- Both Merck and Pfizer are awaiting authorization from federal officials for their COVID-19 antiviral medications.
- Experts say antiviral drugs are designed to prevent serious illness in someone who has developed COVID-19.
- They say the drugs should not be considered a replacement for COVID-19 vaccines, which are designed to stop the replication of the coronavirus as soon as it enters the body.
- It’s still uncertain if insurance companies will cover antiviral medications and how much they might cost someone out of pocket.
Two antiviral medications to treat COVID-19 are awaiting authorization from the Food and Drug Administration (FDA), but experts say the drugs shouldn’t be considered as an alternative to vaccination.
Pharmaceutical companies Merck and Pfizer have both sought emergency use authorization from the FDA for their antiviral pills.
In clinical trials, Merck’s antiviral Molnupiravir, which is being developed in collaboration with Ridgeback Biotherapeutics, reduced rates of COVID-19 hospitalization and death by roughly 50 percent, while Pfizer’s antiviral pill PAXLOVID reduced COVID-19 hospitalization and death by 89 percent.
“Both of them are designed to be given to people very shortly after they develop the infection and their role, of course, is to prevent the evolution of the disease into something more serious that would require hospitalization and intensive care,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Nashville, Tennessee, told Healthline.
“At the moment, we have a treatment that can do that, it’s called monoclonal antibodies,” Schaffner said. “However, in order to benefit from those, you have to go to a specific monoclonal antibody clinic. You have to get an appointment. You have to go there. It may be somewhat delayed… and, of course, it’s in most instances an intravenous infusion. So, that’s more elaborate.”
Schaffner says one of the potential benefits of the antiviral pills is they could be prescribed and administered easily.
However, in order to be effective, the medications must be taken quickly following exposure to COVID-19 or the onset of symptoms.
Dr. Dean Blumberg, the chief of pediatric infectious disease at UC Davis Health. says this could be problematic.
“You need to get diagnosed relatively early, you need to get the treatment relatively early… there are going to be some people who end up [needing] medical attention after that,” Blumberg told Healthline.
He says the high number of pills required on the regime of both Merck and Pfizer’s antivirals could be difficult for a person with COVID-19.
“The pill burden is relatively high. It’s 30 pills over 5 days [for PAXLOVID] and I think that could be a challenge, especially for people who aren’t feeling well,” Blumberg said. “Many patients with COVID-19 may have nausea or vomiting, and I wonder if they’re going to be able to keep down the pills.”
Both Merck and Pfizer’s antiviral treatments work by interfering with the capacity of the coronavirus to replicate, but they do this in slightly different ways.
“The Merck product… mimics the building blocks of the virus… and it leads to faulty replication of the virus. Basically, lethal mutations within the virus so that it’s not viable anymore. The Pfizer product… blocks the viral enzyme that’s important for the replication cycle,” Blumberg said.
In an email to Healthline, a spokesperson for Merck confirmed that the U.S. government will make Molnupiravir available free to people with COVID-19. The company expects to supply 1.7 million courses of the treatment to the federal government.
In an emailed statement to Healthline, Pfizer officials did not confirm the price of PAXLOVID, or whether it would be covered by insurance. They say the pricing of their drug will be based on advance commitment, volume, equity, and affordability.
“High-and upper-middle income countries will pay more than lower-income countries, but at a value that is significantly discounted from our normal benchmarks during the pandemic,” company officials said in their email.
Blumberg says it will be helpful to have an outpatient treatment that prevents serious illness from COVID-19, and says it may be particularly useful for people who are immunocompromised.
“The people who will benefit the most are the people who aren’t vaccinated for whatever reason, maybe they have a contraindication to vaccination or some patients may not respond to the vaccine as well. Patients who are immunocompromised with weakened immune systems, we know that they don’t respond as well to the regular vaccination, and so this might be a backup plan for them to prevent progression of disease,” he said.
However, both Blumberg and Schaffner caution that the antiviral treatments should not be considered a replacement for the COVID-19 vaccine.
“There may be people out there who are vaccine-averse who are thinking of this early treatment as another reason, or we might even say excuse, not to get vaccinated. Of course, I believe that’s completely fallacious reasoning,” Schaffner said.
“I believe that you never want to put yourself at risk of a disease when you stand a good chance at being able to prevent it,” he said. “Vaccines are what we call ‘primary prevention,’ that gives you the prevention before you get anywhere close to the virus. And, it helps you build up your own army of protection such that if you encounter the enemy, your army is already ready to go.”