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More than a billion dollars worth of Pfizer’s Covid-19 antiviral drugs procured in Europe have been wasted, according to health data, as tight controls over who can receive the medication left millions of doses unused before their expiry date.
Paxlovid — designed to be given to patients shortly after they test positive for the virus — has been far easier to obtain in the US than in Europe, where access has often been restricted to the elderly or people at high risk of developing severe Covid.
But data from analytics group Airfinity shows European countries including the UK, France, Spain and Italy could have made the medication more accessible without using up supplies, as more than 1.5mn five-day courses of the pill worth about $1.1bn have expired despite their usage dates being extended by six to 12 months.
By the end of February 2024, a total of about 3.1mn courses are set to expire, pushing the cost to European health systems to about $2.2bn, according to Airfinity. The data does not include contracts that were EU-wide.
Marco Gallotta, an analyst at Airfinity, said some countries may have overpurchased Paxlovid when it became available at the end of 2021, just as the Omicron variant increased global caseloads.
“Governments were keen to buy the highly efficacious antiviral and had a difficult challenge of estimating demand with so many unknowns,” he said.
But a drop in cases and a sharp reduction in testing had hit the take-up of antiviral drugs, which needed to be taken shortly after the onset of symptoms, he said. “This means countries haven’t been able to administer all of their stockpiles before they expire, despite extensions to the shelf life.”
Pfizer said: “Expiry and destruction of doses can be an unavoidable consequence of a pandemic, a natural result of manufacturers and governments collectively aiming to address the public health crisis at speed with the overarching objective of protecting their populations.”
There have also been concerns over how Paxlovid interacts with other common medications, which restricts how often it can be prescribed.
The European country with the biggest expiry rate is the UK, where an estimated 1mn doses worth $700mn were out of date by early December, the data shows. Another 550,000 doses are expected to expire in February, with a further 650,000 by the end of June.
In December 2021, at the height of the Omicron wave, the UK agreed to buy 2.75mn courses of Paxlovid. The country’s National Institute for Health and Care Excellence, the public health body, recommends the drug be used only for people with serious underlying health conditions such as cancer and HIV or recipients of transplants.
The UK health and social care department said more courses had been used, without offering its own data. A spokesperson said the government had “acted fast to secure enough stock of antivirals” at a time of “high global demand”.
The restrictions have been less stringent in other European countries, with elderly citizens and people with more common risk factors such as diabetes and obesity able to obtain the drug. Yet more than 200,000 Paxlovid courses expired before they could be used in Spain and about 100,000 each went out of date in France and Italy.
Even in the US — the largest market for Covid outpatient treatments — demand for Covid antivirals has fallen, tracking the reduced burden of Covid and a drop in testing for the virus.
About 5.3mn courses were prescribed in the US this year, 24 per cent down on 2022. The US government arranged with Pfizer to return 7.9mn Paxlovid courses at the end of 2023, at an estimated cost to the company of $4.2bn.
In Japan, the regulator has approved another antiviral, Xocova, from drugmaker Shionogi. Authorisation of Xocova for use by standard risk patients has expanded the Covid antivirals market.
The market was relatively robust over the summer on the back of a rise in infections. That prompted Shionogi in late October to upgrade its annual guidance for domestic sales of Xocova, while it lowered its target for international sales. The drug is not yet approved in the US or Europe.
According to Shionogi, roughly 23 per cent of patients who tested positive for Covid were prescribed oral drugs for treatment when public funding was available. But this is forecast to fall now that people must pay out of their own pocket for antivirals. A course of Xocova costs up to ¥9,000 ($64).
Additional reporting by Kana Inagaki in Tokyo