Future of Covid: ‘Generic versions of Paxlovid in India may hold out hope for treatment’

“Everywhere in the world there is COVID fatigue. People are fed up. But we cannot let fatigue be our response to the Coronavirus. I am not saying it is easy but the virus has not gone away. We need not worry about it like we did initially. It is not a scary disease, but it is still causing death and illness,” says Prof Salim S Abdool Karim of the Mailman School of Public Health, Columbia University, USA and co-author of the Lancet COVID-19 Commission report. In other words, we cannot drop our alertness levels.
The new report, “The Lancet Commission on lessons for the future from the COVID-19 pandemic”, which was released yesterday, had said widespread, global failures at multiple levels in the COVID-19 response led to millions of preventable deaths and reversed progress made in achieving UN Sustainable Development Goals (SDGs) in many countries. It is the result of two years of work from 28 of the world’s leading experts in public policy, international governance, epidemiology, vaccinology, economics, international finance, sustainability and mental health, and consultations with over 100 other contributors to 11 global task forces.
Analysing the COVID response through three waves, he says, “The first era was the initial year of the pandemic in 2020, which saw public health measures, washing hands, social dancing, masks and lockdowns. The second year, 2021, was that of vaccination. Vaccines became the norm and while India went through this horrible Delta epidemic, we also saw the importance of vaccination. Then there were newer variants, which could escape immune response from vaccination. However they cannot escape treatment. Treatment is going to become progressively important. As the virus is changing, treatments remain mostly effective and hence become the standard of care.”
An effective treatment is the antiviral medication, Nirmatrelvir, developed Pfizer. Sold under the brand name Paxlovid, this medication works really well in older people. It is now the standard of care in the US and Europe. Due to cost and unavailability, the drug is not available in Africa and that is an unfortunate situation. “While generic manufacturers from India are now making it, we hope it is available the end of the year,” Prof Karim says.
“What the Lancet Commission has done is to explore the first two years of the pandemic. One of the things the report focusses on is that we need to have a better coordinated plan. We can’t aim to deal with a pandemic that affects the whole world in a piecemeal, country country approach. There has to be an overall coordination in many ways in terms of a global response – it is not a country level but a global threat,” says Prof Karim, who is also the Vice President of the International Scientific Council. According to global data, there are more than 60 crore cases and over 65 lakh COVID deaths. In India, there are more than 4.45 crore cases and over 5.28 lakh deaths.
The new Lancet report has said that while the COVID outbreak became known globally in early January, 2020, most governments around the world were too slow to acknowledge its importance and act with urgency in response.
It was mainly the countries in WHO’s Western Pacific region, primed their experience with the severe acute respiratory syndrome, that reacted with urgency to the outbreak, and that generally pursued a suppression strategy that led to low cumulative mortality, although the Omicron variant (B.1.1.529) has been undoing some of these gains. Coordination among governments was inadequate on policies to contain the pandemic, including travel protocols to slow the global transmission of the virus, testing strategies, public health and social measures, commodity supply chains, data standards and reporting systems, and advice to the public. This despite the very high interdependence among countries. With the support of WHO, the G20, and major financial institutions such as the World Bank, the Commission has recommended increased and more effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care, achieving universal health coverage and disease control. “The fact that we are so inter-connected was illustrated very well the Omicron variant. When we first announced it here in South Africa last November, it spread to everywhere across the world within a month. If anyone was not clear that we are inter-connected and virus spreading in one part of the world means bad news everywhere, Omicron illustrated it,” Prof Karim says.
The Commission also focussed on bringing home the message of being pro-social. “I did not know the word till we were writing the report. There is a word called pro-sociality. Societies act with pro-sociality when they demonstrate that they care about fellow human beings that the community is as important as the individual. Pro-social behaviour is important and its importance is illustrated the use of masks. Not only are you protecting yourself but more importantly, you are protecting everyone else. In the event of being infected asymptomatically, wearing a mask, one is reducing the risk of everyone around him/her. There are many behaviours like that. A person with cough, cold and fever will first take the COVID test. He/she won’t climb in the bus or train and expose everybody to the virus. That is the level of prosociality where individuals are making decisions for the benefit of the community. When we do that, we are much better placed to take on any pandemic, not just COVID,” the expert says.
Emphasising how masks can help in controlling the spread in indoor settings, Prof Karim admits that they were now also witnessing resance and non-compliance across the world. “A kind of backlash does occur. One has to be prepared and anticipate that you are going to hit these blocks and do what you can to minimise the effect. Ultimately people have to own their own decisions and own their risks – In Covid, one does not know who is infected but it is a huge responsibility, say even for a young person, to choose to stay protected while sitting next to an elderly person. It is a task to educate the public that we are still living in the middle of a pandemic that is causing death and illness. In the US, at least 400 people are dying daily. In South Africa we are now down to single digits,” he says.
Does he see any issues with Monkeypox? “The Monkeypox virus does not spread very easily. It requires prolonged contact. We know this disease is spreading in men having sex with men not because of their sexual orientation but because of personal time spent together. There have been Monkeypox virus outbreaks in Africa and we have routinely and easily controlled it through public health measures,” says Prof Karim, who is also the Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA).