Vaccines have worked but we need potent drugs to combat Covid-19

Once again, Covid-19 is rampaging unchecked through the global population, because there are no longer any public-health measures in place to protect adequately against infection. I myself have taken extraordinary precautions to avoid infection for the last two and a half years, because I met three of the qualifications for severe Covid-19: I am 77 years old; I am a cancer survivor; and for the past 40 years I have been treated for a chronic inflammatory condition that leaves me moderately immunocompromised.

Luckily, I had the privilege of being able to sequester myself in my country home, where I could control my personal interactions. I was vaccinated within weeks of vaccines becoming available, and I have received boosters every three to four months since. Moreover, I was given Evusheld, a monoclonal antibody treatment, four weeks ago.

Yet, toward the end of May, after many months of seclusion, I permitted myself one social occasion – a fundraising event with about 100 people in attendance. Four days later, in bed with a fever, cough, and malaise, I tested positive for Covid-19. Even with multiple vaccinations and Evusheld, I was not protected.

My experience has underscored a sad truth. In the race to return to some semblance of normalcy, the needs of the vulnerable have been forgotten. Given that infection by SARS-CoV-2, the virus that causes COVID-19, has now become almost inevitable for most people, the least we could do is develop drug treatments to alleviate disease symptoms and prevent death and long-term consequences. But we have not done so. Pharmaceutical companies designed and manufactured Covid-19 vaccines on an unprecedentedly accelerated timeline, but drug development has not proceeded apace.

There are three main treatment options for those who develop COVID-19 and are at risk for long-term effects and disability. All three have limitations that prevent wider use. The first is remdesivir, which requires an IV-administered infusion and is thus available only in clinical settings. The second is Evusheld, which its developer, AstraZeneca, claims is effective at preventing infection from the latest Omicron subvariants. However, in my case at least, the treatment failed to work as it should.

The third is Paxlovid, an antiviral drug developed by Pfizer that targets the SARS-CoV-2 protease. Paxlovid gained popularity as a Covid-19 treatment when studies showed that it reduced the risk of serious illness and death by up to 90%. But research into its prophylactic potential has turned up empty, and new evidence suggests that some who take it experience rebound infections, meaning they might unwittingly transmit the virus to others.

What is to be done? Since the start of the pandemic, I have argued that vaccination alone will not be sufficient to prevent repeated COVID-19 infections. The literature on cold-causing coronaviruses demonstrates that they can reappear like clockwork. And with SARS-CoV-2, waves of infection occur not annually, as I would have expected based on previous data, but rather at much shorter intervals – every four to six months.

In addition to recognizing the limitations of vaccination as a form of pandemic control, we are becoming more aware of the seriousness of “long Covid,” which describes a broad range of symptoms – respiratory, gastrointestinal, neurological – that persist after an initial Covid-19 infection has cleared.

While more than one-third of Covid-19 patients will develop long-term symptoms of some kind, 2-4% will experience consequences severe enough to be disabling for many months, if not years. These include intense fatigue, persistent pain, and damage to vital organs, such as the heart, lungs, pancreas, and possibly others. Millions of people around the world have long Covid, and millions more will end up with it. Recent data suggest that the vaccines reduce its impact by a mere 15%.

— William A. Haseltine, a scientist, biotech entrepreneur, and infectious disease expert, is Chair and President of the global health think tank ACCESS Health International.