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more to do with the side effect. it causes birth defects in pretty alarming rate.

Japanese government only allows it to be used as a backup, Chinese licensed the design but the government only allows it to be used when all other avenues are exhausted.

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Aren't most severe patients elderly? Why would birth defects be a problem at this point?

That isn't the issue; it's that this drug is not available at all outside of those two countries. Side effects are the reason it isn't. The WHO is prioritizing drugs with worldwide availability.

If it's effective, I'd hope it would become widely available for future pandemics.

How on earth is Remdesivir available worldwide?

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