Those who will benefit from antiviral treatment should get the medicines on priority, say experts
There needs to be a concerted effort to shift focus towards therapeutics, at a time when COVID-19 infections continue to rise due to emergence of new variants, according to experts. The persisting vaccine inequity only strengthens the need for the same.
“Widespread access to an antiviral like Paxlovid really makes a profound difference in saving lives around the world,” according to the latest projection by the Institute for Health Metrics and Evaluation (IHME), an independent population health research centre at University of Washington Medicine. The centre added:
So a very high priority — both in the US and everywhere in the world, for thinking about health system delivery strategies and access to the drug itself — is that those who can benefit from an antiviral are going to get that antiviral.
Cases are on the rise in several parts of the world, triggered by BA.2 in some places and in others — largely in South Africa — by BA.4 and BA.5. All of these are sub-variants of omicron.
We're now four months or more into the peak of omicron transmission, said IHME. “So, some of that increase in BA.4 and BA.5 could be from waning immunity from what was established through the early omicron wave in November and December in South Africa.”
In such cases as well, vaccine-derived immunity may not protect against an infection, but timely treatment will help prevent it from progressing to a disease stage.
On April 22, 2022, the World Health Organization (WHO) updated its live guidelines on treating a COVID-19 infection to strongly recommend the Pfizer Inc pill (Paxlovid) for the high risk population. This includes those who are still unvaccinated, older or immunosuppressed, in early stages of the infection.
The findings of a study published in JAMA Network on April 22 argued in favour of monoclonal antibodies and the positive impact it has on health outcomes and expenditure on COVID-19 treatment. The study assessed postexposure prophylaxis (PEP) — preventive treatment in case a person has been exposed to a pathogen — for household contacts of those infected with the SARS-CoV-2 virus.
Its findings revealed that if half the exposed people, unvaccinated and above the age of 50, were administered PEP, 1,820 symptomatic infections, 528 hospitalisations and 84 deaths in a low-transmission scenario were averted while 4,834 symptomatic infections, 1,404 hospitalizations, and 223 deaths in a high-transmission scenario were averted.
This programme also revealed some financial benefits of a timely administration of monoclonal antibodies (mAbs). “Without mAb PEP, the estimated cost of hospitalisations due to COVID-19 infections from household exposure in the lower transmission scenario was $149 million, whereas the estimated hospitalisation cost in the higher transmission scenario was $400 million,” the study noted.
“In this modelling study of a simulated United States population, a mAb PEP for COVID-19 program was estimated to improve health outcomes and reduce costs,” the study noted.
In the setting of a susceptible variant of SARS-CoV-2, health system and public health actors would have an opportunity to improve health and reduce net payer costs through COVID-19 PEP with mAbs, according to the report.
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