Which antiviral is 'strongly recommended' for Covid-19 patients at highest risk of hospitalisation?

For Covid-19 patients with milder forms of the disease who are still at a high risk of hospitalisation, the World Health Organization (WHO) “strongly recommends” Pfizer’s antiviral pill Paxlovid. 

The organisation made the recommendation this week, saying Pfizer’s combination of nirmatrelvir and ritonavir was the “best therapeutic choice” of treatment for unvaccinated, elderly or immunocompromised people with Covid-19.

“This recommendation is based on new data from two randomised controlled trials involving 3,078 patients. The data shows that the risk of hospitalisation is reduced by 85% following this treatment. In a high-risk group (over 10% risk of hospitalisation), that means 84 fewer hospitalisations per 1,000 patients,” said the WHO. 

The organisation however advised against its use in patients at lower risk, as the benefits were found to be negligible.

CHALLENGES

The WHO said the challenge of the drug was availability, lack of price transparency in bilateral deals made by the producer, and the need for prompt and accurate testing before administering it. 

“Lack of transparency on the part of the originator company is making it difficult for public health organisations to obtain an accurate picture of the availability of the medicine, which countries are involved in bilateral deals and what they are paying,” it said. 

The organisation said a licensing agreement made by Pfizer with the Medicines Patent Pool limits the number of countries that can benefit from the generic production of the medicine.

CONCERNS

The WHO said it was extremely concerned that low- and middle-income countries will again be pushed to the end of the queue when it comes to accessing this treatment.

“One obstacle for low- and middle-income countries is that the medicine can only be administered while the disease is at its early stages. Prompt and accurate testing is therefore essential for a successful outcome with this therapy.

“Data shows that the average daily testing rate in low-income countries is as low as one-eightieth the rate in high-income countries. Improving access to early testing and diagnosis in primary healthcare settings will be key for the global rollout of this treatment.”

CALLS FOR PRICING TO BE MORE TRANSPARENT

The WHO called on Pfizer to “make its pricing and deals more transparent” for Paxlovid.

According to National Public Radio, the US is paying about $530 ( R8,450) for each 5-day course of Paxlovid.

“We therefore strongly recommend that Pfizer make its pricing and deals more transparent and that it enlarge the geographical scope of its licence with the Medicines Patent Pool so that more generic manufacturers may start to produce the medicine and make it available faster at affordable prices,” said the WHO.

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