Hope on the horizon
The third wave of the pandemic is uncertain, although preventive steps in the form of mass vaccination have already been undertaken on a war footing. India has administered over 100 crore vaccine doses from January to October which is a monumental achievement indeed. Now there is a potential oral pill that could effectively be used to treat COVID-19.
Just prior to India’s achieving the administering of 100 crore vaccines, pharma giant Merck had sought emergency use authorisation (EUA) from the US FDA for Molnupiravir, its antiviral oral pill to treat COVID-19. Merck has developed it in collaboration with Ridgeback Biotherapeutics and in clinical trials, it has reduced incidences of hospitalisation and death among high risk individuals. It cut down hospitalisation and deaths by 50 per cent among non-hospitalised patients with mild to moderate disease.
Once approved, Molnupiravir will be the first antiviral medication against COVID-19 and that too a simple pill to be taken orally. It is an experimental antiviral medicine developed to treat influenza. It affects replication of viruses as it disrupts the enzyme, ribonucleic acid (RNA) polymerase which viruses use for replication.
The pandemic has created such havoc by the number of patients and deaths, that there has been a lot of anxiety across the globe over the disease, its spread, treatment and prevention. The level of anxiety can be judged by a statement by the Japanese Prime Minister over the efforts to develop such treatments. He has described them as ‘key Trump Card’ in the prolonged, uphill battle against COVID-19.
Medication against COVID-19 is important since there have been apprehensions over the efficacy of different vaccines even now. A research article based on the study of 68 countries published in the European Journal of Epidemiology, in September 2021, by S V Subramaniam and Akhil Kumar claims that there appears to be ‘no discernable relationship’ between percentage of population vaccinated and new COVID-19 cases in seven days in the first week of August 2021. They have concluded that the sole reliance on vaccination as a primary strategy to mitigate COVID-19 needs to be re-examined. This observation underlines the need for developing a permanent line of treatment to fight COVID-19 since vaccines alone may not prove totally useful. Molnupiravir trials are heading in that direction.
Merck is collaborating with Cipla, Dr. Reddy’s, Emcure, Sun and Torrent for clinical trials of their new antiviral in India. Although it reduces the risk by 50 per cent and that too in mild to moderate cases, it may lead the path for further development of a ‘complete’ cure for COVID-19, irrespective of the severity of the patients’ infection. Pfizer is already developing a similar pill for COVID-19.
This development is extended to India too, as two pharma companies here have sought permission to end late stage trials for the generic version of the Merck’s oral pill. Both the companies have presented their interim clinical data for moderate patients. In addition to this, Merck has also entered into licensing agreements with over six companies for production of Molnupiravir, once it is approved. This will make India a major production hub for these new drugs.
Reports suggest that by the end of this year Molnupiravir the medication will surely hit the shelves and be available in the US by the end of this year. Merck plans to produce 10 million courses of treatment by the year end and more doses are expected to be produced in 2022. In anticipation of approval many countries are placing orders for the drug. The Bill & Melinda Gates Foundation has also committed $120 million for its generic version of the drug destined for its access to low income countries.
Yet, there are the usual apprehensions that much like vaccines, ‘wonder drugs’ like Molnupiravir won’t be available sooner, for low income countries. Hopes and aspirations of a life without the dread of a deadly pandemic becoming a reality will be another global challenge.