For much of 2020, Donald Trump kept up the pretense that hydroxychloroquine offered a treatment for COVID-19. But when Trump himself came down with the disease, he pointedly did not get any of the snake oil that he had been pushing. Among the treatments that Trump did receive was Regeneron’s synthetic antibodies. In fact, despite the rarity and expense of this treatment, Trump got four times the amount usually provided to COVID-19 patients in dire condition.
Following his return to the White House, Trump promised to provide free antibody treatments for every COVID-19 patient. That would be quite a challenge, as the manufacture of this treatment is difficult, production levels are low, and the market price of the drug is running at over $200 per dose. It’s also worth noting, for all those currently concerned about using vaccines that were made available through an emergency use authorization, that the treatment Trump took wasn’t even at that level. It hadn’t even completed Phase 2 trials.
Not that any of it mattered, because Trump never even tried to follow through on his promise. His final score card was: one dose of false hope, one dose of empty promises. Shake well, and good luck, sucker.
But as the Associated Press reports, this is about to change. On Thursday, Dr. Anthony Fauci appeared at a White House briefing to announce a $3.2 billion investment in an “antiviral program for pandemics” with a focus on creating drugs that can not just fight the virus behind this pandemic, but help prepare the nation for future threats.
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Antibiotics are effective against bacteria, but (despite claims over the last year) don’t work to stop viruses. There are a number of antiviral drugs. However many of those, like Tamiflu, are good against only a very small number of viruses. Others have marginal benefit. Remdesivir, the antiviral that the FDA approved for use against COVID-19, has a significant benefit in most studies, but certainly isn’t a game changer in offering universal treatment. Not only does the drug not prevent many severe effects of COVID-19, it has to be administered by IV in a medical setting. It’s also not without side effects. The benefits vs. the cost are so questionable that the World Health Organization has actually recommended against using the drug.
The ideal antiviral would be one that is as simple to administer as most antibiotics—a pill that could be taken at home, for a limited time, until the disease was eliminated. It should be something that can be taken with few side effects. And it should be shelf-stable over a long period without requiring special handling. Such an ideal and widely applicable antiviral is exactly what the new funding is hoping to generate.
There are already strong indications that such a drug is possible. Companies such as vaccine manufacturers Pfizer and AstraZeneca are testing a new generation of antivirals.
In particular, many drug companies are looking at a technology called “short interfering RNA” (siRNA). As an NIH review showed back in 2018, siRNA offers the potential for treatments that are “easy to design, and can be directed against multiple strains of a virus.” Research in the area has proceeded rapidly over the last two decades. Also generating excitement are “micro RNA” (miRNA) and “short hairpin RNA” (shRNA) which could potentially offer a more potent defense against viruses. All of these offer ways to create targeted antivirals quickly that could be far more effective than previous generations of treatments.
With the increased confidence generated by how messenger RNA (mRNA) vaccines like those from Pfizer/BioNTech and Moderna were created just hours after the genetic sequence of the SARS-CoV-2 virus was released, and the safety and efficacy those vaccines have demonstrated in practice, the willingness to invest in these new technologies has gotten a big boost. Though there are millions of varieties of viruses and bacteria, when it comes to those which infect humans there are only around 100 disease-causing bacteria and 219 known disease-causes viruses. The new generation of antivirals could represent a revolution as great as when Alexander Fleming checked his Petri dish.
Even before these new drugs arrive, the BBC reported on Wednesday that results from the global RECOVERY trial show that a cocktail of intravenous infusion of antibodies—not so different from those given to Trump—can help to neutralize the virus. Like remdesivir, results are far from perfect, and this is an IV product to be administered in a hospital, but it could help to save lives for those who have severe COVID-19.
However, the goal of a pill-based, effective treatment is within grasp. The drugs from Pfizer and AstraZeneca began trials this spring. Rather than being based on the many xxRNA next generation techs that hold the potential to revolutionize antivirals, these two drugs are both protease inhibitors, the same class of drugs as many of the antivirals used to treat HIV. First results of those trials should be available within the next two months, and one or both of these drugs could be available under emergency use by the end of the year.
Considering how many people have still resisted taking the COVID-19 vaccine, having an effective treatment may be the only means of dealing with an infection that is likely to become endemic in America and elsewhere. But the investment in antivirals goes beyond these immediate treatments, and the results could be drugs that are effective in treating COVID-19, more effective against HIV, able to stop Ebola, and capable of dealing with the next virus that appears.
And yes, just as with bacteria, all these drugs have the potential for sparking drug resistance as evolution does its thing. Hopefully we will be smarter this time around, and people will not be getting antiviral drugs in situations where they’re not warranted or effective. It would also be nice if we could limit their use in treating cattle or pigs. Someone should get on that.