Covid antivirals should be our route back to normality
Britain’s coronavirus pandemic is getting worse. We are reporting more than 40,000 cases a day, with more than 1,000 people being admitted to hospital and 150 average deaths. Given this, it is puzzling that we have not yet fully appreciated the need for antiviral medications. These drugs are vital in tackling infectious diseases: indeed, our strategy for pandemics caused by influenza includes the deployment of a range of antiviral medicines, averting the need for lockdowns. Yet the authorities have virtually overlooked the effective monoclonal antibody treatments (a form of antiviral medication) being developed, despite the first data demonstrating therapeutic success being published almost a year ago.
Antivirals shorten the duration of coronavirus and reduce the number of patients needing hospital treatment. They can also be used preemptively on people who have had close contact with an infected person, reducing onward transmission. The positive impact this could have had – and could still have – on NHS bed capacity is significant.
Ronapreve, an antibody cocktail produced by Regeneron, was approved for use in Britain in August. But its use is restricted to hospital patients, and only if they meet certain requirements. This is despite the fact that its Phase III trials were conducted in a community setting, among non-hospitalised members of the public.
The antivirals task force, which has been mostly silent to date, has this week announced the purchase of 480,000 courses of the antiviral drug molnupiravir. We are informed it will be ready for deployment if approved by the Medicines and Healthcare products Regulatory Agency (MHRA) this winter. Given that this drug was first trialled on human volunteers in Britain in August 2020, one might wonder why greater volumes of it weren’t pre-ordered sooner, in anticipation of its approval.
Kate Bingham’s vaccines task force succeeded because it hedged its bets and pre-ordered vaccines quickly. The antivirals task force appears to have been slower off the mark. The courses we have now purchased are a fraction of what is needed – I believe it would only be enough to last around 12 days if widely distributed among the public.
The antiviral task force has also ordered 250,000 courses of a promising – but as yet clinically unproven – antiviral, PF-07321332. It has again only been ordered in tiny numbers. Can the order not be increased, given that success in trials is anticipated?
It is frustrating to see these questions not being asked. But we can salvage success if we act quickly. First, we need the antiviral task force to learn lessons from the vaccine task force – to pre-purchase antiviral medicines that look likely to be successful in early stage clinical trials. We should be ordering tens of millions of courses to ensure adequate supply.
Second, the NHS and local services should enable antiviral combination antibody products to be administered to high risk patients in the community. This can be done through hospitals, GP surgeries, hospital at home services, and in large community centres set up as infusion hubs.
Finally, the MHRA should reconsider whether it is necessary to wait for “full” approval to deploy these medicines. Last year, it enabled the early use of remdesivir via a pre-authorisation approach known as the Early Access to Medicines Scheme. Perhaps applicants with other antiviral treatments can be persuaded to use this route to bring products into wider use more quickly.
Antivirals may prove to be the path back to normality, alongside vaccines, enabling us to live with coronavirus. And by reducing pressure on hospitals, they may allow the NHS to deal with major backlogs for non-covid treatments. We need to make such drugs a real option for the public.
They can shorten the duration of the illness and reduce pressure on the NHS, but they have not been rolled out quickly enough