Max Nisen

Merck’s New Antiviral Promises to Make Covid Less Deadly

Merck & Co. and Ridgeback’s antiviral pill molnupiravir is a potential pandemic game-changer, judging from the positive test data that arrived Friday. To make the most of this promise, governments and global health organizations need to prepare to manufacture the pills in great quantities.

The clinical trial results are preliminary, but impressive. People with fresh symptoms of Covid-19 who took the pills for five days were about half as likely as those on placebo to be hospitalized or die. The difference was so stark — eight who took a placebo died while none who got the pill did — that independent monitors stopped the trial early.

The success is especially auspicious because of the practical advantages of such pills. They can be easily stored and dispensed at any local pharmacy or clinic. And compared with vaccines and antibody therapies, they’re easy and cheap to make.

All this adds up to an unmissable opportunity. By moving quickly to invest in manufacturing capacity, it will be possible to save lives and avoid the global inequity that has plagued the vaccine rollout.

Many people are familiar with Tamiflu and Xofluza, antiviral pills that treat flu infections. Molnupiravir looks to work far better than those. The flu pills, to be effective, need to be taken within two days of symptom onset. The Covid-19 pill can be taken within five days of symptoms, and it appears to disrupt the virus enough to keep a significant share of at-risk people alive and out of the hospital.

Merck expects to produce 10 million courses of the treatment (40 pills per patient) this year, and an April deal to license its formula to generic manufacturers in India should eventually boost global supply. The company also intends to offer developing nations lower pricing than the $700 per course the US will pay for the 1.7 million doses it already has arranged to buy. With the world still suffering three million Covid-19 cases a week, and limited vaccine coverage, 10 million is not nearly enough.

Covid-19 vaccine availability lags because forward-thinking investments in manufacturing weren’t made, and rich countries have hoarded the shots. But with pills, which are much simpler to manufacture, it should be easier to plan for adequate supply. Pharmaceutical manufacturers make tens of billions of prescription pills annually, most of them cheap generics. So there’s plenty of spare and easily adaptable capacity.

To capitalize on this advantage, wealthy countries and global public health organizations should directly finance manufacturing, and anticipate bottlenecks to ensure that the pills are widely distributed. Manufacturing should not be limited to a few sites or countries, but spread globally. It’s also worth investing in expanded capacity for plants that make needed precursors and components for Merck’s drug.

And this effort should go beyond molnupiravir. Roche Holding AG and Atea Pharmaceuticals Inc. are conducting a late-stage test of another antiviral pill, as is Pfizer Inc.

Beyond saving lives and preserving hospital capacity, effective antivirals can make Covid-19 a far more manageable disease. Merck’s pills can be expected to get approval for use by the end of the year. The trick is to be ready to scale up manufacturing right away.