Show 1281: New Antiviral Pills and the Future of COVID-19

Before this pandemic began, a small group of researchers were already paying close attention to coronaviruses and their potential for causing serious illness. Virus experts around the world recognized our guest, Dr. Ralph Baric, as the coronavirus hunter for his outstanding work in this area. In this episode, he joins us to discuss the future of COVID-19.

Predicting the Pandemic:

When we first spoke with Dr. Baric, it was May 2020. Scientists were working on vaccines but had no idea how long the process would take. In the preceding decade, Dr. Baric had worked with colleagues to develop a drug called remdesivir. However, the FDA had not approved its use for treating COVID-19. A year and a half later, a lot has changed. More than 5 million people have died worldwide, with more than 768,000 deaths in the US. We ask Dr. Baric what was predictable and what about the pandemic has surprised him.

The Future of COVID-19 Case Counts:

It seems that we have been on a roller coaster when it comes to case counts. From country to country and month to month, there are huge swings up and down. What should we expect in the future?

New Antiviral Pills and the Future of COVID-19:

The FDA is currently reviewing data on two new antiviral pills. One is from the partnership of Merck and Ridgeback Biotherapeutics. Called molnupiravir, it resulted from some of the early research done by Dr. Baric and his colleagues. The other pill, Paxlovid, was developed by Pfizer. Both appear to be quite effective at preventing hospitalization and death, and both Merck and Pfizer have made some provision for these pills to be manufactured and distributed in lower-income countries. What will they cost in the US? What side effects might they trigger?

One great advantage of antiviral pills is that they can be dispensed through pharmacies and taken at home. Not only is this far more convenient than the IV infusions needed for remdesivir or monoclonal antibodies, it also does not require a person with COVID to leave home and expose others in traveling for treatment. That is why they are important for the future of COVID-19.

Vaccines for the Future of COVID-19:

The mRNA vaccines that were developed to protect us from this infection were actually twenty years in the making. The technology was under development all that time, which explains how the companies could leap into action as soon as the genome of the virus was known. Although it is clear that both the Pfizer and the Moderna vaccines have stronger effects following the booster, it seems unlikely that we will need new boosters every year as we do with the influenza vaccine.

Pandemic Preparedness Plan:

The lessons we have learned in the course of COVID-19 should help us plan pro-actively for the future. Policy makers should consider ways to strengthen public health approaches such as PPE stockpiles and protocols and staffing for contact tracing. Builders should be paying much more attention to adequate ventilation, especially in public spaces. Moreover, scientists should continue their work on a universal sarbecovirus vaccine that would cover a range of viruses related to SARS and SARS-CoV-2. That would help us prepare for a future pandemic.

This Week's Guest:

Ralph Baric, PhD, is the William R. Kenan, Jr. Distinguished Professor in the Department of Epidemiology and Professor in the Department of Microbiology and Immunology. He is a Harvey Weaver Scholar from the National Multiple Sclerosis Society and an Established Investigator Awardee from the American Heart Association. In addition, he is a World Technology Award Finalist and a fellow of the American Association for Microbiology. He has spent the past three decades as a world leader in the study of coronaviruses and contributed greatly to UNC-Chapel Hill’s world leadership in coronavirus research. Dr. Baric received the 2020 North Carolina Award for Science in recognition of his work to develop treatments and vaccines for COVID-19.