Some global reaction to the news of US mass purchase of remdesivir

Canadian physician-researcher James Brophy of McGill University read the news announcing, “US buys up world stock of key Covid-19 drug remdesivir.” Rather than reacting with shock and scorn as many observers did, Brophy celebrated the announcement as “good news for the rest of us” around the globe.

Why?

He explained in an opinion piece published by The BMJ, “US purchases world stocks of Remdesivir—why the rest of the world should be glad to be at the back of the queue.”

• One company-sponsored remdesivir trial showed a shortened median time to recovery in the remdesivir group. There was no effect on mortality. “Moreover, there are numerous reasons why the shortened reported time to symptomatic recovery may be an over-estimate of its true value.”
• “It has been established that company sponsored trials, prematurely stopped trials, poorly executed trials with unsuccessful blinding, and large lost to follow-up, all contribute to exaggerated, embellished and unreliable effect measures. Well, this (New England Journal of Medicine published-) remdesivir study was company sponsored, prematurely stopped, had incomplete blinding, and only about 15% of patients had their outcome determined at the specified primary endpoint of 28 days. An additional concern for some is the modification of the primary trial endpoint shortly before publication, although apparently before unblinding of any results. In contrast, a non-company sponsored trial looking at the same remdesivir doses found no benefit for either symptom duration or mortality. Hmmm, are we still convinced about the magnitude of any potential benefit?”
• “No remdesivir study has demonstrated any reduction in hospital stay or mortality.”
• “For this marginal and uncertain benefit, the manufacturer now proposes charging in the vicinity of $3000 USD per treatment.”
• “The last time countries stockpiled billions of dollars of antivirals, at least $10 billion for oseltamivir (Tamiflu), could hardly be considered a success as that medication was eventually removed from the WHO list of essential medications. The aphorism “Those who don’t know history are doomed to repeat it” does seem appropriate.”
• “In conclusion, yes, the US action may be viewed as unfriendly and is truly the apotheosis of a self-centered nation, but its course of action is potentially beneficial for other countries. Better to have the plutocratic American healthcare system dominate this market with an expenditure of $1.5 billion for such uncertain benefits. The money other countries save can surely be better spent on further research for this and other drugs as well as for public health measures, including testing, contact tracing, and maintaining universal healthcare, all notable lacunae in the American system.”

Brophy asks “Wonder why their healthcare ‘system’ has troubles?”

It sometimes helps to see the US as others see us.  This time it’s viewed as a “chilling move,” “shocking,” “disappointing…inappropriate,”or, as Dr. Brophy wrote, “the apotheosis of a self-centered nation.”

Meantime, please note a separate Los Angeles Times reported angle: How secret deals could keep a COVID-19 drug out of reach for millions.

Much of the criticism within the US focused on the remdesivir pricing announcement from the drug’s manufacturer, Gilead Sciences.  For example, NPR reported:

Some advocacy organizations and members of Congress say Gilead is taking advantage of Americans during a pandemic.

Rep. Lloyd Doggett, D-Texas, called the price “outrageous.”

“Without a taxpayer investment of $99 million, this drug would have been abandoned. It would be on the scrap heap of failures,” he tells NPR. “So it’s the taxpayer who’s really taking the risk here and ought to get the reward of the angel investors that taxpayers are.”

Public Citizen, a nonprofit consumer advocacy group, echoed his remarks with a similar sentiment.

“In an offensive display of hubris and disregard for the public, Gilead has priced at several thousand dollars a drug that should be in the public domain,” Peter Maybarduk, director of Public Citizen’s Access to Medicines Program said in a written statement.