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Most drugs in clinical trials against COVID-19, such as chloroquine phosphate, can be made cheaply.

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Would-be coronavirus drugs are cheap to make

Sciences COVID-19 reporting is supported by the Pulitzer Center.

With a vaccine for the novel coronavirus still likely 1 year or more away, the first weapon against the virus could be one of the drugs now in clinical trials with COVID-19 patients. A new analysis out today shows that many of these drugs, which are currently manufactured or in development to treat other diseases, can be made for $1 a day per patient, or less. If any prove effective against the novel coronavirus, a coordinated international effort will be needed to ensure they are made affordable for people worldwide, the researchers argue.

Scientists worldwide are conducting clinical trials on at least a dozen potential treatments for COVID-19. Some compounds have been on the market for decades, such as chloroquine and hydroxychloroquine used to combat malaria and lupus. That makes it relatively straightforward to estimate the minimum cost of making them, says Andrew Hill, a drug pricing specialist at the University of Liverpool.

For the new analysis, out today in the Journal of Virus Eradication, Hill and colleagues reprised a strategy he previously used to estimate the cost of drugs to treat HIV and hepatitis C. They started with an India-mandated database that includes the cost per kilogram of active pharmaceutical ingredients (APIs) shipped in and out of the country, a major hub for generic drug production. To those figures, they added in additional costs for formulating APIs into medicines, packaging, and a 10% markup for the companies manufacturing the drugs. For eight of the nine candidate COVID-19 treatments analyzed the estimated cost was less than $1.50 per day per person treated and from $0.30 to $31 for a full course of treatment. The bottom line is clear, Hill says. “All of these drugs are fundamentally really cheap to make.” (Hill’s team was unable to estimate the cost of one compound, Tocilizumab, a monoclonal antibody used to treat rheumatoid arthritis, because it is currently made only in small quantities.)

Today, however, these drugs aren’t always cheap to buy. They retail for between $0.20 and $510 per course in countries that strictly hold down drug costs, such as India and Pakistan, but between $19 to $18,610 per course in the United States, Hill and his colleagues report.

Jessica Burry, a pharmacist with Doctors Without Borders, worries that high pricing of COVID-19 treatments would amount to rationing, putting them off-limits for poorer patients and countries. “Rationing drugs because of high prices and limited supply will only serve to prolong the pandemic,” says. “What good is a lifesaving drug if you can’t afford it?”

Hill notes that most of the drugs his group evaluated are off patent, and thus could be manufactured cheaply by generic drugmakers. But some of the antivirals in the COVID-19 clinical trials are proprietary. As the debate over drug pricing for coronavirus drugs is already heating up, one flashpoint is remdesivir, a drug from Gilead Sciences that appears to inhibit an RNA-copying polymerase the new coronavirus uses to replicate. Hill’s team estimates that 1 day’s supply of the drug could be manufactured for $0.93.

Manufacturing cost of potential coronavirus drugs

Though most drugs currently in clinical trials to fight COVD-19 can be made cheaply, they can sell for hundreds of times the price.

DrugEstimated cost price (course)Estimated cost price (day)
Remdesivir (10 days)$9$0.93
Favipiravir (14 days)$20$1.45
Lopinavir/ritonavir (14 days)$4$0.28
Hydroxychloroquine (14 days)$1$0.08
Chloroquine (14 days)$0.30$0.02
Azithromycin (14 days)$1.40$0.10
Sofosbuvir/daclatasvir (14 days)$5$0.39
Pirfenidone (28 days)$31$1.09
A. Hill et al., Journal of Virus Eradication, 2020

But patent protection and limited supplies could send its price soaring, some groups fear. On 30 March, Doctors Without Borders and nearly 150 other civil society organizations sent an open letter to Gilead CEO Daniel O’Day asking “that Gilead take immediate actions to ensure rapid availability, affordability, and accessibility of its experimental therapy remdesivir for the treatment of COVID-19.” The authors implored Gilead to forgo patent protection for the drug and allow generic manufacturers to add to the supply. Gilead’s Corporate Affairs and General Counsel Brett Pletcher responded today that Gilead is already ramping up production sharply. The company is also exploring a partnership with UNICEF to distribute the drug globally, Pletcher wrote the groups in a letter made public by the company.

One model for distributing a coronavirus drug quickly and cheaply comes from ongoing parallel efforts to provide HIV and tuberculosis drugs, run by the Global Fund and the U.S. President’s Emergency Plan for AIDs Relief. Each organization pools financial contributions from governments worldwide or U.S. government agencies, respectively, and use the money to negotiate cheap prices for generic drugs that are then distributed to countries in need—an approach that has been hailed for saving tens of millions of lives. David Nash, a physician and pharmaceutical industry expert at Jefferson College of Population Health, says that model could work with coronavirus as well. “I would not reinvent the wheel here.” Nash says international drug pricing experts should begin to set up such an initiative to mass produce and distribute coronavirus medications, adding that they should move fast. “We ought to start the conversation now in anticipation of the results of the clinical trials.”