The Trump administration says it has locked down nearly the entire supply of one of the only available anti-COVID-19 drugs from the manufacturer for the next several months.
That raises questions about access to one of the few treatments available for COVID-19, the disease caused by the coronavirus, for much of the rest of the world.
Remdesivir is the first drug shown to help patients with COVID-19, though its impact is modest. Hospitalized patients given the drug recovered four days faster than those given a placebo. Preliminary results did not show that it saved lives, but the study is ongoing.
The U.S. Department of Health and Human Services announced Monday that it had secured half a million treatment courses of the antiviral drug from its manufacturer, U.S. pharmaceutical company Gilead Sciences, including 100% of the company's production for July and 90% for August and September.
“President Trump has struck an amazing deal to ensure Americans have access to the first authorized therapeutic for COVID-19,” HHS Secretary Alex Azar said in a statement.
Gilead signed licensing agreements with generic manufacturers in India, Pakistan and Egypt to supply remdesivir to 127 mainly low- and middle-income countries.
But that license excludes more than 70 large middle-income countries, including Brazil, Mexico and China.
"That adds up to half the world's population," noted Peter Maybarduk, director of the access to medicines program at the advocacy group Public Citizen.
"If the U.S. government has bought up the supply, then I don't know where they'd get" the drug, he added.
It is not clear whether generic manufacturers can fill the needs in the other 127 countries. Only two Indian companies have begun producing the drug so far.
"I think it is safe to assume that two companies alone could not currently supply all of the demand," Jessica Burry, pharmacist for the Access Campaign at medical humanitarian group Doctors Without Borders, said in a statement to VOA.
"Gilead does not seem to have any plan to sufficiently supply low- and middle-income countries’ markets during this interim period while generics are coming on board, either, as they seem more focused on high-income country markets where they can make more money," she added.
The drug will cost about $3,200 per treatment course in the United States, a price Maybarduk calls "offensive."
Indian generic manufacturer Cipla said it will charge around $66.
The Institute for Clinical and Economic Review, the drug pricing watchdog, said Gilead's price is "reasonable," provided the drug ultimately shows it can save lives.
Gilead donated the first 1.5 million doses worldwide. The United States received more than 900,000, according to health news website Stat.
"The U.S. was certainly at the front of the line for the donated remdesivir," said Brook Baker, professor of law at Northeastern University and a senior policy analyst for Health Global Access Project. "Now, we find out that the U.S. is wholly at the front of the line for all the additional half-million doses to be produced between now and basically the end of September."
"There's no way to explain this than to say, well, somehow between the U.S. government and Gilead, they have collusively agreed that for whatever reason, Americans come first," he added.
Gilead says it is ramping up production and aims to have 2 million treatment courses available by December, up from 190,000 at the end of June.
"We are doing everything we can to accelerate manufacturing timelines and quantities of remdesivir to meet the growing demand for emergency use of the medicine from around the world," the company said in a statement.
The company said it has "multiple manufacturing partners in North America, Europe and Asia" that are "capable of producing large volumes of remdesivir at the fastest pace feasible," but did not provide details or answer requests for comment.
The global pandemic so far has claimed more than 500,000 lives and infected more than 10 million people worldwide, according to data collected by Johns Hopkins University.
The World Health Organization and a number of public-private partnerships are aiming to make access to COVID-19 countermeasures equitable around the world.
The U.S. government has put billions of dollars into research and development of COVID-19 treatments, vaccines and diagnostics.
"Rich countries have more money to spend on research and development," Baker said. "Does that mean that only rich people get medicine? That's highly problematic in a moral, ethical sense."