Editorial | Let remdesivir saga be a fillip for regional research and development
The Trump administration’s cornering the market for the only antiviral drug approved for use against COVID-19 – and boasting about it – is vulgar and insensitive. The Caribbean, though, shouldn’t only be chagrined by America’s behaviour. It should be a fillip for an accelerated pivot to scientific research in the region, an issue raised by this newspaper early in the coronavirus pandemic.
The number of confirmed coronavirus cases around the world is heading towards 11 million, of which over half-million have died. Roughly 26 per cent of the infections and a quarter of the deaths – more than 130,000 people – are in the United States (US).
There is, as yet, no vaccine against the virus. And until regulators in the US and Europe recently gave the green light to the drug remdesivir, manufactured by the American firm Gilead Sciences, there was no officially recommended antiviral remedy for COVID-19. Slowing the spread of the virus has been best achieved by social mandates such as quarantines, lockdowns, physical distancing, and wearing masks. At these and other areas of managing the disease, Donald Trump’s government hasn’t done an effective job.
Lately, it has been attempting to play catch-up. This week, in the aftermath of green-lighting remdesivir, which is shown to shorten the hospital stay of COVID-19 patients, the US Department of Health and Human Services (HHS) announced that the American government had acquired more than 500,000 treatment courses of the drug, or nearly all of Gilead’s production till September. These supplies are earmarked for American hospitals.
“President [Donald] Trump has struck an amazing deal to ensure Americans have access to the first authorised therapeutic for COVID-19,” Alex Azar, HHS head, crowed.
In other words, the rest of the world won’t have immediate access to this treatment, although Gilead indicated that the drug will be licensed to manufacturers of generic products in the developing world. Cost, though, will likely be a limiting factor for patients in poor countries, like Jamaica, when, and if, remdesivir reaches the market – even in its generic form.
While no price tag is as yet attached to it in the developing countries, Gilead indicated that in American hospitals it would cost an average patient with private insurance US$3,120 for a course of treatment with remdesivir, or an estimated US$520 (nearly J$72,000) per dose. In other developed countries, that cost, when the drug becomes available, will be US$390, which is still nearly J$54,000 per dose.
However, the US think tank, the Institute for Clinical Economic Review, quoted by The Washington Post newspaper, estimated that Gilead could recover its cost for developing the drug between US$1 and US$60 per dose. If all of Gilead’s costs for 2020 were taken into account, it could recover them by charging between US$100 and US$160, the think tank argued. Yet, even at the lowest end of this scale, the bill for a Jamaican would be more than J$8,000 per dose, and the standard treatment is six doses.
Put another way, with these prices, two things are likely to happen. So long as Gilead has a monopoly for an antiviral drug for COVID-19, it can possibly guffaw all the way to the bank. And even with a generic product, patients in developing countries may well struggle to afford the remedy.
Indeed, these observations provide another context to this newspaper’s lament in March over the limited research and development (R&D) activities in science and technology in the Caribbean, including work on a vaccine or antiviral drugs for the novel coronavirus. The region’s limited participation in R&D is highlighted by the paucity of patents either registered to, or applied for from, the Caribbean.
For instance, in 2016, of more than three million patent applications filed globally, the World Intellectual Property Organization reported, a mere 1.9 per cent were from Latin America and the Caribbean. Of the several million patents registered with the US Patent and Trademark Office in 2015, only 479 were from Caribbean Community (CARICOM) countries, including 62 from Jamaica.
The larger point is, the Caribbean spends less than half of one per cent of its GDP on research and development. In countries on the cutting edge of scientific and technological development, it is as high as four per cent.
The Caribbean’s fiscal circumstances limit, we appreciate, the region’s ability to match these levels of R&D expenditure. More, however, can be achieved through coordinated action between CARICOM as a group, regional governments, the region’s private sector, and national and regional academies, especially The University of the West Indies, which has already set itself the task to be more robust on this front. Past achievements on medical research point to what is possible in the future.
Further, we have to become excited by R&D, talk about it, and make it appealing.