How the Covid vaccine squeezes drugs for sick patients

Francis Collins, a longtime director of the National Institutes of Health, and other top Biden advisors such as infectious disease expert Anthony Fauci and David Kessler, who directs vaccine distribution efforts, are effective early days. Finding Covid-19 therapy is a top priority. To three senior health authorities. President Joe Biden’s adviser has drafted a $ 3.2 billion plan during the transition, especially to fund more research on antiviral treatments that can stop early illness, one of the officials said. Said. The plan was incorporated into the $ 1.9 trillion Covid bailout package passed by Congress this spring.

However, effective Covid treatments have proven to be elusive targets. In May, the Biomedical Advanced Research and Development Agency, an agency of the Ministry of Health that funds early action, suspended requests for new treatments. 117). And past trials have yielded different results from many potential products. BARDA continues to fund nine ongoing projects, eight of which target more serious Covid cases. Only a single initial project on potential antiviral prescribing targets mild illness.

There are several treatments available for more common distress such as seasonal flu. However, it is difficult to find an effective antiviral drug. Approved for use is not complete and in some cases difficult to administer. For example, Tamiflu can only be given in the appropriate window to prevent the patient from being hospitalized. And the Trump administration’s decision to prioritize the development of the Covid vaccine shortly after the arrival of the coronavirus meant that the development of new products would go far beyond the worst of the pandemic.

Biden stepped up its vaccine promotion within the first few weeks of his inauguration. Most of the remaining funding goes to the development of drugs for inpatients and critically ill patients.

Drugs like Intravenous Beckleley, also known as Remdesivir, are not practical for early intervention if someone may not be experiencing Covid symptoms: Gilead, the maker of Beckleley, started mild in April. We have completed a late-stage study in patients with moderate illness. Low registration. Dexamethasone, an readily available and inexpensive steroid, on the other hand, is only useful in critically ill patients and can actually do harm if given too early.

A HHS spokesperson said research on Covid therapy is an integral part of the government’s pandemic response. “We are taking every step to accelerate the clinical development and production of therapeutic candidates that are most likely to complement our vaccine efforts, including focusing on antivirals,” the spokeswoman said. The person in charge said.

To fight the virus, ideally, you should take the pill after learning that the patient has been exposed to the coronavirus or when you start getting sick. It would be preferable to using drugs that were infused or inhaled, mimicking the approach researchers took during the AIDS crisis.

“We are investing a significant amount of resources in the same approach as the targeted development of direct-acting antiviral drugs in HIV,” said Fauci, a pioneer in the HIV / AIDS battle. Stated.

However, it takes a long time to complete an antiviral drug. This is a major reason why the current field is so sparse. Drug development requires very specific knowledge of viruses. Biology to help them Steals the viral mechanics and makes millions of copies of antiviral agents. Their copy eventually ruptures from the cell, destroying it and continuing to look for others to infect.

The tricky side is to make sure the drug works only In the virus — and does not interfere with healthy cells. Matthew Hall, a biologist at the National Center for Advancing Translational Sciences, told POLITICO:

“It’s a very technical, small molecule pill. It’s hard to make,” said a senior government official.

Due to the surge in hospitalizations and deaths early in the pandemic, the government skips antiviral drugs and instead finds all sorts of treatments that can save the lives of seriously ill people before scientists know much about the virus. It makes sense to focus on that.

It also makes sense to avoid developing entirely new drugs and instead search for drugs that are already approved for other conditions that can be reused, or for compounds that are already well underway in the development pipeline. I will. This was the case with the generic steroid dexamethasone and the antiviral drug remdesivir, which was developed to fight other viruses. Both received an emergency use authorization from the FDA last year to treat hospitalized Covid-19 patients.

However, these treatments were not slam dunk, especially for patients with mild illness. BARDA has invested $ 6 billion in new therapies specifically targeting SARS-CoV-2, most of which has been paid to major pharmaceutical companies that handle products already in the pipeline. However, in most cases it works best with serious infections. Indeed, only one BARDA contract is directed to better treatment for people with mild symptoms, which is in preclinical research.

One senior health official believes that there is little incentive to develop new treatments because there is no market for products that treat people who are bedridden or better.

“The common cold-causing coronavirus doesn’t make people so sick,” said Hall of NCATS. When the SARS outbreak occurred in 2001, pharmaceutical companies expressed short-term interest in coronavirus antivirals. However, as the threat of the virus diminished, so did drug development. “When SARS was gone … there was no illness to develop antiviral drugs.”

Companies such as Pfizer and Merck have revived some of their previous coronavirus antiviral research without government support. However, these treatments are in the early stages of trial and can take years after approval if found to be safe and effective. Australian virologist McMillan is working on a treatment that is estimated to be ready in 2023.

As a result, there is currently a shortage of early treatments for Covid-19. This is a situation that I feel I was able to avoid. “If the US government and other institutions and pharmaceutical companies continued to develop coronavirus therapy after SARS, we would have been in a much better place,” said a senior health official.

It may be too late to get antivirals for this pandemic, but the government can prepare for a future pandemic. To do this, we need to work with a pharmaceutical company before the pandemic begins.

“Pharmaceutical companies are not going to develop pandemic prophylaxis right away,” said senior health officials.

How the Covid vaccine squeezes drugs for sick patients

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