What will help us live with COVID-19 in the future?

The COVID-19 pandemic has challenged our established systems, demanding action and leaving little time for consideration and assessment either of the overall impact or of different strategic opportunities.

At first, it could appear to some that vaccines are not very effective in controlling the pandemic as they lose efficacy with some mutations. However, this is an over simplification of the problem.

Mutations would have been less common if the vaccine could be rolled out equally to all people in all countries in an efficient way. Also, some of the vaccines seem to be more effective than others and the immunity provided by them lasts longer. However, these vaccines are very expensive and in short supply, commercial companies preferentially sell to wealthier countries.

For countries with lower socioeconomic status, vaccines remain unaffordable despite COVID-19 Vaccines Global Access (COVAX).

It is then pertinent to ask whether having effective drugs would have reduced spread and mutations. This depends. We can tackle COVID-19 with one of two broad strategies. One is to use “antivirals” that target the virus and the other is to “treat the host” by controlling the body’s response to the virus.

Many pharmaceutical companies have “antivirals” in their library. These are often failed therapies developed for other viruses but as safety information is already available, companies can apply relatively quickly for provisional approval, with less clinical data than what is required for a full approval. However, these are likely to be expensive when available.

Instead “treat the host” drugs with cheap, off-patent anti-inflammatory agents such as heparins, statins, steroids, antidepressants and angiotensin blockers could be the way forward. If we had focussed more on repurposing the right drugs, we could have developed effective COVID-19 drugs earlier in the pandemic and made them more available to less wealthy countries.

What will help us live with COVID-19 in the future? It will have to be a combination of both vaccines and drugs. Everyone needs vaccination, this has been proven to reduce deaths, disability (including long covid), transmission and hospital admission. International Governments from developed countries have a duty through COVAX to support the global vaccine effort. Vaccines are the baseline minimum care.

However there will still be breakthrough infections as immunity wanes and some people won’t get a vaccine or a booster, and in a few people, adequate immune response might not even develop.

Antivirals (when available) will be useful to prevent infection at big transmission events such as spread at a pubs or nightclub or for people who despite being vaccinated are still at high risk for getting sick (e.g. those having chemotherapy).

These will be very expensive and few countries will be able to afford them. Instead, drugs that reduce hospitalisations, ICU admission or death i.e. ‘treat the host’ will be needed as a bridge.

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