The new coronavirus variant, Omicron, has renewed uncertainty over the future of the pandemic. The variant seems to be spreading quickly, but the degree to which it can evade or blunt the protection of vaccines remains unknown. While getting vaccines to everyone who needs them remains a top priority, the world has never effectively fought an infectious disease with just one set of tools. The treatment options for Covid-19 will be greatly expanded by new oral antiviral pills. These drugs have the potential to lessen the impact of Covid-19 worldwide if the people who need them can get them.
An expert panel for the Food and Drug Administration voted on Tuesday to recommend that the agency authorize one of these drugs for people at high risk for severe Covid-19. The drug, known as molnupiravir and made by Merck, isn’t perfect. It can modestly lower the risk of hospitalization and death, and there are some safety concerns, including for people who may become pregnant. Pfizer has also submitted its antiviral drug for F.D.A. review. That drug, so far, looks more promising, with early data suggesting that it can reduce the risk of hospitalization or death from Covid-19 by 89 percent.
The need for drugs to treat Covid-19 is critical, and research into treatments should’ve been prioritized much earlier in the pandemic. And despite the discovery and development of extraordinarily effective vaccines at breakneck speed, high-income countries administered 35 times more doses per resident than low-income countries as of the end of September. This vaccination gap has devastating consequences, including hospitalizations, deaths and the risk of the emergence of more dangerous variants as the virus spreads.
Effective oral drugs for Covid-19 can help countries avoid hospital surges, especially in communities where intensive-care capacity is limited and vaccination rates are low. That’s why countries with limited access to vaccines should be prioritized for the new antiviral drugs.
The world has made devastating mistakes in the past when it comes to access to new drugs. I have been working in the field of H.I.V. and AIDS treatment for more than 20 years, and I vividly remember the yearslong struggle to get access to lifesaving treatments for people with H.I.V.
Antiretroviral combination therapy, which transformed H.I.V. to a chronic and manageable infection, was approved in 1995 in the United States. But it took a full decade before these treatments became widely available in sub-Saharan Africa and other poor countries, where a majority of the world’s 40 million people with H.I.V. lived.
In 2006, when I arrived in Lesotho to help open one of the country’s first H.I.V. treatment programs, only a tiny fraction of people with the infection had access to treatment. It took many years of advocacy from AIDS activists, governments and frontline health workers before a declaration on intellectual property and public health was made by the World Trade Organization. This reaffirmed the right of countries to overcome patent barriers and paved the way for generic competition, which made H.I.V. treatments affordable and accessible. Far too many lives were lost in the meantime.
Already millions of people have died of Covid-19, and there are similar barriers to access. The most glaring is with vaccines, but there’s concern that the same mistakes will be made with new treatments.
So far, two companies have signed voluntary licensing agreements that allow for generic production of the drugs at lower prices in certain low-income countries. But most middle-income countries, such as Brazil, Malaysia and Thailand, are excluded from these agreements and will also need to be able to produce the drugs.
If companies refuse to cooperate, governments — many of which fund the underlying research for new drugs and vaccines — can step in to require drug companies to share knowledge, make their products affordable, and override patents and other intellectual property when necessary.
Because of concerns about Omicron, the W.T.O. postponed a meeting scheduled for this week in Geneva, where the group planned to discuss a temporary waiver of patents and other intellectual property protections for all Covid-19 health tools so that manufacturers around the world can produce sufficient supplies of affordable vaccines, tests and treatments, and avoid having to negotiate complex agreements for every new health technology.
To best make use of the new antivirals, there needs to be a huge increase in the availability of, access to and use of rapid tests in countries worldwide so that it is possible to detect cases during the first few days of infection, when the drugs are likely to be most effective. Right now, about 85 percent of coronavirus infections in Africa go undetected. Since most of the new pills must be taken within three to five days of symptoms, it is important to explore ways to stretch this treatment window, possibly by combining different medications.
Looking ahead, the World Health Organization is discussing a global pandemic treaty this week that would set new rules for international cooperation during pandemics. This will come too late to provide solutions for today’s crisis, but it’s important to rethink how the world responds to future outbreaks so that equity is at the heart. Scientists, clinicians and communities in low- and middle-income countries must be recognized as equal partners in global health decision-making, rather than being treated as passive recipients of aid and relegated to the back of the line by the highest bidders.
Decisions made today will determine whether the fruits of scientific progress will be equitably shared for generations to come. For Covid-19 and future pandemics, we have the benefit of hindsight and there’s little excuse for falling short.
Rachel Cohen is the regional executive director of the Drugs for Neglected Diseases initiative, or DNDi, in the United States. She previously worked for Doctors Without Borders, overseeing H.I.V./AIDS, tuberculosis, sexual violence and migrant health programs in South Africa and Lesotho.
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