Long-Awaited Covid-19 Pill: Will it Aid in Combating COVID-19 Pandemic as Hoped?

Written by: Raima A. Islam '25
Edited by: Chris Shin '24

Biopharmaceutical company Merck recently developed a pill that would combat COVID-19 cases, which could reportedly cut deaths and hospitalizations in half. The U.S. based company has created a drug called “molnupiravir,” and has begun running trials to see how it treats COVID-19. Molnupiravir was developed at Emory University in 2018, initially intended to treat the flu virus. However, since then it has been found to prevent the replication of other RNA viruses besides influenza, including COVID-19. Molnupiravir prevents the progression of COVID-19 by imitating other RNAs, infiltrating COVID-19 RNA and mutating it. This action results in the destruction of viral components, therefore inhibiting the virus from surviving and proliferating.

Trials have been conducted to see how effective molnupiravir is at treating infected patients. People were either treated with a placebo pill or molnupiravir. The number of people who were hospitalized or died were recorded for each group. In the first trial, 377 people received the placebo pill, where eight people passed away and fifty-three were hospitalized. On the other hand, three hundred fifty-eight people were treated with the molnupiravir pill, where only twenty-eight people were hospitalized and none died. Those treated with molnupiravir reported side effects currently undisclosed by Merck.

 Currently, the delta variant of the coronavirus has been infecting twice as many people in comparison to previous strains. In this case, the pill is especially effective, considering it targets the delta variant, while still being effective enough for previous strains. Molnupiravir is intended to be taken as soon as someone gets infected with Covid-19 or tests positive for the disease.

 Merck says they intend to produce upwards of ten million doses of molnupiravir before 2022. Although this gives hope to many that this would be a cure-all solution to the pandemic, it’s realistic to believe that this will not be the case. Merck has entered agreements with over one hundred countries around the world to help produce and distribute this pill. With these countries being low and middle income, chances are these agreements will not follow through. With the rollout of the Pfizer vaccine earlier in 2021, it was assumed everyone would be eager to receive the vaccine and that most, if not all, communities would reach herd immunity. Clearly that was not the case; not only were many hesitant to take the vaccine, but many communities did not even receive vaccines. According to data published by Our World in Data from Oxford University, only 4.5% of people in low income countries have been able to receive at least one dose of the covid vaccine. With the low rate of Pfizer and Moderna vaccinations, the COVID-19 vaccine clearly is not the solution we expected.

Furthermore, people in countries with full access to the vaccine willingly chose not to take the vaccine. During August of 2021, there were ninety million people in the United States who were fully eligible for the vaccine but did not want to take it. Part of this distrust could potentially be attributed to healthcare disparities present in our society today. African Americans notably have been mistreated by the U.S. healthcare system. During November of 2021, only 42% of African Americans said they would be comfortable taking the vaccine. This hesitancy can be attributed to never being treated appropriately in healthcare in the past. With the reluctance surrounding the rollout of vaccines, how would we be able to convince infected individuals to take a pill that has been produced and approved even more recently?
Moving past this hesitancy, the general distribution of the vaccines has posed a problem. The United States throws out millions of vaccines each month. Despite this, there are millions of people who still have not been vaccinated around the world. Distribution of healthcare amenities are concentrated in high income countries like the United States. Countries like Burundi, Tanzania and North Korea are among the least vaccinated countries, correlating with their low-income levels as according to Our World in Data from Oxford University. If this was the pattern with the vaccine, who’s to say the pill will be any better?

Although it is simple to be pessimistic and assume the distribution of the pill will be a repeat of the vaccine, there are actions that can be taken to prevent this outcome. A pill does not expire like a vaccine does; a vaccine requires specific conditions to be kept in in order to still be usable. Considering pills do not need as much maintenance, even if there are leftovers from other countries, they can still be transported to other countries. Additionally, pills do not need to be administered like a vaccine does, but they rather can be self-administered, increasing their accessibility. With the increase in transportability and accessibility of the COVID-19 pill, we now have a more realistic solution to the pandemic that can contribute to herd immunity. With the pill posing a real possibility to end the pandemic, Merck should actively work to ensure appropriate distribution and production of Molnupiravir. In this way, if the pharmaceutical company can create enough of the pill to be distributed to all communities, the public can see the changes the pill is making within their surrounding communities. This can contribute to people being willing to actually trust the pill, subsequently leading to the development of herd immunity. Clearly, it is only with repairing healthcare disparities and healthcare misconceptions in communities that we can move forward together past the pandemic; the effort must be a collective one.

References
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Delta variant: What we know about the science [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [cited 2021Nov14]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html 

Doheny K. COVID vaccine hesitancy: 90 million still on the fence [Internet]. WebMD. WebMD; 2021 [cited 2021Nov14]. Available from: https://www.webmd.com/vaccines/covid-19-vaccine/news/20210810/covid-vaccine-hesitancy-90-million 

History [Internet]. Merck.com. 2021 [cited 2021Nov14]. Available from: https://www.merck.com/company-overview/history/ 

Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E, et al. Coronavirus (COVID-19) vaccinations - statistics and research [Internet]. Our World in Data. 2020 [cited 2021Nov14]. Available from: https://ourworldindata.org/covid-vaccinations 

Saey TH. A new antiviral pill cuts covid-19 hospitalization and death rates [Internet]. Science News. 2021 [cited 2021Nov14]. Available from: https://www.sciencenews.org/article/coronavirus-covid-antiviral-pill-merck-molnupiravir-hospitalization-death

Understanding and ameliorating medical mistrust among Black Americans [Internet]. Commonwealth Fund. [cited 2021Nov14]. Available from: https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans