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Opinion: Vaccines alone are not enough to beat COVID-19


Vaccines are a crucial tool in the fight against COVID-19, so it’s great news that the UK, on ​​Tuesday December 8, became the first country to start mass inoculations using a new vaccine developed by Pfizer Inc. and BioNTech SE.

This vaccine and another developed by Moderna Inc. are expected to be approved in the United States soon, and a handful of additional vaccines are on the way. But even though they are as effective in the real world as they appear in clinical trials, they cannot change the course of the pandemic overnight and may not be able to completely stop the spread of the disease. virus. We need reinforcements.

It will take months for COVID-19 vaccines to reach a large enough percentage of the population to create ‘herd immunity’ – and that is assuming they gain public trust and the vaccination effort goes smoothly. . Manufacturing sufficient doses may not be as easy as the agreements with various countries suggest. There are also questions about the duration of immunity to COVID-19. And vaccines can fail in frail or elderly people, especially those with pre-existing illnesses. Worse yet, the virus can mutate around our vaccines and start re-infecting people. This is one of the reasons public health officials have called for continued social distancing and masks even after the vaccination effort is in full force.

While vaccines aren’t a silver bullet and won’t be widely available early on, even as the number of cases continues to rise, this makes COVID-19 treatments – drugs that reduce hospitalizations and deaths, and even help in warding off the virus – just as important in fighting the pandemic. The easier they are to take, the better. The good news is that there are several promising therapies in use and more in development. But the biggest game changers are still months away. Here is where it stands.

To date, companies and clinicians have been somewhat successful in their quest for therapies. For example, remdesivir from Gilead Sciences Inc., baricitinib from Eli Lilly & Co., and the generic steroid dexamethasone have been shown to reduce hospital stays and improve recovery rates. Dexamethasone also appears to reduce the risk of death. Another new group of therapies called monoclonal antibodies, which mimic the body’s response to infection, have worked relatively well in reducing hospital admissions in high-risk patients. Two of these treatments, one from Lilly and the other from Regeneron Pharmaceuticals Inc., have been approved for use so far, although, as my colleague Max Nisen wrote, Lilly’s therapy and the best how to use it raise questions. In addition, both new drugs require intravenous infusions under medical supervision and may only be effective for a few months, requiring repeated intravenous visits which could strain health systems.

Without taking anything away from the above achievements, all these drugs fall short of what is really necessary to fight the disease and prevent hospitalizations: either oral antivirals that target the virus’s ability to copy itself, or long-lasting antibodies. duration that can be used as viable. preventive measures in people who are unable to use or respond to vaccines. These treatments are coming, but they are only in the early stages of their development, so we have to wait. There is still some progress.

AstraZeneca Plc is working on a two-antibody infusion cocktail that can be effective for six months to a year and has been designed to reduce the risk of treatment making the disease worse. The first data is expected in the first half of 2021. There is also Vir Biotechnology Inc., which, in collaboration with GlaxoSmithKline Plc, is developing two antibodies with long-lasting potential. Vir also engineered one of the antibodies in a way that could leave an immune “memory” like a vaccine. The first antibody is in an advanced stage trial with data expected in the first trimester, while the second has yet to be tested.

What would really step up our efforts to fight the pandemic is a safe oral antiviral drug. Merck & Co. and Pfizer are in pursuit of this. These are drugs designed to interfere with the virus’s ability to reproduce, and they work in much the same way as the highly effective anti-HIV and anti-HCV drugs. But just like vaccines and antibodies, we need to watch the virus closely and assess any mutations that make drugs inactive. Therapies for HIV and HCV use drug cocktails for precisely this reason. Merck and its partner Ridgeback Therapeutics are expected to release data from a small Phase II trial of their drug, molnupiravir, before the end of the year, while larger Phase III trials will be released in 2021, starting with that of Merck in the first half of the year.

As we increase the huge machinery needed to immunize the world’s population against the coronavirus, we will continue to need treatment. As the arsenal of treatments has grown, I’m much more excited about what’s on the horizon.