While vaccines have so far been at the front line of the fight against COVID, pharmecutical companies have been working hard to develop other methods of treating the disease.
Drugs like Pfizer’s paxlovid and Merck and Ridgeback Biotheraputics’ molnupiravir have been authorised for use by the Food and Drug Administration in US. Both pills could be a game changer in the way that we deal with COVID as they allow for at-home treatment that could see further reductions in the demands on hospital care.
Paxlovid is currently the front runner in terms of research and efficacy as well as adoption for use by different governments. Just two days ago, the Canadian health authorities also cleared the pill for use in adults.
The drug works as an oral antiviral treatment which is prescribed by a doctor and administered in pill form. It combines a new drug developed by Pfizer called nirmatrelvir with an existing antiretroviral drug called ritonavir. The latter is a low-dose drug used in the treatment of HIV which helps the former drug stay active for longer in the patients system.
Pfizer’s treatment works by blocking the activity of SARS-CoV-2 enzymes that are used by the virus for replication. In this way, it slows the spread of the disease, giving our immune systems more time to mount an effective response and limiting the overall quantity of the virus in our system.
The drug’s effectiveness has been confirmed in three separate non-published studies conducted by the company which show that it can cut the risk of hospitalisation or death by 89% compared to a placebo. The latest of these studies confirms that the treatment remains effective against the Omicron variant, currently accounting for at least 90% of COVID cases in Australia.
It’s easy to see why having a course of pills — 30 over five days — would lend a huge boost to the fight against the disease. They are easy to take at home and doctors are suggesting that they could be a tool that changes the tradjectory of the pandemic.
There are downsides, of course. The drug has to be taken as soon as a positive result is confirmed, something that could be tricky given the delays in testing being experienced currently. They will also need to be sourced and aquired, with the need for prescriptions throwing up extra barriers to access. They are not yet designed for widespread public use, owing to supply, but will be targeted at those considered at higher risk of complications from COVID.
What Is Australia Doing?
It shouldn’t come as much of a surprise to hear that Australia is somewhat behind the ball on this one, although it’s not as bad as you might think.
Not unlike the backlog of Australian-made rapid antigen tests which are yet to be approved by the Therapeutic Goods Administration, health authorities are still assessing the risks and the rewards of these new drugs.
That being said, the TGA are also looking at a number of other frontline treatments, including sotrovimab and ronapreve in addition to the Pfizer and Merck and Co drugs.
Ronapreve, an antibody treatment, was approved back in November of last year and at least 31,000 doses have been ordered. It will mainly be used in frontline medicine and not as an at-home treatment.
Australia has also ordered 300,000 doses of Molnupiravir, Merck’s anti-COVID drug, which could be available for use later this year, provided it passes the TGA’s safety checks.
The same can be said of Pfizer’s pill, of which Australia has secured at least 500,000 treatment courses. Of course, until we get TGA approval, the drugs wont be hitting the pharmacy shelves any time soon.
That’s a process that is typically long and fairly complicated. Australia’s medicines regulator has some of the strictest safety protocols in the world and will need to see the details of Pfizer’s trials which have only just been finished. Further trials will likely need to be done to confirm the real-world efficacy of these drugs too, so we could be waiting a while.
This is of course frustrating for the millions of Aussies who have had to manage the disease on their own, either looking after loved ones with COVID or catching it themselves.
While Australia waits, more countries continue to approve at-home COVID medications, including the UK, which approved paxlovid at the start of the year for adult use.
It is right, of course, that these drugs are rigorously tested. While they may be highly sought after, they are also not the only tool that we have in our arsenal. Vaccination remains the most effective way of preventing the spread of the disease and the effects of serious illness and, while the vast majority of Australians have yet to get their booster jab, getting through this next stage of the vaccine roll out is likely to be more important than waiting on these pills.
As Victoria’s Chief Health Officer Professor Brett Sutton said, “Antivirals are great if you are developing illness regardless, but getting vaccinated will be 10, 20, 50 times more powerful an intervention in preventing severe illness than any antiviral that’s currently available”.