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Credit…Pfizer

Pfizer said on Tuesday that it has agreed to sell up to four million treatment courses of its Covid-19 pills for use in 95 lower-income countries that are home to about four billion people, with the first supplies expected to become available next month.

The company’s supply agreement with UNICEF, the arm of the United Nations, covers all countries classified as low- or lower-middle-income, as well as some upper-middle-income countries in sub-Saharan Africa and other parts of the world.

The pills will most likely be the first Covid drugs available in some of the poorest parts of the world. But they are enough for only a small fraction of the patients who could benefit.

Pfizer has said it can make 120 million treatment courses of Paxlovid this year. Wealthy countries have locked up much of Pfizer’s early supplies.

Pfizer’s treatment, known as Paxlovid, has been found to be highly effective in staving off severe disease in Covid patients when given early in the course of an infection. It is seen as having promise in lower-income countries because it is given in pill form, taken at home and easily stored at room temperature.

But there are also significant hurdles to widespread use in low-resource settings, including a lack of testing and shortage of health care providers needed to prescribe the pills.

Covid treatments that became available in wealthy countries earlier in the pandemic, such as monoclonal antibodies and the infused antiviral drug remdesivir, have not been used on this scale in low-income countries because they are expensive and difficult to administer.

A spokeswoman for the supply division of UNICEF described Tuesday’s deal as an agreement in anticipation of orders, which will be placed in response to demand from countries. She said there are several possible funding mechanisms for the orders, including money from recipient governments and UNICEF’s pooled fund for Covid therapeutics and other supplies.

Pfizer said it would sell its pills to low- and lower-middle-income countries at a nonprofit price that it has not disclosed. The company said it would charge more for pills supplied to upper-middle-income countries. The United States, paying a still higher price for wealthy countries, is being charged about $530 per treatment course.

Manufacturers around the world are also gearing up to produce generic versions of the drug through a deal negotiated between Pfizer and the Medicines Patent Pool, a U.N.-backed nonprofit. Last week, the M.P.P. said that 35 companies had signed up to produce Paxlovid and sell the pills inexpensively in lower-income countries. But those supplies are not expected to be ready for many months, not nearly as quickly as the pills made by Pfizer.

Many lower-income countries haven’t authorized Paxlovid and must do so before the pills can be used there. The World Health Organization, which lower-income countries look to for guidance on how to use Covid drugs, has not yet made a recommendation on Paxlovid, though it says the drug is one of several “currently under consideration.”

Stephanie Nolen contributed reporting

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