During the global struggle to secure vaccines, many countries in the Asia-Pacific region have been slow. They don’t make the same mistake this time.
Countries in the region are rushing to place orders for the latest weapon against Covid-19: an antiviral pill that isn’t even approved for use.
Molnupiravir – manufactured by US pharmaceutical company Merck – is being heralded as a potential game changer for a pandemic, especially for those who cannot get vaccinated. Merck is applying for emergency approval from the U.S. Food and Drug Administration for the drug – and if granted, the capsule will be the first oral antiviral treatment for Covid-19.
According to analyst Airfinity, at least eight countries or territories in the Asia-Pacific region have already signed contracts or are in talks to source the drug, including New Zealand, Australia and South Korea, all of which have been relatively slow to launch vaccine programs.
Experts say although the pill looks promising, they fear some people will use it as an alternative to vaccines, which still offer the best protection.
And they warn that Asia’s race to stock up on the pill could mean a repeat of the vaccine last year, when wealthier countries were accused of hoarding doses as lower-income countries failed.
“(Molnupiravir) really has the potential – the potential – to change the game a bit,” said Rachel Cohen, North American executive director of the nonprofit Drugs for Neglected Diseases.
“We have to make sure we don’t repeat history – that we don’t fall into the same patterns or repeat the same mistakes that we saw with Covid vaccines.”
What is Molnupiravir?
Molnupiravir is seen as a positive move as it offers a way to treat Covid-19 – without the need for patients to be in the hospital.
The pill works like this: As soon as a patient has been diagnosed with Covid-19, he can start treatment with molnupiravir. That includes four 200 milligram capsules twice a day for five days – a total of 40 pills.
Unlike vaccines, which trigger an immune response, molnupiravir disrupts replication of the virus, said Sanjaya Senanayake, an infectious disease doctor and associate professor of medicine at the Australian National University Medical School. “In a way, it makes the virus produce unhealthy babies,” he said.
Interim phase 3 results of a study of more than 700 unvaccinated patients published earlier this month showed that the pill could reduce the risk of hospitalization or death by about 50% compared to those taking a placebo. Participants all received the pill or placebo within five days of the onset of symptoms – and none of those taking the pill died within 29 days, compared with eight who received the placebo. Full data from the molnupiravir study have not yet been published, and the data have not yet been peer-reviewed or published.
Wendy Holman, Ridgeback Biotherapeutics’ chief executive officer, who is working on the development, said in a statement the results were encouraging – and she hoped the drug could have “a profound impact on controlling the pandemic.”
“Antiviral treatments that can be taken at home to keep people with Covid-19 out of the hospital are badly needed,” she said.
Experts agree that the drug shows promise. Instead of waiting for patients to get seriously ill, the virus could potentially be treated right after diagnosis, said Cohen of the Drugs for Neglected Diseases Initiative.
And unlike other Covid-19 treatments, molnupiravir can be taken at home, freeing up hospital resources for more critically ill patients.
“Getting a tablet is so much easier,” said Senanayake. “This is a game changer.”
What the Covid pill means for vaccines
Vaccines are still the best protection, say experts – after all, they can reduce the risk of a person getting Covid-19 in the first place.
But even in Asia Pacific, where vaccination rates have improved in many countries after a slow start, millions of people are still not vaccinated, either because they do not qualify or because they do not have access to vaccinations.
And this is where the pill comes in.
“There are many people who cannot get vaccinated,” said Nial Wheate, associate professor in the University of Sydney’s School of Pharmacy. “This drug will be a frontline solution for those who end up getting sick.”
However, Wheate and other experts fear the pill may make it harder to convince some people to get vaccinated, compounding vaccination reluctance seen in a number of countries, including Australia.
Research shows that people prefer to swallow medication than get injected, Wheate said.
“If you’d told me a year and a half ago that people were rejecting a vaccine for a disease that is wiping out the planet, I would have thought you were crazy,” he said, thinking that this drug is a much better solution than getting vaccinated permit.”
However, experts say the pill is not a substitute for vaccines.
Senanayake says the approach is similar to treating the flu – there is a flu vaccine, but there are also antiviral drugs available to treat those who are sick.
Cohen says the pill doesn’t mean there is less urgency to expand equal access to vaccines.
“Vaccination equality is, so to speak, the decisive challenge of our time. But you never fight an infectious disease with just one set of tools, ”she said. “We really need the full arsenal of health technologies.”
Why Asia Pacific Countries Buy The Covid Pill
According to Airfinity data, 10 countries or territories are in negotiation or have signed agreements on the pill – and eight of them are in the Asia-Pacific region.
Some of these countries may be trying to avoid past mistakes when slow orders caused delays in vaccine launches.
“I think we just want to make sure we’re at the forefront of these other new developments,” said Senanayake.
“There are a few middle-income countries that I think they are just trying to avoid falling into the same trap they fell into when high-income countries were hoarding all of the vaccines,” Cohen added.
It is not clear how much each of these countries will pay for the pills.
The United States has agreed to pay $ 1.2 billion for 1.7 million courses if the pill is approved, meaning the government will pay about $ 700 per course. Analysis by researchers Melissa Barber and Dzintars Gotham found that it would cost about $ 18 to make a molnupiravir regimen based on a calculation of raw material costs.
Gotham, who researches drug access, said it was common for drug companies to charge a high markup on drugs but said it was surprised to see that high price as US funding helped develop the pill.
Merck did not confirm whether these estimates were correct, though the company said in a statement to CNN that the calculations did not take into account research and development.
“We have not yet set a price for molnupiravir because it has not yet been approved for use,” the company said. “We have a pre-purchase agreement with the US government and this price is specific to a significant amount of molnupiravir and is not a US list price or any other country.”
In a June statement, Merck announced that it would use a tiered pricing approach for different countries and has also entered into licensing agreements with generic drug makers to accelerate availability of the pill in 104 low and middle income countries.
A lack of equality
Lower-income countries may be at a disadvantage when taking the pill.
Once the drug is approved for use, countries must decide whether to give it to anyone who shows symptoms or require a positive test before they can get it.
But that requires access to tests. And in some countries that could be a problem, Cohen said. The interim results of the pill are for people who received it within five days of the onset of symptoms – and in some countries, getting such a quick test could be a problem.
Nonprofit Doctors Without Borders hailed the drug as a “potentially life-saving treatment” for people living in areas where many are unvaccinated and prone to the disease.
The first question, however, is how to access it.
While the drug would be easy to manufacture, according to Leena Menghaney, South Asia boss for the company’s access campaign, Merck controls the patent and can decide which countries the drug is delivered to and at what price.
She again called for a patent waiver that would nullify intellectual property rights so countries around the world can manufacture versions of the drug – potentially saving many more lives. At the beginning of the pandemic, activists pushed for a Covid-19 vaccine waiver, but the request has been blocked by a small number of governments, including the UK.
Cohen said health tools and technologies should be treated as a public good – and that the situation raises questions about how we can ensure these benefits are fairly shared.
“We are concerned that this could potentially lead to some kind of therapeutic nationalism,” she said. “
Senanayake said again that there is a risk that richer countries will get more than their fair share.
“With Covid you have to be selfless to be selfish,” he told Vaccination. “
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