With a steep increase in the number of cases and deaths caused by COVID-19, the health care system in Manaus, the capital of the state of Amazonas, collapsed for the second time in January 2021. MSF supports 28 de Agosto and José Rodrigues Emergency Unit - depicted in these photos - with doctors, nurses and mental health care.
Explainer |

Latin America: How patents and licensing hinder access to COVID-19 treatments

1 min
Photograph by Mariana Abdalla
With a steep increase in the number of cases and deaths caused by COVID-19, the health care system in Manaus, the capital of the state of Amazonas, collapsed for the second time in January 2021. MSF supports 28 de Agosto and José Rodrigues Emergency Unit - depicted in these photos - with doctors, nurses and mental health care. Photograph by Mariana Abdalla

Almost two years have passed since the declaration of the COVID-19 pandemic that has claimed nearly 6 million lives. During these two years we have witnessed stark inequity in accessing not only vaccines but also promising treatments.

In Latin America, where the impact of the pandemic in many countries, including Brazil, Bolivia, Colombia and Peru, has been devastating, access to new treatments recommended by the WHO could be limited due in part to patent barriers and restrictive licensing deals controlled by pharmaceutical corporations.

As countries in Latin America continue to live in fear of the emergence of new waves or newer variants that may threaten the efficacy of existing preventive tools, access to affordable generic medicines such as nirmatrelvir/ritonavir and baricitinib will be key to treating the most vulnerable people and those contracting severe forms of the disease.

In the graphs below we break down the patent landscape for these two COVID-19 treatments for Latin America:

The case of nirmatrelvir/ritonavir

In December 2021, the US pharmaceutical corporation Pfizer received emergency use authorisation (EUA) for the oral antiviral candidate nirmatrelvir in combination with ritonavir, from the US Food and Drug Administration (FDA) for the early treatment of people with mild to moderate COVID-19 who are at increased risk of developing severe disease.

With vaccination rates lagging behind in many parts of the world, people are left unprotected against COVID-19 and access to recommended, easy-to-administer medicines is critical. However, a number of high-income countries have already quickly bought up the limited global supply available in the first half of 2022 from Pfizer.

Erratum: The map has been updated to correct the status of Uganda and Yemen as 'Included countries and regions'.

In December 2021, civil society organization Knowledge Ecology International (KEI) submitted a request for an open compulsory license for public interests in the Dominican Republic to enable generic supply.

In January 2022, non-profit organization Corporación Innovarte in Chile submitted a request to the Ministry of Health urging the issuance of a compulsory license on this medicine.

In February 2022, 67 civil society organizations in Latin America co-signed an open letter calling governments to make full use of TRIPS flexibilities, especially compulsory licenses and government use licenses to improve access to nirmatrelvir/ritonavir.

Local production and supply of generic nirmatrelvir/ritonavir in Latin American countries would need to be supported by removing the main intellectual property barriers, which could be accomplished by adopting the TRIPS Waiver.

The case of baricitinib

In hospitalised patients, the oral drug baricitinib can be a potential alternative to current WHO-recommended anti-interleukin-6 inhibitors monoclonal antibody treatments (mAbs) (tocilizumab and sarilumab) that remain in short supply and expensive for governments and patients in many low- and middle-income countries.

But in many countries, generic baricitinib will not be available as the drug is under patent monopoly, with US pharmaceutical corporation Eli Lilly having filed and obtained patents widely, including in countries hit hard by the pandemic.

Generic versions of baricitinib are available for under US$7 per 14-day treatment course in India and Bangladesh, which is significantly less than patent holder Eli Lilly’s prohibitive price of $1,109 per 14-day treatment course in the US. Eli Lilly’s licensing deal with Indian generic companies restricts the supply of generic versions of the drug outside of India.

The case of baricitinib demonstrates the urgent need to adopt the TRIPS Waiver so that countries are not vulnerable to the will of pharmaceutical corporations.