UK’s approval for Merck’s antiviral pill molnupiravir and Pfizer’s claim that its version cuts hospitalisation and death risk by 89% opens a new front against Covid after vaccines have succeeded in reducing disease severity. Merck claims global clinical trials showed deaths reduced by nearly half among high-risk persons with mild to moderate illness when given early into onset of symptoms. A low-cost antiviral pill can be a boon for countries with both high- and low-vaccination coverages battling Covid surges and those with relatively poor medical infrastructure like India.

Merck’s agreement with the UN-backed Medicine Patents Pool offers a royalty-free licence for generic manufacturers to market the drug in 105 low- and middle-income countries. It had separately tied up with some Indian companies which have been conducting local trials for pursuing emergency-use authorisation from DCGI. Indian companies must tie up with Pfizer too because its antiviral technology has been around for decades, and is thus potentially safer. Indian regulators must move energetically on the molnupiravir trial data so that production can scale up, for both India and the world.

During the pandemic, India has carved out exemptions for vaccines and drugs granted EUA by US, UK, EU and Japan regulators besides WHO. UK’s molnupiravir approval is important: It was the first country to approve an mRNA vaccine, the then cutting-edge Pfizer-BioNTech jab, and to demonstrate effectiveness of low-cost steroid dexamethasone in mitigating cytokine storms.

The desperate remdesivir hunt during the second wave surge is reason enough to stockpile large quantities of antivirals. The safety of molnupiravir, which introduces errors into the genetic code of the coronavirus and prevents its replication, must be continually evaluated. Antivirals work best when Covid patients are detected positive early. So there mustn’t be any slack in testing, which is also our only early warning system against another surge.



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This piece appeared as an editorial opinion in the print edition of The Times of India.



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