Effective treatments for Covid-19 are here and countries are lining up to purchase them.
In a critically under-vaccinated Africa, oral antiviral treatments are now a viable option and, combined with safe and effective vaccines, are well placed to relieve the burden of illness and death on health-care systems and communities. It is now time to look critically at the opportunities that different treatments offer African nations and the challenges that these nations may face in obtaining and administering them.
The two most exciting treatments that will soon be available are Pfizer’s Paxlovid and Merck’s Molnupiravir. Recently concluded trials have shown that these oral antiviral treatments significantly reduced the risk of hospitalisation or death: 89 per cent in the case of the Pfizer pill and 30 per cent for Merck. These pills have been shown to be at their most effective when taken within five days of the onset of symptoms.
Opportunities
These treatment options present a significant opportunity for Africa where only 7.5 per cent of the population has been fully vaccinated. Although known cases and mortality rates in Africa are lower than in the rest of the world, those who do contract Covid-19 and become critically ill are more likely to die given the continent’s comparatively weaker health-care systems. This is expected to become even more marked as new variants of concern, such as Omicron, emerge, which are potentially more transmissible and deadlier than those we have already experienced. Treatments will play a critical role in minimising the impact of Covid-19.
First, even for the unvaccinated, oral antiviral treatments are proven to be effective. With most of the African population unprotected against Covid-19, these pills can be a lifesaver for high-risk, unvaccinated patients with mild or moderate disease.
Second, unlike more invasive treatments that require injections, oral antiviral treatments are easy and quick to administer at home. They also demand less medical supervision, although assessment by a medical professional is required to determine suitability for treatment, to explain about the medication and how to take it, and to ensure absolute adherence to avoid resistance.
Lastly, other treatments for Covid-19, such as monoclonal antibodies and antiviral drugs like remdesivir, are comparatively more expensive. These new treatments make access more equitable and simultaneously relieve pressure on overwhelmed health systems and personnel.
Challenges
These opportunities can be seized only if African nations can secure supplies of the treatments. The most pressing challenges to the successful use of treatments are access, testing infrastructure, the time between testing positive and administration of a treatment, monitoring of resistance to treatment, and any indirect effects of the availability of treatments.
Access is a familiar challenge. The United States government has already ordered 10 million doses of Paxlovid and the United Kingdom 250,000, while other wealthy countries have already entered into advance purchase agreements with Pfizer. There are real concerns that poorer nations will once again be left behind. However, in an exciting development, Pfizer has recently signed an agreement with the United Nations-backed Medicines Patent Pool (MPP), which works towards establishing equitable access to treatments by allowing generic manufacturers to provide copies of the drug to 95 low- and middle-income countries
The key message in the response to Covid-19 remains: test, test, test. A course of oral antiviral treatment should be administered in the early stages of the infection cycle to be most effective. This means that its use needs to be supported by a widespread, cost-effective and efficient testing infrastructure to ensure that people are encouraged to get tested, that turnaround times for results are consistently fast, and that infected people are immediately notified of the result and of the next steps to take.
Complications may arise because many Covid-19 symptoms are similar to those of malaria and other diseases, leading to delays in people deciding to get tested for Covid-19 and thereby shortening the window of opportunity for early treatment.
The emergence of a drug-resistant variant of Covid-19 is a likely possibility if anti-viral treatments are used incorrectly; this is particularly important when using antivirals in immunocompromised people (for example, people who are HIV+). To avoid or mitigate this, treatments should be used cautiously, prescribed only when appropriate, and patients must complete their course. There is also a likelihood that combination therapy may be needed at some stage to limit drug resistance.
As treatments become more accessible across Africa and elsewhere, it will be important for governments to monitor the correlation between their availability and vaccine uptake. Some people may feel less inclined to get their vaccine if they know there is an easy treatment available were they to contract Covid-19. A reduction in vaccine uptake increases the likelihood of other variants emerging, increasing pressures on already strained health-care systems, economies and societies.
In the immediate term, political leaders must do three things:
Increase pressure on countries and manufacturers to follow through on commitments to make treatments immediately available to under-vaccinated countries.
Financially support countries in Africa to establish a widespread, cost-effective and efficient testing infrastructure.
Incentivise pharmaceutical companies and other technology holders to share technology know-how to make cutting-edge, life-saving vaccines and treatments accessible to Africa.
Highly effective treatments are a way to reduce the burden of Covid-19 and should be equitably available across Africa, but they are not the solution. It remains true that the most powerful tool at our disposal is safe and effective vaccination. Antiviral drugs should be used in tandem with vaccines and not be seen as an alternative to vaccination.
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