The people of the world vs Pfizer Inc.

During the Covid-19 pandemic, Pfizer has used every opportunity to maximize its profits, even if this meant reduced access to life-saving medical products for most of the world. The same is about to happen in the case of Paxlovid, the company’s Covid-19 oral treatment

February 05, 2022 by Jyotsna Singh

On January 24, US advocacy group Public Citizen wrote a letter to Albert Bourla, Pfizer’s Chairperson and Chief Executive Officer. It asked Pfizer to step up and make its Covid-19 treatment, Paxlovid, widely accessible. The letter expressed the concern that going by Pfizer’s announcements so far, we can expect that more than half of the world population in need of this treatment won’t get it.

In mid-December, Pfizer told investors it estimated an addressable patient population of nearly 250 million for its oral treatment. However, the company will be able to manufacture only 120 million courses of treatment in 2022. The high price of treatment and different charges in different countries is equally concerning. While the US government is paying USD 530 per course, Panama will pay USD 250. Meanwhile Beximco, a firm in Bangladesh, is selling a generic version of Paxlovid at USD 186 per treatment course. Lack of transparency of cost of production doesn’t allow rational pricing and companies such as Pfizer are able to exploit the desperation for treatment in an emergency situation like the pandemic.

Almost all the treatment courses are directed towards the populations of rich nations. According to a tracker by US-based organization, Knowledge Ecology International, Pfizer has signed contracts exclusively with high-income and upper-middle-income countries, mostly from Europe and North America. No African country figures in the list, although the region has the lowest vaccination rates and is most in need of treatments.

Unprecedented crisis, unprecedented revenue

Concerns regarding access to Pfizer’s medicine emerge from the experience of glacially slow vaccination in lower and lower-middle income countries. While Pfizer was among the first few companies to have developed an effective mRNA vaccine, access to the vaccine has been very low outside of the Global North.While only 11% of the African population is fully vaccinated, in Europe, the same stands at 63%.

With Pfizer now having an effective treatment as well as vaccine, it is more necessary than ever to challenge the power it holds during an unprecedented crisis. In the 3rd quarter of 2021 (July-September), Pfizer’s revenue was USD 24.1 billion, which was a 134% increase from last year. Excluding Comirnaty, the Pfizer-BioNTech Covid-19 vaccine, Pfizer’s revenue grew by just 7%, clearly indicating that the company’s exponential growth in 2021 relied almost exclusively on the vaccine. This revenue is set to increase as Pfizer is projecting the production of 4 billion vaccines in 2022 compared to 3 billion in 2021.

It wasn’t only selling the vaccine that has led to this spectacular performance. During bilateral negotiations for purchasing the vaccine, the company signed contracts with governments which undermine their sovereignty. Some of the clauses give complete immunity to the company at the cost of national laws and assets. All contracts between Pfizer and national governments follow a non-disclosure agreement. The clause doesn’t cover only the contents of the agreement, but also the talks and negotiations that preceded the final contract. Thus, no one gets to know when the negotiations are on, and their content is forever hidden.

However, some leaked contracts give us an insight into the contents. In a report on Pfizer’s contracts, Public Citizen notes, “The contracts offer a rare glimpse into the power one pharmaceutical corporation has gained to silence governments, throttle supply, shift risk and maximize profits in the worst public health crisis in a century.” While reading the contracts, it appears that a powerful entity is calling the shots compromising sovereignty of countries, law of the land and decision making power of the elected governments.

State-owned enterprises as collateral

Among other things, the contracts define that in the event of any dispute between the company and the government, it will not be settled according to the laws of the country, but rather under a secret private arbitration process under the laws of New York. The company has also kept national assets as collateral to be used in case a country’s government does not pay in accordance with the arbitral award. These include US-based assets such as foreign bank accounts, foreign investments, and foreign commercial property, including the assets of state-owned enterprises like airlines and oil companies.

The Brazilian government has been prohibited from making any public announcement regarding its agreement with Pfizer, including even its existence, without prior written permission from the company. Similar non-disclosure clauses are contained in contracts with the European Commission and the US.

Pfizer has managed to absolve itself of consequences if vaccines are not delivered on time. Their contract with the government of Colombia says, “Under no circumstances will Pfizer be subject to or liable for any late delivery penalties.” Similar clauses are part of contracts with Albania and Brazil.

Brazil is also denied the right to accept donations of the Pfizer vaccine, or buy it from any other source without Pfizer’s permission. This, in effect, means that if Brazil wants to use its laws such as compulsory licensing to improve access to Pfizer’s mRNA vaccine, it can’t do so. In case it does, Pfizer reserves the right to terminate the contract and Brazil would have to pay full price for any remaining contracted doses. Brazil also cannot donate, distribute or export the vaccine without the company’s permission. Such impunity on part of a private corporation is worrisome and calls for strict regulation by governments across the world.

Calls to facilitate mRNA vaccine technology transfer

The price for the vaccine is also high, just like the oral treatment. An analysis of production techniques by Public Citizen with engineers from Imperial College London estimated that the mRNA vaccine produced by Pfizer/BioNTech could be mass produced for as little as $1.18 to $2.85 a dose. Yet it is one of the most expensive on the market at an average price of $16.25.

On January 13, seven US senators of the ruling Democratic Party wrote to the government urging the Biden Administration to invoke the Defense Production Act (DPA) to increase the global supply of COVID-19 vaccines. They wrote that DPA should be used to facilitate mRNA vaccine technology transfer and scale up production through publicly-owned vaccine manufacturing facilities. They emphasized the importance of boosting vaccine production at home and abroad to control the devastating pandemic.

Given Pfizer’s actions during the pandemic, it is no wonder Public Citizen and other health activists and academics have started raising concerns regarding access and affordability of Paxlovid early on. In its mid-December presentation to investors, Pfizer indicated that LMICs will come on board for Paxlovid through the Medicines Patent Pool only in 2023. We can not allow the devastation of people’s health and profiteering of Big Pharma for one more year. Free riding on people’s suffering should be stopped and companies like Pfizer should be reigned in.

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