The Biden administration announced a series of initiatives Tuesday aimed at increasing the use of antiviral pills to treat Covid-19, with a particular focus on Pfizer’s Paxlovid.
Officials had telegraphed the move. On Friday, Ashish Jha, the new White House coronavirus response coordinator, tweeted that the administration would this week take a series of actions to increase the use of the Pfizer drug.
“Paxlovid is extraordinarily effective at preventing bad outcomes,” he said. “We’re getting it out to the American people.”
The first step will be simply to make Paxlovid and Merck’s molnupiravir, another oral antiviral treatment, available at more places. Administration officials said they plan to nearly double the number of locations where the drugs are available, including pharmacies, community health centers, urgent care centers, and Veterans Affairs clinics. Currently the drugs are available at 20,000 locations. That figure is expected to jump to more than 30,000.
The U.S. government will also substantially increase the number of “test-to-treat” facilities, where eligible patients can receive a Covid test, followed by a prescription and then the prescribed medicine. There are currently 2,200 test-to-treat sites at pharmacies, long-term care facilities, and community health centers.
Other initiatives will try to communicate to both doctors and patients that treatments are available, safe, and effective. Senior administration officials said on a call with reporters Monday night that they would work to make sure that health care providers have the latest information on Covid treatments. To that end, the Centers for Disease Control and Prevention released an alert to public health officials to increase awareness on existing treatments.
The Biden administration also plans to target an awareness campaign at the general public, and will provide services including an online test-to-treat locator and a call center (1-800-232-0233) to provide help in more than 150 languages.
Both Paxlovid and molnupiravir were authorized by the Food and Drug Administration in December. Paxlovid combines a new drug developed by Pfizer with an older medicine, ritonavir, that is frequently used to boost blood levels of antiviral medicines. The combination can interact with many older medicines. But it also shows very high efficacy, reducing hospitalizations and deaths by more than 89% in a large clinical trial. Initially, supplies of the drug were extremely limited, but the U.S. has committed to buying more than 20 million courses of the medicine.
Paxlovid is given as two pills of Paxlovid plus one of ritonavir, another antiviral, twice daily for five days, for a total of 30 pills. Ritonavir can interact with many other medicines, which could add logistical hurdles for its use.
Molnupiravir, developed by Merck and partner Ridgeback Biotherapeutics, interacts with fewer drugs, and was initially more widely available, but it was only 30% effective at reducing hospitalization in a large trial, although it appeared effective at preventing death. Experts raised concerns about whether the drug could cause birth defects or, potentially, lead to resistant strains of the virus that causes Covid. Four capsules of the drug are taken twice a day for five days, a total of 40 pills.
In a fact sheet sent to reporters, the White House mentions Paxlovid by name, but not molnupiravir.
The treatments are authorized only for those with risk factors for severe illness — but as much as 60% of those who are contracting Covid may be eligible for the antivirals, because common risk factors like age and diabetes are included.
So far, a senior administration official said, some 500,000 courses of Paxlovid have been administered. Recently, weekly courses of Paxlovid administered hit 55,000; that figure had previously been just 22,000. The administration official said that there is no longer a limited supply of the drugs.
There’s no doubt that the process of getting Paxlovid has been complicated. Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah, said that he recently prescribed the drug for a college professor, and it took her a half-hour of web surfing and phone calls to locate a place that could dispense it. “A poor patient with few resources or without internet access would have had a great deal of trouble,” he said.