Before celebrating the new anti-COVID-19 pill


Molnupiravir capsules, a drug developed by Merck

Its name, molnupiravir, seems to come from the bestiary of the fantastic creatures of Harry Potter. But learning how to pronounce it is far from the only complex issue surrounding this new drug candidate against COVID-19 developed by the multinational Merck.

Posted on October 8, 2021 at 5:00 am

There’s a lot of talk about the pill these days and it makes sense. According to Merck, it would cut hospitalizations in half for people at risk (such as the elderly) with mild or moderate COVID-19.

It depends on the immense promise of freeing up beds. Ask hospital managers in Alberta and Saskatchewan if they are interested and may pounce on you, check book in hand. This is even more true in underdeveloped countries, where hospital capacity is even more fragile and where vaccination is minimal.

The excitement also comes from the fact that molnupiravir is a pill that can be swallowed at home. It is not a drug to be administered intravenously like those in the current arsenal against the virus.

But still wait before celebrating. Because this new molecule raises a number of scientific, ethical and financial questions that we probably haven’t finished discussing.

First question at the top of the list: does it really work? The short answer: we don’t know. Because this time, again, we only have one press release to chew on, without the full study data.

This movie, we’ve already played it. And each time, the outcome did not live up to the trailer. Remember the runaway around remdesivir. Or colchicine. Therefore, it will be necessary to wait for the full publication of the study (and, ideally, its peer review) before deciding on the efficacy and safety of molnupiravir.

It is also necessary (again!) To wonder about this disclosure of scientific results as a press release, the terms and data of which are chosen by the pharmaceutical companies. Falling promises fuels confusion and loss of confidence.

But even if molnupiravir proves to be as effective and safe as Merck claims, the questions will be far from over.

One of the most important is cost. Molnupiravir is designed for people who have a risk factor such as obesity, diabetes, or age (60 years or older). As soon as the diagnosis of COVID-19 is made, it would be consumed twice a day for five days. Treatment cost: approximately US $ 700 or approximately CAN $ 880.

The problem is that there is already a much cheaper and more effective solution to prevent hospitalizations: the vaccine. Those who reject him are collected en masse from the hospital. Ethically, should we offer them a more expensive solution at the expense of taxpayers (or those insured with private plans)? And is there not the risk of comforting the unvaccinated in their rejection of the vaccine, since they have another possibility?

Economic calculations are also expected to be difficult. According to figures from Merck, 14 unvaccinated people would have to be treated to avoid hospitalization. The number of vaccinated people to be treated would be even higher, since they are hospitalized less frequently.

Is the game worth it?

These thoughts are far from easy. If the drug is approved by Health Canada, you can bet that experts at the National Institute for Excellence in Health and Social Services will access their calculator to compare costs and benefits.

For poorer countries, it is encouraging to know that Merck has already signed licensing agreements with five major Indian generic manufacturers. And that promises to adjust the sale price according to the payment capacity of the different countries. We will have to be vigilant about this, but it is reasonable to think that the global distribution would be less shocking than that of vaccines.

We all want molnupiravir to free hospitals and save lives. But before we get there, we’ll have to answer the big questions this little pill raises.

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