An MSF doctor taking the medical history of someone coming for their COVID-19 vaccination. They check if he has any symptoms of COVID, or is currently taking any medication. Photograph by Pirah Qasi
Press release |

MSF responds to Medicines Patent Pool deal with 35 manufacturers to produce COVID-19 treatment nirmatrelvir/ritonavir

3 min
Photograph by Pirah Qasi
An MSF doctor taking the medical history of someone coming for their COVID-19 vaccination. They check if he has any symptoms of COVID, or is currently taking any medication. Photograph by Pirah Qasi

Geneva, March 17, 2022 – The news that the Medicines Patent Pool (MPP) has just signed agreements with 35 manufacturers in 12 countries to produce and supply nirmatrelvir/ritonavir is a positive step towards addressing the ongoing access challenges for this COVID-19 treatment. However, the limitations of the deal remain concerning.  

Nirmatrelvir/ritonavir is the most promising oral drug to date to treat people at high risk of progressing to severe/critical COVID-19, based on available data. Yet the limited global supply from the US corporation Pfizer has so far largely been bought up by a number of high-income countries. It is estimated that generic manufacturers will not be able to bring supply to the market until 2023. Pfizer signed a voluntary license deal with the MPP in November 2021, leading to the current sublicense agreements signed with manufacturers, which exclude some key regions and middle-income countries with manufacturing capacity, several of which have suffered a high burden of COVID-19. These are also countries where nirmatrelvir/ritonavir is already patented, or patent claims are pending.  

The recent reported development of the ongoing ‘TRIPS Waiver’ negotiation process at the World Trade Organization (WTO) does not address the concerns of countries left out of this licensing deal and has excluded treatments from the scope of the intended solution.  


Felipe de Carvalho, MSF Access Campaign Coordinator in Brazil: 

This agreement underscores why countries need to take immediate steps to remove barriers for generics supply for this important COVID-19 treatment: this means overriding patents with ‘compulsory licenses,’

Felipe de Carvalho
Campaign Coordinator
MSF’s Access Campaign Brazil

“The agreements signed between the MPP and 35 manufacturers to produce and supply nirmatrelvir/ritonavir are a welcome step, but the deal only covers 53 percent of the world’s population and excludes millions of people in middle-income countries. Most Latin American countries, including Brazil, are left out of this deal, as well as other middle-income countries, such as China, Malaysia and Thailand – this will have a chilling effect on the availability of more affordable generic versions of the drug produced under this license if Pfizer is granted patents in those countries. While a company in Brazil, for example, that signed this agreement will be able to produce the medicine for export, it will not be able to supply Brazil itself to meet local needs.  

This agreement underscores why countries need to take immediate steps to remove barriers for generics supply for this important COVID-19 treatment: this means overriding patents with ‘compulsory licenses,’ and not enforcing any patents or rejecting patent applications held by Pfizer. The better solution would be for WTO members to endorse a ‘TRIPS Waiver’ that includes all countries and covers treatments and not just vaccines, as otherwise the countries excluded from this deal will be left with limited options other than to buy high-priced treatments directly from Pfizer.”