Yesterday, Merck announced an agreement with the Medicines Patent Pool (MPP) for the COVID-19 therapeutic molnupiravir, reported to cut COVID-19 hospitalizations and death in high-risk patients in half, that makes the pill available for generic manufacture in 105 countries, dramatically increasing access and affordability in low- and middle-income countries.
SGI believes this is an important event for two reasons. First, the agreement makes molnupiravir the first COVID product to allow for the sale of lower-cost generic versions of medicines in over a hundred developing countries. Second, the agreement is transparent. You can read the agreement, without any redactions, here. At the same time, we remain concerned about the enduring price for health systems in high income countries and how the company will ensure access in the countries not covered by the MPP license. While not perfect, the agreement is vastly better than what the other companies have done.
The pharmaceutical industry deserves praise for producing safe and effective COVID-19 vaccines so quickly. Developing a vaccine takes an average of 10 years — if it works at all. Despite years of well-funded research, there are still no vaccines for HIV or malaria.
These vaccines are the product of innovative research, spurred by unprecedented public investment. Operation Warp Speed provided more than $10 Billion in support of vaccine makers for the development and expansion of manufacturing capacity. Another $825 million has been given in support of monoclonal antibody therapies. As of March, U.S. commitment to the CT-Accelerator stood at $6 billion. In April, President Biden pledged another $2 billion to the international COVAX effort.
Amid such vast public investment, most pharma companies have been pursuing monopolistic deals rather than getting those vaccines and therapeutics to everyone, everywhere, at the lowest cost possible, as quickly as possible. Merck’s agreement with the MPP goes a long way toward advancing access globally.
ICCR’s 2021 filings with Johnson & Johnson, Pfizer, Merck, and Eli Lilly, asked the board of directors to report on how public investment in vaccines and therapeutics is or will be accounted for in such things as settings prices. This is important because drugs can’t work if people can’t afford them. An increasing number of signs — the rise of coronavirus variants and our collective failure to mask up and maintain social distance — suggest that Covid-19 will become an endemic condition, much like the flu. Billions of us will likely need the vaccine each year. This is not an issue that only depends on governments. Corporations have an important role to play in ensuring equitable access to affordable, quality care. These resolutions asked pharma companies to account for their role in our collective fight against the Coronavirus. Many shareholders agreed with our concerns; 33% of Merck shareholders voted in favor of the proposal filed by the Capuchin Province of St. Joseph, 31.8% at Johnson & Johnson, and 29.9% at Pfizer (while the SEC allowed Eli Lilly to omit the resolution).
The MPP agreement has transparency that is lacking in the bilateral agreements signed before this one. Pfizer’s practice has been especially egregious. Only 6% of the text of contracts between vaccine-makers and countries remains after redactions. The non-redacted material suggests particularly harsh terms for Latin American countries including Brazil, Colombia, the Dominican Republic, and Peru. The Guardian reports that Pfizer has held Brazil “to ransom,” including putting up sovereign assets as collateral to guarantee indemnity. Public Citizen outlines some of Pfizer’s draconian terms here.
We do believe that Merck’s decision to make the agreement with MPP is consistent with our proposal request. We now hope that Johnson & Johnson, Pfizer, Moderna, and so many other pharmaceutical companies follow Merck’s lead and make these lifesaving medications available broadly through mechanisms like the MPP and to do so in terms that are transparent.
Connecting faith and finance for 50 years, ICCR had a hand in the early years of the Medicines Patent Pool. The MPP, established in July 2010, in response to the global HIV/AIDS epidemic, had difficulty acquiring commitments from pharmaceutical companies. In February of 2011, ICCR hosted a multi-stakeholder roundtable including representatives from the MPP, leading pharmaceutical companies, NGOs such as Doctors without Borders and Oxfam, as well as intergovernmental organizations like the World Health Organization, to explore and work through some of the barriers to entering the patent pool. In response to investor encouragement, Gilead Sciences became the first company to join the MPP in 2011, sharing licenses with generics manufacturers for its vital HIV and Hepatitis B drugs. (To learn more, read this report.)
For more information about the Merck-MPP agreement, please, read the ICCR press release here.