Paxlovid seemed early this year the miracle cure against corona: A pill that reduces the risk of hospitalization by 89 percent. The drug consists of two virus inhibitors, which should be taken immediately at the onset of the first symptoms: one that inhibits the multiplication of the virus, and another that ensures that virus inhibitor number one is not broken down too quickly.
But while the US, Canada, France, Germany, Belgium, Austria and the United Kingdom, among others, recommend the drug for use in the frail and over-65s, is the advice in the Netherlands to prescribe it only to the most vulnerable patients, such as transplant patients.
‘The studies on Paxlovida were done among unvaccinated people, during the time when the more harmful delta variant was circulating’, says Mark de Boer of the Antibiotic Policy Working Group (SWAB), which deals with the use of the drug. ‘At the time you had to treat twenty people to prevent one hospitalization. That begs the question: how many people would we need to treat now to avoid one hospitalization, now that most people have been vaccinated and we have the omikron variant, which rarely causes admissions anymore? Hundreds?’
De Boer points out the drawbacks that the drug also has. For example, Paxlovid can disrupt the effect of other medicines (including blood thinners), and the medicine is not watertight: in about 10 percent does the virus flare up again after the cure. ‘That is why we have said, taking everything into consideration: it is not logical to immediately treat everyone with this,’ says De Boer.
Also effective with omikron
But in Nijmegen, professor of infectious disease outbreaks Chantal Bleeker-Rovers sees things differently. She points to a Israeli study just published: Paxlovid also reduces the chance of hospitalization by about 70 percent among vaccinated people who become infected with omikron.
‘I think it would be very sensible if people reconsider the previous advice and consider advising a somewhat broader group’, she says. ‘Every patient who doesn’t end up in the hospital is one. And this drug offers people the opportunity to reduce the risk of hospitalization themselves.’
De Boer says he will take the new study with him if asked. But whether that also changes the advice remains to be seen: he points out that the number of admissions in the new study is very low. ‘And one of the questions that arise is: which patients are those exactly?’
There are more things in the background. For example, broad deployment of Paxlovid would discourage people from taking the booster shot. However, Bleeker sees it differently: ‘I find it difficult to understand that in Germany there are almost commercials on TV for this resource and we would like to use it very limited here. In Germany it is part of the strategy to keep patients out of hospital. We can use every bed that we keep for other patients.’
Meanwhile, there is another problem. The drug, of which tens of thousands of doses have already been prescribed in Europe, is not yet available in our country. Reason: a complicated quarrel between manufacturer Pfizer and the Ministry of Health about the purchase procedure.
Purchase almost complete
The ministry wants Pfizer to offer the drug through the National Health Care Institute, so that pharmacies and hospitals can order it. However, Pfizer finds this too cumbersome and prefers to do business with the countries themselves. As a result, all neighboring countries now have the drug in stock, but not yet in the Netherlands – although the purchase is almost complete, a ministry spokesperson assures when asked.
‘I hope we’ll have it on the shelf before the fall’, says Bleeker. ‘And it’s still a short day. A campaign is also needed to keep people well informed.’ After all, it is important to start with the course – three pills twice a day, for five days – when the first symptoms have just appeared.