER itself suggests that if Remdesivir only shortens recovery time, then it could be priced at USD 390 instead. This price tag, however, is still a difficult one to swallow for many Malaysians.
Secondly, the cost of manufacturing Remdesivir does not justify a high price tag. An independent study by Dr Andrew Hill and his colleagues published in the Journal of Virus Eradication estimated the cost of manufacturing a full 10-day course of Remdesivir at USD9, or USD0.93 per day. Even if we factor in the costs of marketing and packaging, it is difficult to see how the price of Remdesivir might justifiably be in the thousands or tens of thousands of dollars.
As for research and development costs, it is worth noting that a large portion of the Remdesivir development costs were funded by a USD37.5 million grant from the US government and the current clinical trials on Remdesivir are funded by non-profit organizations such as the World Health Organization and the the US National Institute of Allergy and Infectious Diseases.
Keep in mind as well that prior to Covid-19, Remdesivir was an experimental drug with no approval for any uses in any country.
In short, there is no reason that Remdesivir should be highly priced. The patent system and Malaysian’s exclusion from Gilead’s voluntary licensing agreements, however, means that we have no alternatives even if an exorbitant price is set on the drug.
Hopefully Gilead and other pharmaceutical companies with vaccines and treatments in their pipeline will consider the global need for their products and make compassionate decisions on pricing and availability.
Otherwise, Malaysia and other low- and middle-income countries should remember that they have the legal right to set aside patents using compulsory licenses in order to protect the people during a public health emergency.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
