Can Pfizer’s New Pill Beat Back the Pandemic of the Poor?

Here is today’s Foreign Policy brief: Pfizer announces plans to license COVID-19 pill to developing countries, Armenia and Azerbaijan agree on a border cease-fire, and Chilean President Sebastián Piñera survives impeachment vote.

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Pharmaceutical giant Pfizer threw a lifeline to the developing world on Tuesday, as the company announced it would share the license on its experimental COVID-19 treatment to poorer countries, greatly expanding access to the pill, which has shown 89 percent efficacy in preventing hospitalization and death in unvaccinated patients in company trials. It is currently under consideration for Food and Drug Administration approval.

The decision jars with the company’s vaccine strategy from last year: Prioritizing rich countries and reaping the benefits, with vaccine revenues of $36 billion expected in 2021.

Still, with many in the developing world still waiting to receive a vaccine (including 90 percent of people in African countries) the new drug may give those suffering COVID-19 symptoms a much higher chance of remaining out of the hospital, relieving the strain on intensive care unit beds already in short supply.

The pill’s relatively simple manufacturing process means that countries frozen out of the current vaccine supply and distribution chain, particularly in Africa, now have the chance keep pace with rich countries. Prashant Yadav, a senior fellow at the Center for Global Development and a global health supply chain expert, told Foreign Policy that since the drug’s chemical structure closely resembles HIV treatments already manufactured in Kenya, Uganda, and South Africa, problems of access are likely to be fewer.

Still, the drug is not a silver bullet for developing countries, and it faces significant structural challenges.

The most urgent issue is timing. With manufacturing companies facing an approval process that could take months, the drug would be unlikely to become available in large quantities to developing countries until mid-2022. With the sluggishness of the vaccine rollout, that may not be soon enough for some countries.

Even if manufacturers meet the standards, there is still the problem of sourcing supplies of raw materials from a highly concentrated pharmaceutical active ingredient market, an issue that has dogged vaccine distribution efforts and could hamstring attempts to make generic versions of the Pfizer pill. “We cannot say we hope someone will create sufficient capacity for the active ingredient and then those who are making the finished pill will buy it,” Yadav said. “We need a slightly more planned intervention there.” A recent $120 million commitment from the Bill & Melinda Gates Foundation is an example of what that intervention could look like.

Finally there is the issue of capacity. Smaller producers are unlikely to be able to afford to take the kind of financial hit Pfizer could if initial demand for the drug is lower than expected. Thus, they may need a helping hand from governments to keep production processes going. “We need to think about smoothing demand, creating the stability that, even in months or years when individual patients aren’t taking it, there is a steady buyer in the market,” Yadav said.

Armenia-Azerbaijan tensions. Armenia and Azerbaijan agreed to a cease-fire along their border, Armenia’s defense ministry reported on Tuesday, following periodic exchanges of fire since a six-week conflict ended last year. The Russian-mediated agreement came after a deadly clash over the weekend that killed one Armenian soldier and led to the capture of 12 others. Before Tuesday’s agreement was reached, each country blamed the other for instigating the weekend’s violence.

Piñera holds on. An impeachment attempt against Chilean President Sebastián Piñera ended late Tuesday night after opposition senators failed to garner enough votes for a trial to go forward. Piñera had been impeached by the lower house last week over allegations that he had facilitated a family property deal using his presidential powers, a case given new life when the terms of the sale were revealed in the Pandora Papers.

Nord Stream 2 delayed. The approval process for Nord Stream 2, the controversial gas pipeline linking Russia with Germany, was put on hold by German regulatory authorities on Tuesday, further delaying its eventual rollout. Although the decision may have political undertones, the German energy regulator Bundesnetzagentur said that the project first needed to incorporate a German subsidiary company before it could be certified. If the project does receive German approval, it faces a further hurdle in a final European Commission review process.

A Rome-Paris alliance? Italian Prime Minister Mario Draghi and French President Emmanuel Macron are set to sign a deal next week designed to shift Europe’s duopoly to include Rome rather than Berlin as German Chancellor Angela Merkel leaves office, Reuters reports. Details of the agreement have not yet been disclosed but will cover the “economy, trade, tourism and culture” according to a government source quoted in the report.

The world has 200 million fewer tobacco users than at the same point in 2015, the World Health Organization reported on Tuesday, as it praised countries for pursuing policies to cut back on smoking. There are 1.3 billion people still using tobacco, 37 percent of men and 8 percent of women worldwide, according to the report. If trends continue, smoking may become extinct in many Western countries, including the United States, by 2050, according to some estimates.

Correction, Nov. 17, 2021: This article has been updated to correct an error in the percentages of men and women worldwide who are tobacco users.