The World Health Organization (WHO) has just made a strong recommendation for Pfizer’s new COVID antiviral pill, sold under the name, Paxlovid. They are presenting evidence that this pill can help those at risk of a bad infection make a full recovery.

Paxlovid is an oral pill that uses a combination of Pfizer’s nirmatrelvir, a COVID-19 antiviral, and ritonavir, an HIV antiretroviral (ARV) (Schnirring, 2022). This medication is supposed to be taken at the start of a COVID-19 infection and then twice a day for the next 5 days (Schnirring, 2022).

Paxlovid is meant to stop the COVID virus from reproducing and spreading across your body. You can never know exactly how a COVID-19 infection will turn out just based on the first day, so the pills are meant to be given to people who have a strong chance of having a bad infection and may need to go to the hospital.

The World Health Organization, is calling it the best therapeutic choice for high-risk patients to date. This recommendation was based on new data from two randomized controlled trials involving 3078 patients (WHO, 2022).

The data gathered by FIND shows that the risk of hospitalization is reduced by 85% by using this medication. In a high-risk group (who have an over 10% risk of hospitalization), that means 84 fewer hospitalizations per 1000 patients (WHO, 2022).

A meta-analysis study (a statistical analysis that combines the results of multiple scientific studies) by Wen et al., (2022) on COVID oral antiviral treatments, found that Paxlovid reduced the risk of hospitalization or death by 89%.

Scientists have found that there is no significant difference in side effects between the group that took Paxlovid and the placebo group (the group that thought they took Paxlovid but actually took a sugar pill). The chance of having side effects were 19% with Paxlovid and 21% if you had the sugar pill (Wen et al., 2022). This suggests that the oral medication did not significantly improve the chance of not having an ‘adverse event’, but they also did not make it more likely that there would be any ‘adverse events’, i.e. Basically Paxlovid is generally safe (Wen et al., 2022).

The most common side effects of the top three oral antiviral drugs (molnupiravir, fluvoxamine and Paxlovid) were nausea, diarrhoea, headache, runny nose and muscle pain (Wen et al., 2022). Studies show that most of the side effects after taking these medications are mild, and there have been few serious adverse events reported (Wen et al., 2022).

Pfizer has agreed to supply CDC Africa with Paxlovid (Hoije & Kew, 2022); but there have been serious issues around availability, a lack of price transparency in deals made by the producer, and a need for prompt and accurate testing before administering it (WHO, 2022). These factors have made this medicine very difficult to secure for low- and middle-income countries like South Africa.

Recently, researchers in an important African clinical trial, have been denied access to Paxlovid (Ledford & Maxmen, 2022). This is frustrating efforts to test this treatment in African populations and see how it works in combination with other therapies that could potentially expand its use in Africa (Ledford & Maxmen, 2022).

The Drugs for Neglected Diseases Initiative (DNDi) asked Pfizer for supplies of Paxlovid for use in their ANTICOV clinical trial, a large study started in 2020 and based in 10 African countries. This study, aims to identify and test the safety of treatments for mild to moderate COVID-19, which will specifically work in resource-poor settings (Ledford & Maxmen, 2022). Pfizer denied the request and said that they already had plans to do similar trials. But the details and results of those trials have not yet been made public, and Pfizer did not give any more info on their plans (Ledford & Maxmen, 2022).

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