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VACCINES are a crucial tool in the fight against COVID-19 (coronavirus disease 2019), so it is great news that the UK on Tuesday became the first country to start mass inoculations with a new vaccine. Developed by Pfizer, Inc. and BioNTech SE. This vaccine and another developed by Moderna, Inc. are scheduled for early approval in the US soon, and there are a handful of additional vaccines on the way. But even if they are as effective in the real world as they appear in clinical trials, they cannot change the course of the pandemic overnight and may not be able to completely stop the spread of the virus. We need reinforcements.
It will take months for COVID-19 vaccines to reach a large enough percentage of the population to create “herd immunity,” and that’s assuming they win the public’s trust and the vaccination effort runs smoothly. Manufacturing sufficient doses may not be as easy as multi-country agreement holders suggest. There are also questions about how long immunity to COVID-19 can last. And vaccines can fail in the really frail or elderly, especially those with pre-existing conditions. Worst of all, the virus can mutate around our vaccines and begin to re-infect people. That’s one reason public health officials have called for continued social distancing and masks even after the vaccination effort is in full force.
If vaccines aren’t a silver bullet and won’t be widely available at first, even if the number of cases continues to rise, then that makes COVID-19 treatments – drugs that reduce hospitalizations and death, and even help prevent the Viruses are equally important in the fight against the pandemic. The easier to take, the better. The good news is that there are several promising therapies in use and more in development. But the biggest game changes are still months away. This is where things are.
To date, companies and physicians have had some success in their search for therapies. For example, remdesivir from Gilead Sciences, Inc., baricitinib from Eli Lilly & Co., and the generic steroid dexamethasone have been shown to reduce hospitalizations and improve speed of recovery. Dexamethasone also appears to reduce the risk of death. Another new group of therapies called monoclonal antibodies, which mimic the body’s response to infection, have worked relatively well to reduce hospitalizations in high-risk patients. Two of these treatments, one from Lilly and one from Regeneron Pharmaceuticals, Inc., have been approved for use thus far, although, as my colleague Max Nisen has written, there are some questions about Lilly’s therapy and what is the best way to use it. Also, both new drugs require physician-supervised IV infusions and may only be effective for a few months, requiring repeat IV visits that could strain healthcare systems.
Without taking anything away from the previous achievements, all of these drugs fall short of what is really needed to fight disease and prevent hospitalizations: either oral antivirals that target the virus’s ability to copy itself, or long-lasting antibodies that can be used as viable. preventives in people who cannot use or respond to vaccines. These treatments are yet to come, but they are in the early stages of development, so we must wait. However, there is progress.
AstraZeneca Plc is working on a two-antibody infusion cocktail that can be effective for six months to a year and has been designed to reduce the risk of treatment worsening disease. Initial data is expected in the first half of 2021. There is also Vir Biotechnology, Inc. which, in collaboration with GlaxoSmithKline Plc, is developing two antibodies with the potential for long-lasting durability. Vir has also engineered one of the antibodies in a way that could leave an immune “memory” like a vaccine. The first antibody is in a late-stage trial with data expected in the first trimester, while the second has not yet entered trials.
What would really intensify our efforts to fight the pandemic is a safe oral antiviral drug. Merck & Co. and Pfizer are pursuing this. These are drugs that are designed to interfere with the virus’s ability to make copies of itself, and they work in the same way as the highly successful anti-HIV and anti-HCV drugs. But, like vaccines and antibodies, we need to keep a close eye on the virus and assess for any mutation that renders drugs inactive. Both HIV and HCV therapies use drug combinations for exactly this reason. Merck and its partner Ridgeback Therapeutics are expected to release data from a small phase II trial of their drug, molnupiravir, before the end of the year, while larger phase III trials will report in 2021, beginning with Merck’s in the first half of the year.
As we increase the vast machinery needed to vaccinate the world’s population against coronavirus, we will continue to need therapies. While the arsenal of treatments has grown, I am much more excited about what lies ahead.
BLOOMBERG’S OPINION
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