Corona Daily 058: Quest for a Magic Pill

Yesterday’s announcement by the White House may take the world closer to the pandemic finish line. The Biden administration will invest more than $3 billion for the discovery, development and manufacturing of a medicine, ideally an oral pill, against Covid-19. America’s $18 billion investment in vaccines produced five vaccines at miraculous speed. Reliable covid tests and effective vaccines were great scientific and political achievements. An oral pill is missing in the portfolio. AIDS, once considered a death sentence, can now be managed with pills. Flu and hepatitis C also have pills.

The plan is to have a rapid test kit at home. If you test positive, you buy a strip of covid pills, and complete the 5-10 day course. As easy as measuring temperature and swallowing a paracetamol. It is hoped this investment will produce pills by the end of this year. In the next few months, you will likely keep hearing three names of pill makers: Pfizer, Merck and Roche.

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Why is this investment by the US government so important? Because private investors are absolutely not interested in drugs that cure anything quickly. The commercial angel investors prefer chronic ailments such as high cholesterol, diabetes or rheumatoid arthritis. Only lifelong drugs attract private investors.

The $3.2 billion are invested for scientists to develop pills not only against covid-19, but against any viruses with pandemic potential. Compared to vaccines, pills can have wider applications, they are easier to repurpose. Vaccines are incredibly disease specific, medicines less so. Remdesivir, initially approved to treat covid, was originally developed for hepatitis C, and tested during the 2018 Ebola epidemic in Congo.

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Scientists have found that the best way to defend against the covid virus is to control it right when the infection starts. This is the time when the virus is multiplying rapidly in the infected body. The pills will disable this process of copying. Once the patient is taken to the hospital, it is generally too late. The virus has already made millions of copies that are eroding the organs. Remdesivir failed because it can be applied only intravenously, in a hospital setting, by which time the virus has already penetrated the body.

The antiviral pills we are likely to see this year will aim to stop the virus’s ability to make copies.

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Vaccines are given to healthy people. It is not difficult to find healthy volunteers for trials. Testing antiviral pills is a difficult job. Because you want to catch volunteers immediately after they are infected. Many Covid-19 positive people are asymptomatic, so it is difficult to know if the pill worked on such people. Making safe pills is not the difficult part. Scientists need to have an ongoing disease for carrying on tests. Getting enough covid-19 positive people for trials should not be a problem yet.

Tamiflu, a pill that is taken both to prevent and cure flu, is a role model. Scientists expect covid-19 to become seasonal like flu. Vaccinating the whole world with two doses (16 billion) every year is impractical. Much easier to take pills on first sight of the symptoms. So far, the official number of worldwide cases is 178 million, including asymptomatic cases. Even allowing for under-reporting, these are more manageable numbers.

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This month, on 9 June, USA booked their first pre-order for 1.7 million courses of the pills Molnupiravir. (This is another name you are likely to hear often in the coming months). Developed by Merck, the Biden administration will pay $1.2 billion only if the drug is approved by FDA.

Where private investors are reluctant, such public-private partnership is a viable commercial model to develop treatments against diseases. America’s vaccine gamble paid off; let us hope the antiviral pills one is successful as well.  

Those hesitating to take vaccines will surely run to the chemist to buy pills once they feel the symptoms.

Ravi