Supply & Demand of Oral Therapeutics

The supply of oral therapeutics for the treatment of COVID-19 is expected to be limited in 2022. Despite broad licensing to generic manufacturers through the Medicines Patent Pool, generic production is unlikely to make a meaningful contribution to supply this year and manufacturing capacity will be largely limited to that of the originator companies, Merck and Pfizer. Merck expects to produce 30 million courses by the end of 2022 and Pfizer expects to produce 120 million courses.

Purchases for both drugs began even before the first regulatory authorizations were received. Pfizer’s drug Paxlovid (nirmatrelvir/ritonavir) demonstrated strong efficacy data in Phase 3 clinical trials and therefore has been in greater demand. Almost the entire available supply of Paxlovid for the first half of the year has been purchased but there is still significant supply available later in 2022.

Source: COVID GAP analysis, updated August 22, 2022

Similar to what we saw with vaccines, the majority of the purchases for oral therapeutics to date have been placed by high-income countries, with no purchases by low-income countries. Merck has allocated 3 million courses of molnupiravir to UNICEF throughout the first half of 2022 “for distribution in more than 100 low- and middle-income countries following regulatory authorizations.”

Source: Duke Global Health Innovation Center, updated August 22, 2022

Global Fund has announced that Pfizer will supply 10 million courses of Paxlovid to ACT-A for use in low- and middle-income countries but no specific purchases have yet been confirmed. UNICEF has similarly announced a supply agreement with Pfizer for 4 million courses of Paxlovid, dependent on “country demand, clinical recommendations, and necessary approvals.” Pricing information is not publicly available.

 The ACT-A therapeutics pillar is still largely unfunded which limits the ability to make large purchases or support test and treat models.