Merck’s Covid Pill



November 2, 2021

It has been a long time that the world living in the fear of pandemic as the virus that causes it keeps on mutating and the result is wave upon wave of the pandemic that has caused widespread deaths. The severity of the virus could be gauged by the fact that the worldwide deaths related to COVID-19 surpassed 5 million with unvaccinated people particularly exposed to the virulent Delta strain. The variant has exposed the wide disparities in vaccination rates between rich and poor nations and the upshot of vaccine hesitancy in some western nations. It is reported that primarily the brunt of the pandemic has been borne by United States, Russia, Brazil, Mexico and India where more than half of all global deaths have been reported.

More worrying is the aspect that while it took just over a year for the COVID-19 death toll to hit 2.5 million, the next 2.5 million deaths were recorded in just under eight months and an average of 8,000 deaths were reported daily across the world over the last week, or around five deaths every minute. Though it is now noted that the global death rate has been slowing down yet there has been increasing focus in recent days on getting vaccines to poorer nations, where many people are yet to receive a first dose, even as their richer counterparts have begun giving booster shots. It was reported in this context that more than half of the world has yet to receive at least one dose of a COVID-19 vaccine.

The breakdown of the cases reported is that America has been battling vaccine misinformation that has caused about one-third of the population to avoid inoculations and the result is that the country surpassed 700,000 deaths last week, the highest toll of any country. Russia reported 887 coronavirus-related deaths last week, the largest single-day death toll it has recorded since the pandemic began and the fourth day in a row it has set that record. Only 33% of Russia’s eligible population has received a first vaccine dose. As a region, South America has the highest death toll in the world accounting for 21% of all reported deaths, followed by North America and Eastern Europe contributing more than 14% of all fatalities each. The Delta variant is now the dominant strain around the globe and has been reported in 187 out of 194 World Health Organisation member countries.

In this dismal situation the news that an antiviral pill developed by US drugmaker Merck & Co  could halve the chances of dying or being hospitalised for those most at risk of contracting severe COVID-19, with experts hailing it as a potential breakthrough in how the virus is treated. If it gets authorisation, molnupiravir, which is designed to introduce errors into the genetic code of the virus would be the first oral antiviral medication for COVID-19. The company says that they plan to seek US emergency use authorisation for the pill as soon as possible and to make regulatory applications worldwide. Current treatment options include Gilead Sciences Inc’s  infused antiviral remdesivir and generic steroid dexamethasone, both of which are generally only given once a patient has already been hospitalised.

It is reported in this context that the existing treatments are cumbersome and logistically challenging to administer but a simple oral pill would be the opposite of that. The results from the Phase III trial, which sent Merck shares up more than 9%, were so strong that the study is being stopped early at the recommendation of outside monitors. Shares of Atea Pharmaceuticals Inc  which is developing a similar COVID-19 treatment, were up around 20% on the news. Shares of COVID-19 vaccine makers Pfizer Inc and Moderna Inc were off more than 2% and 14%, respectively.

It is also reported that Pfizer and Swiss drugmaker Roche Holding AG are also racing to develop an easy-to-administer antiviral pill as for now, only antibody cocktails which have to be given intravenously are approved for non-hospitalised patients. A planned interim analysis of 775 patients in Merck’s study looked at hospitalisations or deaths. It found that 7.3% of those given molnupiravir were hospitalised and none had died by 29 days after treatment, compared with hospitalisation of 14.1% of placebo patients. There were also eight deaths in the placebo group. The result brought to fore the deduction that antiviral treatments that can be taken at home to keep people with COVID-19 out of the hospital are critically needed.

Merck said viral sequencing done so far shows molnupiravir is effective against all variants of the coronavirus including the highly transmissible Delta, which has driven the recent worldwide surge in hospitalisations and deaths.  Merck said it expects to produce 10 million courses of the treatment by the end of 2021, with more coming next year. The company has a US government contract to supply 1.7 million courses of molnupiravir at a price of $700 per course. Merck has similar agreements with other governments, and is in talks with more. Merck said it plans a tiered pricing approach based on country income criteria.

The tablet – molnupiravir – was given twice a day to patients recently diagnosed with the disease and its results were so positive that outside monitors had asked to stop the trial early. Dr. Anthony Fauci, chief medical adviser to US President Joe Biden said the results were very good news. If authorised by regulators, molnupiravir would be the first oral antiviral medication for Covid-19.  Unlike most Covid vaccines, which target the spike protein on the outside of the virus, the treatment works by targeting an enzyme the virus uses to make copies of itself. It is reported that an antiviral treatment for people who are not vaccinated or who are less responsive to immunity from vaccines, is a very important tool in helping to end this pandemic. Trial results suggest molnupiravir needs to be taken early after symptoms develop to have an effect.

Merck is the first company to report trial results of a pill to treat Covid but other companies are working on similar treatments. It is expected that the other pharmaceuticals will capitalise on this breakthrough and they will shift more money towards it. The funds do not appear to be a hindrance as American government has already agreed to buy $1.2bn worth of the drug if it receives approval from the regulatory body, the FDA. The prospects are extremely bright as Merck plans to negotiate licensing deals with a number of generic manufacturers to supply the treatment to low and middle-income countries.

The success of the venture is widely appreciated and it has given rise to hopes that the antiviral task force has, like the vaccines taskforce, pre-ordered courses of this medication. The scientific community is of the opinion that a safe, affordable and effective oral antiviral would be a huge advance in the fight against Covid. They also mention that Molnupiravir has looked promising in the laboratory but the real test was whether it shows benefit in patients. Many drugs fail at this point, so these interim results are very encouraging.


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