WHO: Plan to provide a coronavirus pill for €8.5

A programme under the leadership of World Health Organization to ensure equitable access for the poorest countries to vaccines, tests and treatments for coronavirus, aims to provide antiviral drugs for patients with mild symptoms for as little as $10 (€8.5) per treatment, according to a draft document cited by Reuters.

Merck's experimental pill molnupiravir is likely to be one of the drugs while other drugs are being developed to treat mild patients.

The document, which outlines the goals of the Access to COVID-19 Tools Accelerator (ACT-A) by September next year, says the programme wants to deliver around 1 billion COVID-19 tests to poorer countries and provide drugs to treat 120 million patients worldwide, out of the estimated 200 million new cases estimated to occur in the next 12 months.

These plans highlight how the WHO wants to increase supplies of drugs and tests at a relatively low price, after losing out in the vaccine race to rich countries that have gained a huge share of global supplies, leaving the world's poorest countries with very few doses.

An ACT-A spokesman said the document, dated 13 October, was still a draft under consultation and declined to comment on its contents before it was finalised. The document will also be sent to world leaders ahead of the G20 summit in Rome at the end of this month.

ACT-A is asking the G20 and other donors for additional funding of $22.8 billion by September 2022, which will be needed to purchase and distribute vaccines, medicines and tests to poorer countries and close the huge gap in supplies between rich and less advanced countries. So far, donors have pledged $18.5 billion for the programme.

Although it does not explicitly mention molnupiravir, the ACT-A paper estimates that it will pay $10 per treatment for «new oral antivirals for patients with mild/moderate Covid».

Although other pills are being developed to treat mild patients, molnupiravir is the only one that has so far shown positive results in end-stage trials. ACT-A is in talks with Merck and generic producers to buy the drug.

The price is very low compared to the $700 (€600) per treatment that the United States has agreed to pay for 1.7 million patients.

However, a study conducted by Harvard University estimated that molnupiravir could cost around $20 (€17) if produced by generic manufacturers, with the price potentially falling to $7.7 (€6.6) under a perfected production.

Merck has licensing agreements with eight generic pharmaceutical companies in India.

The ACT-A document says its aim is to reach agreement by the end of November to secure the supply of an «oral medicine», which will be available from the first quarter of next year.

The money raised will initially be used to «support the procurement of up to 28 million treatments for high-risk patients with mild/moderate infections over the next 12 months, depending on product availability, clinical guidance and volume that changes as needs evolve,» the document says, noting that this volume would be secured under a preliminary purchase agreement.

Larger additional quantities of new antivirals to treat mild patients are also expected to be procured at a later stage, the document said.

Another 4.3 million COVID-19 pill regimens to treat critically ill patients are also expected to be purchased at a price of $28 per treatment (€24), the document said, without naming any specific drug.

ACT-A also aims to meet the basic medical oxygen needs of 6-8 million critically and seriously ill patients by September 2022.

Mass tests

In addition, the programme plans to invest massively in COVID-19 diagnostics in order to at least double the number of tests carried out in poorer countries, defined as low and middle income countries.

Of the $22.8 billion, ACT-A plans to raise about a third in the next 12 months, and the largest share will be spent on diagnostics, the document said.

Currently, poor countries average about 50 tests per 100,000 people every day, compared to 750 tests in richer countries. ACT-A wants to bring these test rates to at least 100 per 100,000 per day in poorer countries.

This means making available about 1 billion tests over the next 12 months, about 10 times as many as ACT-A has procured so far, according to the document in question.

The largest share of the diagnostics will be rapid antigen tests priced at around $3 (€2.5) and only 15% will be spent on procuring molecular tests, which are more expensive but take longer to give results and are estimated to cost around $17 (€14.5), including delivery costs.

The push for testing is aimed at narrowing the gap between rich and poor, as only 0.4% of the nearly 3 billion tests taken around the world have been conducted in poor countries, the paper says.

Such a move will also help in the early detection of potential new mutations, which tend to proliferate when infections are widespread, and are therefore more likely in countries with lower vaccination rates.

The paper highlights that «access to vaccines is highly unequal with coverage ranging from 1% to over 70%, depending on a country's wealth».

The programme aims to vaccinate at least 70% of the eligible population in all countries by the middle of next year, in line with WHO targets.