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Countries in Asia are placing orders for a new drug to treat coronavirus. Poorer nations could miss out again
Experts say while the pill looks promising, they worry some people will use it as an alternative to vaccines, which still offer the best protection. And they caution that Asia’s race to stock up on the pill could see a repeat of the vaccine grab last year, when wealthier countries were accused of hoarding doses…
Experts say while the pill looks promising, they worry some people will use it as an alternative to vaccines, which still offer the best protection.
And they caution that Asia’s race to stock up on the pill could see a repeat of the vaccine grab last year, when wealthier countries were accused of hoarding doses as lower-income countries missed out.
“(Molnupiravir) really does have the potential — the potential — to change the game a bit,” said Rachel Cohen, the North American executive director at non-profit Drugs for Neglected Diseases Initiative.
“We need to make sure that we don’t repeat history — that we don’t fall into the same patterns or repeat the same mistakes that we saw for Covid vaccines.”
What is molnupiravir?
Molnupiravir is seen as a positive step because it offers a way to treat Covid-19 — without patients needing to be in hospital.
The pill works like this: Once a patient is diagnosed with Covid-19, they can start a course of molnupiravir. That involves four 200-milligram capsules, twice a day, for five days — a total of 40 pills.
Unlike vaccines, which prompt an immune response, molnupiravir disrupts replication of the virus, said Sanjaya Senanayake, an infectious diseases physician and associate professor of medicine at Australian National University Medical School. “In a sense, it makes the virus produce unhealthy babies,” he said.
“Antiviral treatments that can be taken at home to keep people with Covid-19 out of the hospital are critically needed,” she said.
Experts agree the drug is promising. Rather than patients waiting to see if they get seriously ill, the virus could potentially be treated straight after they are diagnosed, said Cohen, from the Drugs for Neglected Diseases Initiative.
And unlike other Covid-19 treatments, molnupiravir can be taken at home, freeing up hospital resources for more seriously ill patients.
“Getting a tablet is so much simpler,” Senanayake said. “This is a game changer.”
What the Covid pill means for vaccines
But even in Asia-Pacific, where vaccine rates in many countries have improved after a slow start, millions of people are still not inoculated either because they don’t qualify, or they can’t access shots.
And that’s where the pill comes in.
“There are lots of people that cannot get vaccinated,” said Nial Wheate, an associate professor at the University of Sydney’s School of Pharmacy. “This drug will be a frontline solution for those people that end up getting sick.”
But Wheate and other experts are concerned the pill may make it harder to convince some people to get vaccinated, compounding the vaccine hesitancy seen in a number of countries, including Australia.
Research shows people prefer to swallow medicines rather than be injected, Wheate said.
“If you’d said to me a year and a half ago that people will refuse a vaccine for a disease that’s wiping out the planet, I would have thought you’re crazy,” he said. “There is always scope for people to think that this drug will be a much better solution than getting vaccinated.”
But experts say the pill isn’t a replacement for vaccines.
Senanayake says the approach is similar to how we treat the flu — there’s a flu vaccine, but there are also antiviral medicines to treat those who become ill.
Cohen says the pill doesn’t mean there’s less urgency in scaling up equitable access to vaccines.
“Vaccine equity is sort of the defining challenge of our time. But you never fight an infectious disease with just one set of tools,” she said. “We really need the full arsenal of health technologies.”
Why Asia-Pacific countries are buying the Covid pill
According to Airfinity data, 10 countries or territories are in negotiations or have signed deals for the pill — and eight of them are in Asia-Pacific.
“I think we just want to make sure that we’re ahead of the game when it comes to these other new developments,” Senanayake said.
“There’s a few middle-income countries in there that I think are just trying not to fall into the same trap that they were left in when high-income countries hoarded all the vaccines,” added Cohen.
It’s not clear how much each of these countries will pay for the pills.
Merck did not confirm whether those estimates were accurate, although in a statement to CNN, the company said the calculations don’t take into account research and development.
“We have not yet established a price for molnupiravir because it has not been approved for use,” the company said. “We have an advance purchase agreement with the US government and that price is specific to a substantial volume of molnupiravir and does not represent a list price for the US or any other country.”
A lack of equality
Lower-income countries may be at a disadvantage when it comes to using the pill.
Once the drug is approved for use, countries will need to decide whether to give it to anyone who shows symptoms, or to require a positive test before they can get it.
But that requires access to testing. And in some countries that could be an issue, said Cohen. The interim results on the pill are for people who were given it within five days of symptom onset — and in some countries, getting a test that quickly could be a problem.
First, though, is the question of how they can access it.
While the drug would be simple to produce, according to Leena Menghaney, the South Asia head for the group’s access campaign, Merck controls the patent and is able to decide which countries to supply the drug to and at what price.
Cohen said health tools and technologies should be treated as a public good — and that the situation raised questions about how we can make sure those benefits are shared equitably.
“We are concerned that that could potentially lead to a kind of therapeutic nationalism,” she said. “What we’re most concerned about, though, is that equitable access to antivirals may be particularly challenging in low- and middle-income countries.”
Senanayake said once again there was a risk of richer countries getting more than their fair share.
“With Covid, you have to be selfless to be selfish,” he said. “Otherwise, if you protect your own little cocoon, your own little country, if it occurs in other countries, then a new variant can emerge that can escape the vaccine.”
Who is Terry McAuliffe, the Democratic gubernatorial candidate in Virginia?
Earlier this year, the seasoned candidate — whose story in the Democratic Party is defined by millions of dollars raised, the Clintons, and a tenure as chair of the Democratic National Committee — held his ground among a primary field of younger, more liberal challengers, proving, at least in Virginia, Democrats are not yet tired…
Earlier this year, the seasoned candidate — whose story in the Democratic Party is defined by millions of dollars raised, the Clintons, and a tenure as chair of the Democratic National Committee — held his ground among a primary field of younger, more liberal challengers, proving, at least in Virginia, Democrats are not yet tired of longtime politicians.
McAuliffe has rolled out policy after policy, aiming to both burnish his progressive credentials and argue because Virginia’s legislature is now in Democratic control, something he did not enjoy during his tenure, he will be able to get more done the second time around.
Both Democratic politics and Virginia have changed since McAuliffe’s successful 2013 run, a shift exemplified by the state’s Democratic legislature — which went blue in 2019 with McAuliffe’s help. Since Democrats won control, they have moved to abolish the death penalty, tighten gun laws and reckon with the legacy of the Confederacy.
McAuliffe has said he would require vaccines for students, teachers and health care workers and would support businesses that imposed mandates.
A staple in Democratic politics
McAuliffe, who served as governor of Virginia from 2014 to 2018, has been a staple in Democratic politics for decades. Before putting his own name on the ballot, McAuliffe had long been a prolific Democratic fundraiser and adviser, with close ties to Bill and Hillary Clinton. McAuliffe would often boast of raising around $275 million for an assortment of Clinton efforts, including both of Bill Clinton’s presidential campaigns and Hillary Clinton’s first Senate campaign.
He later was chair of the Democratic National Committee from 2001 to 2005, before serving as chair of Hillary Clinton’s failed 2008 presidential bid.
The former governor’s 2021 bid will be his third for governor. McAuliffe mounted a failed bid in 2009, losing the Democratic primary to state Sen. Creigh Deeds (who went on to lose to Republican Bob McDonnell). Four years later, McAuliffe ran unopposed in the Democratic primary.
He focused intently on bringing business to Virginia during his four years in office, often touting the economic success he had during his tenure, such as bringing 200,000 new jobs to Virginia, he says. He often sparred with the state’s Republican-controlled legislature, vetoing a record number of bills. He ended his time in office by restoring voting rights for thousands of formerly convicted felons in Virginia. And McAuliffe, who was governor when Donald Trump was elected to the presidency in 2016, became one of many Democratic governors who worked to oppose much of what Trump’s administration attempted.
Following his time as governor, he was also a CNN commentator.
McAuliffe, after considering a presidential run himself, endorsed Joe Biden during the 2020 Democratic primary and was considered for a Cabinet post in the Biden administration. In 2020, Biden referred to McAuliffe as the “once and future governor of Virginia.”
Since taking office, Biden has stumped for McAuliffe and in June told Virginians they had to make him their state’s governor again.
“You got to elect him again, and I mean this, not just for Virginia, for the country. The country is looking, these off-year elections, the country’s looking. This is a big deal,” Biden said at the time.
McAuliffe doubled down on the potential national ramifications of the Virginia gubernatorial race during an interview with CNN.
“Donald Trump will use this as a major victory for himself, to help himself for the 2022 midterms and this will be the kick-off for his 2024 race,” McAuliffe told CNN’s Jim Acosta on “Newsroom.” “Youngkin is a Trump wannabe.”
He continued: “We don’t want (Trump) back again… (Youngkin) says that the single biggest issue facing Virginia today is election integrity. No it’s not. It’s jobs, it’s healthcare, it’s education.”
He has beaten the odds before
Since the 1970s, the winner of Virginia’s gubernatorial election came from the party opposite the one that had won the White House. The lone exception was when McAuliffe was elected in 2013, a year after Barack Obama had won his second term, a fact the former governor has often used on the campaign trail.
Despite a number of primary challengers eager to knock down the old guard, the former governor entered the Democratic primary race as the clear front-runner, boasting strong fundraising numbers, a long list of endorsements and near-total name recognition he carried through to clinch the primary election.
From the start of his campaign, McAuliffe focused his attention on Glenn Youngkin, the Republican nominee for governor.
While McAuliffe would require vaccines for students, teachers and health care workers and would support businesses that imposed mandates; Youngkin says he encourages everyone to be vaccinated but opposes mandates.
When it comes to schools, McAuliffe in the second and final gubernatorial debate last month said, “I don’t think parents should be telling schools what they should teach.”
The comment quickly became part of an attack ad from Youngkin, whose campaign hopes it will serve as a rallying cry that could harness the recent Republican focus on education issues, ranging from what should be taught in public schools to issues around transgender students.
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