Unvaccinated, untreated: Africa may not get its fair share of Covid-19 drugs

No access to Covid-19 vaccines has left millions of Africans unprotected against an infectious virus. Now, countries may also not be able to afford life-saving Covid-19 treatments. 

The World Health Organisation (WHO) has approved just three drugs to treat severe Covid-19. The WHO recommends a two-drug combination of the common steroid, dexamethasone, and either the drug tocilizumab or sarilumab to treat life threatening Covid-19. Tocilizumab and sarilumab belong to a class of drugs called monoclonal antibodies that use laboratory-made proteins to mimic aspects of the body’s natural immune response. 

Multiple studies reviewed by the WHO show that either tocilizumab or sarilumab — when paired with dexamethasone — can help prevent that. The combination treatment has also been shown to reduce the need to put serious Covid-19 patients on ventilators while giving them a better chance of surviving. The medicines have also been found to shorten hospital stays. 

Only 18 countries in Africa have said they are using dexamethasone, the most affordable of the trio to treat severe Covid-19, according to a WHO Africa survey of 30 countries. A course of the drug costs about R86. The WHO’s Africa office cannot say whether any country has been able to roll out tocilizumab and sarilumab, which can cost hundreds or even thousands of dollars a dose. And despite an expert panel in South Africa finding that tocilizumab reduced deaths, the recommendation was that the drug not be used because it is “not affordable at the current offered price”. 

It was the same case in Kenya, where the Daily Nation newspaper reported that although the country had approved tocilizumab for use in critically ill patients, it remained expensive and in short supply. Last week, tocilizumab’s maker, Roche, said it has not been able to keep up with demand for the drug. Monoclonal antibodies remain too pricey for use by medical humanitarian organisation Doctors Without Borders (MSF), says the senior legal and policy adviser with MSF’s Access Campaign, Yuan Qiong Hu. 

The MSF works in at least 10 countries on the continent. “For now, this life-saving therapy is largely out of reach for African populations, at the cost of around $2 000 per patient,” the WHO’s regional director for Africa, Matshidiso Moeti, said in July. “We are advocating for generics to be produced rapidly to make these products more affordable.” 

But Hu and others fear that patent protections will hamper affordable, generic versions of the drugs.

Although the initial patents on Roche’s tocilizumab expired in 2017, it’s been able to extend patent protection in at least 30 countries, Hu says. Roche spokesperson Nina Maehlitz confirms that tocilizumab is patented in four African countries. But the company has agreed not to enforce patents on the medicine in low and middle-income countries. She says Roche is also willing to waive patent protection on tocilizumab in upper-middle-income countries, like South Africa, in emergency situations. 

Maehlitz says Roche has been in discussions with South Africa’s health department to increase access to the drug. But the firm says it has a limited presence in low-income countries and is willing to donate doses to the WHO’s Access to Covid-19 Tools (ACT) Accelerator for distribution to developing countries. 

The company maintains that 60% of its estimated Covid-19 tocilizumab supply has gone to developing countries — quadruple the amount of the drug delivered to these countries prior to pandemic. 

Meanwhile, Hu says the WHO recommended monoclonal antibody, salirumab, is under patent until about 2030 in many low and middle income countries, including at least 14 African countries. 

Sanofi, which distributed the drug outside the United States, declined to confirm the exact number of African countries in which Salirumab is under patent. A Sanofi spokesperson confirmed that no national drug regulator has approved the medicine as a Covid-19 treatment. Sanofi confirmed it is not looking to ramp up production of the medication beyond meeting the needs of patients that currently use it to treat rheumatoid arthritis.

This is an edited version of an article first published by The Continent

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Laura López González
Laura López González is a freelance health journalist and editor with more than 15 years of experience covering global health. She is the former deputy editor of South Africa's Bhekisisa Centre for Health Journalism.

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