Data shows that expired Pfizer Covid antiviral medications will cost Europe $2.2bn.

According to data from the European Health Agency, more than one billion dollars of Pfizer Covid-19 antiviral medications procured by Pfizer in Europe were wasted because strict controls on who could receive the medication led to millions of doses being unused prior their expiration date.

Paxlovid, which is designed to be administered to patients soon after they have tested positive for the virus, has been easier to get in the US than it has been in Europe. Access has usually been limited to elderly people or those at high-risk of severe Covid.

Data from Airfinity, a group that provides analytics, shows that European countries such as the UK, France and Spain could have made this medication more affordable without wasting supplies. More than 1.5mn 5-day courses worth $1.1bn of the drug have expired, despite the fact their use dates were extended by 6 to 12 months.

Airfinity estimates that by the end of 2024, approximately 3.1mn courses will expire. This will result in a cost of $2.2bn for European health systems. Data does not include EU-wide contracts.

Marco Gallotta is an analyst with Airfinity. He said that some countries could have purchased too much Paxlovid, when it was available in the market at the end 2021.

He said that governments were eager to purchase the highly effective antiviral, but it was difficult to estimate demand because there were so many unknowns.

He said that a decline in cases and a sharp decrease in testing had affected the uptake of antiviral medications. These drugs needed to be taken soon after symptoms began, he explained. This means that countries are not able to use all their stocks before they expire despite the extension of shelf life.

Pfizer stated: “Expiry of doses and their destruction can be unavoidable consequences of a pandemic. This is a natural outcome of manufacturers and government collectively trying to respond quickly to the public health crisis with the overall objective of protecting the population.”

Paxlovid can also interact with other medications. This limits how often it is prescribed.

Data shows that the UK has the highest expiry rate in Europe. By early December, an estimated 700mn doses, worth 1mn dollars, were no longer valid. In February, another 550,000 doses will expire. A further 650,000 are due to expire by June.

The UK has agreed to purchase 2,75mn Paxlovid courses in December 2021 at the peak of the Omicron Wave. The National Institute for Health and Care Excellence in the UK, the country’s public health agency, recommends that the drug only be used by people with serious health conditions, such as HIV and cancer, or those who have received transplants.

The UK Department of Health and Social Care said that more courses were used without providing its own data. A spokesperson for the UK government said that it had “acted quickly to secure enough antivirals”, at a time when “global demand” was high.

In other European countries the restrictions were less strict, allowing elderly people and those with common risk factors like diabetes and obesity to get the drug. In Spain, more than 200,000 Paxlovid treatments expired before they were able to be used. About 100,000 courses each in France and Italy had become outdated.

The demand for Covid’s antivirals is down in the US, the biggest market for outpatient Covid treatments. This decline can be attributed to the decreased burden of Covid as well as a decrease in virus testing.

In the US, 5.3mn courses have been prescribed this year. This is a 24 per cent decrease from 2022. The US government has arranged for Pfizer, to return 7.9mn Paxlovid course at the end 2023 at an estimated cost of $4.2bn to the company.

Shionogi, a Japanese drugmaker, has been approved to sell Xocova in Japan. The Covid antivirals have expanded their market with the approval of Xocova to be used by patients at standard risk.

A rise in infections led to a relatively healthy market over the summer. Shionogi upgraded its guidance for domestic Xocova sales in late October, but lowered the target for international sales. The drug has not been approved yet in the US and Europe.

Shionogi claims that approximately 23 percent of patients with Covid who were treated orally when funding was provided by the government. This is expected to drop now that people have to pay for their antivirals themselves. Xocova is priced at up to Y=9,000 (about $64) for a course.