Why are supplies of Paxlovid, Pfizer's COVID-19 treatment, so limited?

A combination of a new molecule (nirmatrelvir) and an older drug (ritonavir), it's been shown to reduce the risk of hospitalisation and death by 89 per cent for high risk groups when taken early in the course of the infection.

A drug as effective as this, and which can be taken in tablet form at home, could change the course of the pandemic if it were widely available globally.

It's easier and cheaper to make than most existing treatments for COVID-19.

While it's not suitable for everyone, it could save huge numbers of lives of those in high-risk groups, and in countries with limited health systems.

But Paxlovid is not available to almost half the world's population, and even in a wealthy country like Australia, there isn't enough to go around.

Why not?

Essentially, it's a part of a wider story of greed and inertia. And both the pharmaceutical industry and wealthy countries are to blame for the world's failure to provide sufficient access to lifesaving COVID-19 drugs.

Pfizer expects to generate US$22 billion in revenue this year from Paxlovid sales.

To protect its market, it has filed, or plans to file, patent applications in at least 61 countries.

For high-income countries, it has priced Paxlovid at $US530 ($A722) for a five-day course.

Fortunately, Pfizer has entered into a voluntary licensing agreement with the Medicines Patent Pool, enabling generic companies to make cheaper copies to supply 95 low and middle-income countries.

But this agreement excludes 47 per cent of the global population. Middle-income countries like Thailand, China and Mexico will all miss out.

And while Pfizer says it will set prices based on a country's income level, this type of 'tiered pricing' often fails to make drugs sufficiently affordable.

Of the 120 million courses of Paxlovid Pfizer plans to make in 2022, at least 30 million (the bulk of supply for the first half of 2022) have already been snapped up by wealthy countries, while only four million have so far been committed for low and middle-income countries.

Australia has pre-purchased 500,000 courses of Paxlovid, but it's unclear how much has yet reached our national stockpile and when the remainder will arrive.

The exclusive rights held by Pfizer, which enable it to control the global supply of Paxlovid, are underpinned by a World Trade Organization treaty called the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

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In October 2020, India and South Africa proposed that patents and other intellectual property rules enshrined in TRIPS be waived for products to prevent, treat and manage COVID-19 for the duration of the pandemic.

This would enable widespread manufacturing of COVID-19 vaccines, treatments, diagnostic tests and other products to fight the pandemic.

Opposition from wealthy countries, including the EU, the UK and Switzerland, stalled this proposal for more than 18 months, while millions of people around the world died from COVID-19.

Last week, a tentative compromise 'solution' struck by four parties to try to break the impasse was leaked. But the compromise would waive TRIPS rules only for vaccines, doing nothing to increase the global supply of treatments and tests.

Fraught with problems - and leaving out a large number of developing countries - the compromise won't go far enough to change the status quo, even for vaccines.

It seems crazy that we continue to accept a situation where a handful of pharmaceutical companies control the global supply of lifesaving COVID-19 products.

At the WTO, member states must overcome greed and inertia to find a workable solution to provide access to all the COVID-19 products the world needs.