U.S. to Buy Enough of Pfizer’s Covid Antiviral Pills for 10 Million People

WASHINGTON — The Biden administration plans to pay more than $5 billion for a stockpile of Pfizer’s new Covid-19 pills, enough for about 10 million treatment cycles in the next 10 months, according to people familiar with the agreement.

Top federal health officials are counting on the drug to be a powerful weapon against Covid. When administered immediately to experimental groups of unvaccinated high-risk subjects who developed symptoms, the drug significantly reduced the risk of hospitalization and death.

Pfizer on Tuesday applied for a federal license for the drug on an emergency basis. Similar pills developed by Merck and Ridgeback Biotherapeutics could be allowed as soon as early December, meaning pharmacies could have a limited supply on hand within weeks. Pfizer is taken as a regimen of 30 tablets over five days; Merck’s requires 40 tablets over five days.

Antiviral drugs have helped create hope among senior administration officials that the United States will be able to stem the devastating losses from the Delta variant and its predecessors. Some experts believe the worst of the coronavirus pandemic has passed in the country, in part because more than four out of five Americans aged 12 or older have been at least partially vaccinated.

Others say infection rates have only stopped and could easily rebound, especially with the onset of winter. After declining for more than a month, the daily rate of cases is starting to rise.

“I believe these new oral antivirals will change the way that Covid is managed,” said Dr. David Dowdy, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

“This will help reduce the burden on hospitals and the number of deaths,” he said, but added that “even without these pills, these numbers are going down.”

Antivirals are a new class of treatment for Covid and are eventually expected to reach far more patients than others. Monoclonal antibody therapies usually require injections, and are usually given on an outpatient basis. In contrast, antiviral pills are supposed to be taken from pharmacies and taken orally at home.

Their promise depends in part on access to rapid, over-the-counter tests, because the pills have been shown to be effective within five days or less after symptoms appear. While the government has pledged $3 billion for rapid tests and the Food and Drug Administration has cleared a dozen of them, the test typically costs about $12 and not everyone can easily obtain it.

Federal officials said one of the latest rapid tests costs $7, and by the end of the year the total supply is expected to be nearly 10 times what it was in August.

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“But they are still not used to their full potential,” he added, and “rapid testing will be critical to those antiviral tests.”

A much bigger hurdle, at least initially, will likely be availability. Merck is expected to offer enough courses to cover just over three million people before February. Pfizer is expected to have enough to cover about 300,000 people by the end of February, then sharply increase deliveries.

This means that the drug that seemed less effective in the studies will be more abundant initially. Pfizer’s pills reduced the risk of hospitalization or death by 89 percent when given within three days after symptoms began. Merck’s pills were only 50 percent effective when given within five days of onset of symptoms, although different clinical trial designs and timings make comparisons inaccurate.

Both drugs are intended for people over 65 years of age or who have medical conditions that make them more susceptible to severe Covid-19. Pfizer provided data showing the treatment’s effectiveness only for unvaccinated people at high risk, though officials said the company could provide more data later as clinical trials progress.

Both Pfizer and Merck, which applied for a license for their drug last month, said it is up to the Food and Drug Administration to determine which groups are eligible for treatment. The panel of experts that advises the Food and Drug Administration on antimicrobial drugs is scheduled to meet at the end of the month to discuss Merck’s drug.

“I think this is a powerful new tool in terms of keeping people alive and getting out of the hospital,” said Dr. Doody. “But the people who will get these are the ones who can be diagnosed quickly and who are at enough risk that someone will think they might need to get to the hospital.”

Pfizer and Merck plan to ramp up production over the next year. Pfizer said it expects to be able to produce enough grain to cover more than 21 million people in the first half of next year and 50 million by the end of the year.

Australia and Britain have already cut off some supplies. On Tuesday, Pfizer said it had reached an agreement to allow other manufacturers to make and sell the pills cheaply for use in 95 developing countries.

The US government had initially planned to order 1.7 million treatment courses from Pfizer, with an additional option of 3.3 million, for $700 per course. But under the 10 million treatments contract, the cost is expected to be much lower – perhaps $180 less per treatment.

The contract is not final yet, but an announcement is expected this week.

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