Experts say that while the pill looks promising, they worry that some people will use it as an alternative to vaccines, which still offer the best protection.
And they caution that Asia’s race to stock up on the pill could see a repeat of the vaccine grab last year, when wealthy countries were accused of hoarding doses as low-income countries.
“(molnupirvir) really has the potential — the potential — to change the game a little bit,” said Rachel Cohen, North American executive director of the nonprofit Drugs for Neglected Diseases Initiative.
“We need to make sure we don’t repeat history – that we don’t fall into the same patterns or repeat the same mistakes we saw for Covid vaccines.”
What is Molnupiravir?
Molnupiravir is seen as a positive step as it provides a way to treat Covid-19 – without requiring patients to stay in hospital.
The pill works like this: Once a patient is diagnosed with Covid-19, they can start a course of mollupiravir. It contains four 200 mg capsules, twice a day, for five days – a total of 40 tablets.
Unlike the vaccine, which induces an immune response, mollupiravir inhibits the replication of the virus, said Sanjay Senanayake, an infectious disease physician and associate professor of medicine at the Australian National University Medical School. “In a sense, it makes children unwell to the virus,” he said.
“Antiviral treatments that people with Covid-19 can take at home to keep them out of hospital are critically needed,” she said.
Experts agree the drug is promising. Cohen of the Drugs for Neglected Diseases Initiative said patients could potentially be treated directly after being diagnosed with the virus, rather than waiting to see if they are seriously ill.
And unlike other Covid-19 treatments, mollupiravir can be taken at home, freeing up hospital resources for more seriously ill patients.
“Getting a tablet is so easy,” Senanayake said. “It’s a game changer.”
What does the covid pill mean for vaccines
But even in Asia-Pacific, where vaccine rates in many countries have improved after a slow start, millions of people are still not vaccinated because they are not eligible, or they cannot access shots.
And that’s where the bullet comes in.
“There are a lot of people who can’t get vaccinated,” said Niall Wheat, associate professor at the University of Sydney’s School of Pharmacy. “This drug will be a frontline solution for people who eventually become ill.”
But Wheat and other experts are concerned that the pill could make it harder to persuade some people to get vaccinated, prompting vaccine hesitancy in many countries, including Australia.
Research shows that people prefer to ingest drugs rather than inject them, Wheat said.
“If you told me a year and a half ago that people would refuse a vaccine for a disease that is decimating the planet, I would have thought you were crazy,” he said. “There is always room for people to think that this drug will be a far better solution than vaccination.”
But experts say the pill cannot replace vaccines.
Senanayake says the approach is the same as how we treat the flu – there is a flu vaccine, but there are also antiviral drugs to treat those who do get sick.
Cohen says the pill doesn’t mean there’s less urgency in increasing equitable access to vaccines.
“Vaccine equity is the defining challenge of our times. But you never fight an infectious disease with just one tool,” she said. “We really need a full arsenal of health technologies.”
Why Asia-Pacific Countries Are Buying Kovid Pills
According to data from Airfinity, 10 countries or territories are in talks or have signed deals for the pill – and eight of them are in the Asia-Pacific.
“I think we just want to make sure that we are ahead of the game when it comes to these other new developments,” Senanayake said.
“There are some middle-income countries out there that I think are trying not to fall into the same trap that high-income countries hoarded all vaccines with,” Cohen said.
It is not clear how much each of these countries will pay for the pills.
Merck did not confirm whether those estimates were accurate, although in a statement to Granthshala, the company said the calculations did not take into account research and development.
“We are yet to fix the price of Molnupiravir as it is not approved for use,” the company said. “We have an advance purchase agreement with the US government and this price is specific for substantial quantities of molnupiravir and does not represent a list price for the US or any other country.”
lack of equality
Low-income countries may be at a disadvantage when it comes to pill use.
Once the drug is approved for use, countries will need to decide whether to give it to anyone who shows symptoms, or whether to test positive before receiving it.
But this requires access to testing. And that could be an issue in some countries, Cohen said. Interim results on the pill are for people who were given it within five days of symptom onset — and in some countries, getting a test that quickly can be a problem.
However, the first question is how they can access it.
While the drug would be easier to produce, Merck controls patents and is able to decide which countries to supply the drug to and at what cost, according to Lina Menghani, South Asia head for the group’s outreach campaign.
Cohen said health devices and technologies should be treated as a public good – and the position raised questions about how we can ensure those benefits are shared equitably.
“We are concerned that this could potentially lead to a kind of therapeutic nationalism,” she said. “However, what we are most concerned about is that equitable access to antivirals can be particularly challenging in low- and middle-income countries.”
Senanayake said that once again the rich countries were at risk of getting more than their fair share.
“With Covid, you have to be selfless to be selfish,” he said. “Otherwise, if you protect your little cocoon, protect your little country, if this happens in other countries, a new variant may emerge that can survive the vaccine.”
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