Asian countries are placing orders for this new drug to treat Covid. The poorest nations might still be missing

During the global rush for vaccine safety, many countries in the Asia-Pacific region have been slow to respond. This time, they don’t make the same mistake.

Countries in the region are rushing to place orders for the latest weapon against Covid-19: an antiviral pill whose use is not even authorized yet.

Molnupiravir – produced by US pharmaceutical company Merck – is being touted as a potential pandemic change, especially for those who cannot get vaccinated. Merck is seeking emergency use authorization from the United States Food and Drug Administration for the drug – and if granted, the capsule will become the first oral antiviral treatment for Covid-19.

Already, at least eight countries or territories in the Asia-Pacific region have signed agreements or are in talks to procure the drug, according to analysis firm Airfinity, including New Zealand, Australia and South Korea. , who were all relatively slow to start their immunization programs.

Experts say that while 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 Asia’s race to stock up on pills could see a repeat of vaccine uptake last year, when richer countries were accused of racking up doses while countries with low doses. income had not succeeded.

“(Molnupiravir) really has the potential – the potential – to be a game changer,” said Rachel Cohen, North American executive director of the nonprofit Drugs for Neglected Diseases Initiative.

“We have to make sure that we don’t repeat history – that we don’t fall into the same patterns or repeat the same mistakes that we have seen for Covid vaccines. “

What is molnupiravir?

Molnupiravir is seen as a positive step because it offers a way to treat Covid-19 – without patients needing to be hospitalized.

The pill works like this: Once a patient is diagnosed with Covid-19, they can start a course of molnupiravir. This involves four 200-milligram capsules, twice a day, for five days, for a total of 40 pills.

Unlike vaccines, which trigger an immune response, molnupiravir disrupts virus replication, said Sanjaya Senanayake, an infectious disease physician and associate professor of medicine at the Australian National University School of Medicine. “In a sense, it makes the virus produce unhealthy babies,” he said.

Phase 3 interim results from a trial involving more than 700 unvaccinated patients published earlier this month showed the pill could reduce the risk of hospitalization or death by about 50%, compared to patients who took a placebo. The participants all received the pill or the placebo within five days of symptom onset – and within 29 days none of those who took the pill died, compared to eight who received the placebo. Complete data from the molnupiravir trial have not yet been published and the data has not yet been peer reviewed or published.

Wendy Holman, managing director of Ridgeback Biotherapeutics, which works on development, said in a statement the results were encouraging – and she hoped the drug could have a “profound impact in controlling the pandemic.”

“Antiviral treatments that can be taken at home to keep people with Covid-19 out of hospital are absolutely necessary,” she said.

Experts agree that the drug shows promise. Rather than patients waiting to see if they become 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 seriously ill patients.

“Getting a tablet is so much easier,” Senanayake said. “It changes the game. “

What the Covid Pill Means for Vaccines

Vaccines are still the best protection, experts say – after all, they can reduce a person’s risk of contracting Covid-19.

But even in Asia-Pacific, where immunization rates in many countries have improved after a slow start, millions of people still go unvaccinated either because they don’t qualify or can’t. not access vaccines.

And that’s where the pill comes in.

“There are a lot of people who cannot get vaccinated,” said Nial Wheate, associate professor at the University of Sydney’s School of Pharmacy. “This drug will be a first line solution for people who end up getting sick.”

But Wheate and other experts fear the pill will make it harder for some people to convince some people to get vaccinated, compounding the vaccine reluctance seen in a number of countries, including Australia.

Research shows people prefer to swallow drugs rather than get injected, said Wheate.

“If you had told me a year and a half ago that people would refuse a vaccine against a disease that destroys the planet, I would have thought you were crazy,” he said. “There is always a possibility that people will think this drug will be a much better solution than getting the vaccine.”

But experts say the pill is no substitute for vaccines.

Senanayake says the approach is similar to how we treat the flu – there is a vaccine for the flu, but there are also antiviral drugs to treat those who get sick.

Cohen says the pill doesn’t mean expanding equitable access to vaccines is less urgent.

“Vaccine equity is sort of the defining challenge of our time. But you never fight an infectious disease with one set of tools, “she said.” We really need the full arsenal of health technologies.

Why Asia-Pacific Countries Are Buying The Covid Pill

According to Airfinity data, 10 countries or territories are in negotiations or have signed agreements for the pill – and eight of them are in Asia-Pacific.

Some of these countries may be trying to avoid the mistakes of the past when slow orders caused a delay in vaccine deployment.

“I think we just want to make sure we’re ahead of the game when it comes to these other new developments,” Senanayake said.

“There are a few middle-income countries that I think are just trying not to fall into the same trap they were left in when high-income countries racked up all the vaccines,” Cohen added.

It is not known 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, which means the government pays around $ 700 per course. An analysis by researchers Melissa Barber and Dzintars Gotham found that it costs around $ 18 to produce a course of molnupiravir based on a raw material cost calculation.

Gotham, which studies access to drugs, said it was common for drug companies to impose a large mark-up on drugs, but was surprised to see such a high price since US funding helped development of the pill.

Merck has not confirmed whether these estimates are accurate, although in a statement to CNN, the company said the calculations did not take into account research and development.

“We have not yet established a price for molnupiravir because it has not been approved for use,” the company said. “We have an advance purchase agreement with the United States government and this price is specific to a substantial volume of molnupiravir and does not represent a list price for the United States or any other country.”

In a statement released in June, Merck said it plans to use a tiered pricing approach for different countries and has also entered into licensing deals with generic manufacturers to speed up availability of the pill in 104 income countries. low and intermediate.

A lack of equality

Low-income countries can be at a disadvantage when it comes to using the pill.

Once the drug is approved for use, countries will need to decide whether to give it to anyone with 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. Intermediate results for the pill are for people who received it within five days of symptom onset – and in some countries getting tested quickly could be a problem.

Doctors Without Borders, a nonprofit, hailed the drug as “potentially life-saving care” for people living in areas where many are unvaccinated and vulnerable to the disease.

But first, the question arises of how they can access it.

While the drug would be straightforward to produce, according to Leena Menghaney, the group’s South Asia head of the group’s access campaign, Merck controls the patent and is able to decide which countries to supply the drug to and at what price.

She renewed her calls for a patent waiver that would waive intellectual property rights so countries around the world can produce versions of the drug – potentially saving many more lives. Earlier in the pandemic, activists asked for a waiver for Covid-19 vaccines, 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 the situation raised questions about how we can ensure these benefits are shared fairly.

“We are concerned that this could potentially lead to a kind of therapeutic nationalism,” she said. “What concerns us most, however, is that equitable access to antivirals can be particularly difficult in low- and middle-income countries.”

Senanayake once again said there was a risk that the richer countries would get more than their fair share.

“With Covid, you have to be altruistic to be selfish,” he said. “Otherwise, if you protect your own little cocoon, your own little country, if it happens in other countries, then a new variant may emerge that may escape vaccine.”

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