What in the world is Remdesivir?
On June 29, 2020, the US Department of Health and Human Services (HHS) announced that President Trump had secured “an amazing deal to ensure Americans have access to the first authorized therapeutic for COVID-19”, at least according to HHS Secretary, Alex Azar (1). The release says that the administration has secured 500,000 treatment courses of the drug, Remdesivir, from the American company, Gilead Sciences, Inc. The drug got a lot of attention in May when the FDA released an emergency use authorization for it in the treatment of COVID-19, saying that clinical trials showed it shortened the time to recovery (2). This meant that physicians could give it through IV to patients with severe disease: those who weren’t breathing well anymore or even had to be ventilated.
But researchers still aren’t sure why it seems to help patients get to recovery faster, and there is still no evidence that it improves the survival of those patients. We know that the drug works by target enzymes this type of virus, the RNA virus, needs to survive, which is why it has been helpful against a wide variety of viral infections (3). But we aren’t sure how that translates to COVID-19 infections, just that it seems to help in the few clinical studies that have been completed.
Regardless, isn’t it a good thing that the US has ample supply for its population, even if it isn’t a complete cure? The United States currently has the highest number of COVID-19 patients in the world, with more than 2.5 million cases and 127,000 deaths (5). Additionally, US law says that the government can ban the export of medicines that are needed to manage our own health crises, albeit this would be a more indirect approach; and it isn’t the first country to have this safety net for its population. Gilead is also a US-based company that has worked closely with the government on drug manufacturing in the past, including on Remdesivir itself! So it makes sense that they would give priority to their home and close collaborator.
But in today’s interconnected day and age, it’s just not that simple. The United States buying virtually all of the global supply of this drug for the next three months tells the rest the world that we as a nation are not interested in working together against this pandemic (4). While that may arguably work in other crises, it isn’t a good battle strategy for a crisis that does not care about national borders. Epidemiologists, healthcare providers, and other researchers rely heavily on data from all over the globe to effectively track this infection and to know what strategies are working in other countries. Removing the US from that collaborative effort is an enormous blow that could set progress back significantly.
This move also means that other countries will not be able to purchase Remdesivir for the next three months. It’s especially concerning as cases numbers around the world are beginning to spike again. While several industrialized, Western countries like Germany and the UK have enough of a stock to last, other poorer countries could be left to dry.
Finally, while this purchase is for Americans, it will also cost Americans. Gilead’s development of Remdesivir was substantially funded by the public, i.e. American taxpayers. This makes sense since the US government was involved in Remdesivir’s creation, and government money often comes from taxes. Yet, it will still cost approximately $3000 for a complete treatment course for a patient. In comparison, the other treatment approved for COVID-19, Dexamethosone, costs just $1-3 per day if given continuously.
So while it may be understandable why the Trump administration bought this Remdesivir supply, arguably seeking to protect American citizens, it raises questions about the United States’ place in the world and in a global crisis. This purchase, along with President Trump ending US funding to the World Health Organization, isolates us from global efforts to control and end this pandemic. It puts strain on foreign relationships as experts from all over denounce the US’s recent actions. It does make some Americans feel safer, knowing they will have a treatment option available if they need it. But many of them are the same people who won’t wear masks or socially distance. Then the question becomes whether the US is using its resources appropriately: focusing on treatment rather than prevention. That may only be answered with time, as we continue to fight the COVID-19 pandemic.