In this Comment article in the journal The Lancet HIV, MSF’s Christa Cepuch and co-authors assert that the production of new COVID-19 drugs should not come at the expense of HIV drug supply.
When demand exceeds supply, medicines generally go to the highest bidder, regardless of the greatest clinical need. Throughout the COVID-19 pandemic, high-income countries have purchased treatments well in advance of comprehensive clinical evidence, while low- and middle-income countries (LMICs) have been left behind.
This pattern may continue with ritonavir-boosted PF-07321332 (Paxlovid), a new COVID-19 treatment currently under review for approval by the US Food and Drug Administration (FDA). Ritonavir is a key drug for HIV treatment. A run on ritonavir stock, and manufacturing capacity to produce it, could thus occur. Action is needed to avoid potential disruptions of ritonavir supplies, which could unravel years of progress in HIV treatment.
The authors recommend five actions:
- The WHO, Global Fund, US PEPFAR, and national procurement agencies should coordinate to anticipate ritonavir shortages and reallocate stock as needed.
- Pfizer should make information on procurement mechanisms, supply capacity, price and global registration status publicly available.
- Pfizer should ensure there is sufficient global capacity to manufacture ritonavir, including investing in new or repurposed manufacturing lines.
- Pfizer should not enforce patents for the duration of the COVID-19 pandemic in LMICs.
- High-income countries purchasing ritonavir-boosted PF-07321332 should immediately increase funding available to national HIV treatment programmes and Global Fund to offset antiretroviral price increases.