The manufacturer of one of the few medicines known to help treat patients with the coronavirus has been accused of "profiteering from the COVID-19 pandemic".
And the US decision to buy up almost the entire supply of remdesivir for the next few months has experts wondering if countries should just ignore pharmaceutical giant Gilead's patent and make it themselves.
The US this week said it's secured all of Gilead's remdesivir for July, and 90 percent of its output for August and September.
"President [Donald] Trump has struck an amazing deal to ensure Americans have access to the first authorised therapeutic for COVID-19," US Department of Health and Human Services secretary Alex Azar said.
"To the extent possible, we want to ensure that any American patient who needs remdesivir can get it."
But that leaves many other countries having to go without. While Gilead has arrangements with generic suppliers to manufacture and sell the drug to low-income countries, other rich countries will struggle to get their hands on some.
"The outrageous move by the US government to buy up almost the entire supply of remdesivir for the next three months throws the problems with the current model for funding development of pharmaceuticals into stark relief," said Deborah Gleeson, public health senior lecturer at La Trobe University in Melbourne, parts of which are back under lockdown after another outbreak of the disease.
"Under this model, patents are granted to incentivise investment in research and development. They provide a time-limited monopoly, when no one else can make or sell the product. While a drug is under patent, companies can set high prices, while keeping competitors out of the market.
"This presents obvious problems in a public health emergency, where rapid access to large supplies of affordable products is needed."
Remdesivir was developed about a decade ago to treat hepatitis C patients. It didn't work, but did against Ebola. Studies have found while it doesn't necessarily reduce the chance of death in COVID-19 patients, it can reduce the amount of time they need to stay in hospital or intensive care if administered early enough.
Gilead has priced it at about NZ$5000 for a five-day treatment, even though the manufacturing cost is estimated to be less than $10.
"Gilead could make billions of dollars in profit during the pandemic, while preventing others from manufacturing the drug on the scale needed to meet global demand," said Dr Gleeson.
"Gilead's actions show that pharmaceutical companies can't be trusted to act ethically, and governments need to attach conditions to their funding for research and development to ensure that drugs and vaccines for COVID-19 are shared equitably."
Britain, Germany and South Korea have all said they have enough remdesivir for now, and the EU is still in negotiations - but said Gilead had an "implied obligation to deliver sufficient quantities in the future".
Ohid Yaqub, senior lecturer at the Science Policy Research Unit of Britain's University of Sussex, said the United States' move "clearly signals an unwillingness to cooperate with other countries, and the chilling effect this has on international agreements about intellectual property rights".
The alternative is for countries to essentially ignore Gilead's patent.
"Under international trade agreements in a public health emergency, governments can issue compulsory licenses to bypass patent protection and either produce a drug themselves or buy the drug from generic manufacturers," said Barbara Mintzes of the University of Sydney, a specialist in pharmaceutical policy.
"The Netherlands is currently considering an amendment to its patent law to allow compulsory licensing of remdesivir."
If remdesivir - which will be sold under the brand name Veklury - continues to be the best treatment for COVID-19, Dr Mintzes says other countries should consider following the Netherlands.
Under World Trade Organization rules, countries which issue a compulsory licence still have to compensate the patent holder, but how much is up to the country (the manufacturer can appeal this later). Countries have to at least try to cut a deal with the manufacturer first, and they can't go on making their own version forever - once the crisis is over, they have to go back to the patent owner if they want to keep using it.
Pharmac told Newshub it has not been asked to fund remdesivir yet. In response to an Official Information Act query last month, Pharmac said it's had no discussions with Gilead about supplying the drug.
Pharmac said it would get back to Newshub on whether it would consider a compulsory licence.
New Zealand only has one patient currently in hospital with COVID-19, in a stable condition. All our cases in the past month have been found in new arrivals, and there is no known community transmission of the disease, which has killed more than 500,000 people worldwide.
Gilead, based in the US, says it has drugmakers based in India and Pakistan that will make low-cost remdesivir for 127 developing nations, but hasn't yet figured out how it's going to make enough for developed nations outside the United States.
The World Health Organization has called for any vaccine developed for COVID-19 to be made available for everyone, as it could be the only way to stop the pandemic, which is accelerating.
"We will only halt COVID-19 through solidarity," Director-General Tedros Adhanom Ghebreyesus said in April. "Countries, health partners, manufacturers, and the private sector must act together and ensure that the fruits of science and research can benefit everybody."
