Covid-19: Vaccine focus necessary, but diverse array of pharmacological interventions needed over long term

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December 31, 2020 4:15 AM

With the shadow of long Covid and the long-term physiological complications arising out of the Covid-19 pathology, there is a need to stall the progression of the disease from mild/moderate to severe manifestation.

With the shadow of long Covid and the long-term physiological complications arising out of the Covid-19 pathology, there is a need to stall the progression of the disease from mild/moderate to severe manifestation.With the shadow of long Covid and the long-term physiological complications arising out of the Covid-19 pathology, there is a need to stall the progression of the disease from mild/moderate to severe manifestation.

Non-pharmacological interventions against SARS CoV-2 infection, such as the use of masks, distancing, hand-hygiene (including use of sanitiser), avoiding likely super-spreader scenarios, remain the key weapon in the fight against Covid-19. But, against the backdrop of highly infective strains—like the UK one—the pharmacological arsenal assumes new significance. Vaccines dominate this space, with the WHO listing 60 candidates in the clinical trial stage and 172 in the pre-clinical stage. Massive investments have been made in vaccine development; as per data from Airfinity, a science information and analytics company, cited in a BBC report, nearly $18.6 billion has been pumped into the development of just nine vaccine candidates, including the three most discussed ones (Moderna, Oxford-AstraZeneca, and Pfizer/BioNTech). The commercial consideration of the vaccine developers aside, such big bets would seem justified against the benefits of global equitable access to vaccines being pegged at $466 billion for 10 major economies — Canada, France, Germany, Japan, Qatar, South Korea, Sweden, United Arab Emirates, United Kingdom and the United States — in a report by the Eurasia Group, commissioned by the Bill & Melinda Gates Foundation that partners Gavi, the Vaccine Alliance, which, in turn, is part of the WHO’s COVAX initiative which seeks to give low-income countries access to Covid-19 vaccines.

While vaccines must lead the pharmacological charge against Covid-19—prophylaxis has obvious benefits, especially in a pandemic scenario—as vaccine expert Dr Gagandeep Kang told this newspaper, the focus is almost exclusively on vaccines and investment in antivirals and other therapeutics against the disease has languished. Dr Kang spoke of the need to balance vaccine deployment with antivirals, and called for greater investment in the latter. Given the duration of protection from vaccines can’t be predicted with certainty this early in vaccine roll-out, and the need to treat infected populations to reduce the burden of Covid-19 morbidity and mortality, there is a need to invest in research on repurposing of existing antivirals and other therapeutics as well as de novo development. Nine months into the pandemic, the US has approved just one antiviral for therapeutic use against Covid-19 — remdesivir — while a handful of other drugs have received emergency use approval and a clutch of others are marked for trials. None of these drugs are new. The monoclonal-antibodies space has seen some traction—a clutch of companies, including AstraZeneca, Eli Lily, Regeneron, and Celltrion, have announced development projects/trials, but these have been overshadowed by vaccine development and funding; for perspective, AstraZeneca’s vaccine project has received nearly $8.2 billion—the US government has pledged $1.2 billion-while its monoclonal antibody cocktail development has received just under $500 million. To be sure, a vaccine is a more pragmatic solution, but as Dr Kang asks, does the world really need 200-plus competing Covid-19 vaccines?

With the shadow of long Covid and the long-term physiological complications arising out of the Covid-19 pathology, there is a need to stall the progression of the disease from mild/moderate to severe manifestation. The US National Institutes of Health’s Covid-19 Treatment Guideline underscores the importance of antivirals in doing this; it says, given viral replication, which leads to many of the clinical manifestation of the disease, “may be particularly active early in the course of Covid-19, antiviral therapy may have the greatest impact before the illness progresses into the hyperinflammatory state that can characterize the later stages of disease”. Whether vaccines eventually save the day for the Covid-19 stricken world or not, there is no doubt that development/discovery of antivirals and other therapeutics is imperative. Indeed, as WHO director-general Tedros Adhanom Ghebreyesus put it, we need to “do it all” as there may never be a silver bullet.

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