When clinical trial data for the antiviral drug Paxlovid emerged in late 2021, doctors hailed its astounding efficacy, leading to an almost 90 percent reduction in the risk of severe COVID-19.
But more than a year later, COVID-19 is still a leading cause of death in many countries, not just in low-income countries where there is a shortage of this drug. In the United States, for example, hundreds of people still die from COVID-19 every day nature Scientific.
Researchers say the drug’s rollout has been hampered by concerns about “rebound” (the mysterious return of symptoms or detectable virus days after a person begins to feel better) and side effects — and also by reduced concern about the risk of COVID-19. Inadequate financing for distribution, the high price of the drug, and the need to take it soon after infection also slowed its administration.
As a result, doctors prescribed the drug in only about 0.5% of new COVID-19 cases in the UK, and in about 13% in the US, according to a report by health analytics firm Airfinity.
Sentiment against the drug persisted even as regulators globally revoked licenses for a monoclonal antibody therapy against COVID-19, leaving Paxlovid as one of the only tools to prevent death in high-risk individuals, says Davey Smith, an infectious disease physician at the University of California, San Diego. .
“It’s a game-changing drug that has good efficacy, even in the Omicron setting,” says Smith. “But recovery was put forward as a reason not to take the drug, which is a shame.”
Premium protection
Paxlovid is a combination oral antiviral drug that reduced the risk of hospitalization or death by 89% in high-risk individuals who took the drug within three days of the onset of symptoms, according to a clinical trial sponsored by Pfizer, which produces the drug.
US regulators first authorized Paxlovid in December 2021, and have since eased restrictions on who can prescribe the drug in an effort to make it more widely available.
But health officials say the drug has not been deployed as often as they expected. About 10 million courses of Paxlovid have been delivered to the United States, but only about 6.7 million have been used.
This underuse stems in part from misinformation and misconceptions about the drug, says Daniel Griffin, MD, an infectious disease physician at Columbia University in New York City.
For example, people perceive COVID-19 as less serious than they did earlier in the pandemic, Griffin says, which makes them less likely to seek treatment and doctors less likely to prescribe medications right away.
Paxlovid works by inhibiting viral replication, which mostly occurs early in the course of the disease.
This means that the drug must be taken within the first five days of the onset of symptoms, leaving a narrow window of time for people to receive treatment.
And that doesn’t sit well with the “let’s-wait-and-see” mentality, which is circulating among doctors treating people with COVID-19, Griffin says.
Adding to the confusion, fears have swirled about the virus “rebounding” after taking the drug, and such publicity has had a chilling effect on the number of people looking for Paxlovid, says Smith.
But the researchers found that recovery often occurred even in people not taking Paxlovid3.
The recovery of symptoms tends to be very mild, Smith says, and is still much better than hospitalization or death.
once pill
In addition, Paxlovid cannot be taken with many other drugs, and in some people the drug makes certain foods taste bitter or metallic, both of which reinforce the perception that it is toxic, Smith says.
But there are also institutional reasons for the lack of spread, says Anne Susen, a public health policy specialist at Dartmouth College in Hanover, New Hampshire.
Sosin notes that the drug relies on strong COVID-19 testing infrastructure and access to primary care physicians and pharmacies.
This amplifies pre-existing differences in race and income. For example, Black and Hispanic populations were 36% and 30% less likely to receive Paxlovid prescriptions, compared to white populations, and Sosen says concerns about reluctance provide an excuse to blame individuals rather than policymakers and divert “attention from the system that should be in place to deliver.” pharmaceutical”.