As the number of SARS-CoV-2 infections and deaths continues to grow, the focus of the world rests on the promise of a mass-vaccination program. While these developments are good reasons for optimism, there will still be challenges that vaccines alone cannot solve. Effective therapeutic agents against SARS-CoV-2 act as a defense to those who become severely infected running alongside the vaccination offensive.
The vaccine offensive should massively reduce the number of severely infected patients. There have been many promising developments in the vaccine arena recently, with three now being rapidly administered in more than 60 countries and newer vaccines emerging close behind. However, therapeutics able to reduce the need for hospitalisation, reduce the time in hospital and prevent death will be as critical a component as vaccinations to help resolve the pandemic. Widespread vaccination acting together with effective therapeutics will have a far more comprehensive impact in controlling the virus and helping us regain the normal in our daily lives. A two-pronged offense and defense strategy is critical for a number of reasons.
Mitigating the burden of infection
Different governments’ abilities to control infection levels vary considerably but nowhere has the virus been eradicated. In recent months some governments, faced with pressure to revive economies, have loosened restrictions, sometimes with the worrying consequence of increased viral spread, only to have to lock down again.
The sequencing and identification of new variants of SARS-CoV-2 by the United Kingdom, South Africa and Brazil adds further complexity to this attempt to control it and raises questions as to the efficacy of current vaccines. The speed with which the virus is able to mutate is now clear. Some variants seem able to spread more rapidly and some have reached other parts of the world, while others occur naturally and unconnectedly in separate parts of the globe. The exponential growth in new infections during this ‘second wave’ of the pandemic demonstrates the challenge.
This means that, in addition to the hundreds of thousands of people already hospitalised worldwide with SARS-CoV-2, concern remains of a continued influx of new, severely ill patients in the times ahead. For these people, we need a range of effective therapeutic options that can help reduce the severity of their illness and prevent death.
Vaccines are not enough
Current infections aside, many hope that widespread vaccination will soon provide herd immunity and largely control COVID-19 – by bringing overall infections down to levels that are manageable by the existing healthcare infrastructure. This does not save the lives of those that have still contracted the disease, nonetheless.
We have seen the start of successful rollouts of the Pfizer/BioNTech, Oxford/AstraZeneca, and Moderna vaccines, as they begin to be administered in countries such as the United Kingdom and Israel (which currently has the highest rate of SARS-CoV-2 vaccination anywhere in the world). This is outstanding progress and truly a great achievement in the pandemic fight. But, as with vaccines for any disease, there remain challenges.
Not everyone will choose to be vaccinated, and some will be unable to receive the vaccine for health reasons. And for those willing and able to be vaccinated, manufacturing and distribution challenges may limit supply – an uncomfortable issue that we have already seen in the European Union (EU). Not to mention the immense logistical challenges of rolling out vaccination programs at an unprecedented scale.
With these considerations, the predicted vaccination rate currently sits at 67% for the EU, which will leave around one third of the population still at risk of infection. Additionally, the effective immunization period is still unknown, as is the level of efficacy of vaccines against the new variants of SARS-CoV-2.
Therefore progress toward herd immunity will be slower than we would like. It is estimated that by March of this year, the global infection rate will reach nearly 300 million. It is unlikely that vaccines alone will be enough to entirely prevent mortality from SARS-CoV-2 or eradicate the virus. This reinforces the vital role that therapeutics will need to play to mitigate the most severe impacts of this disease.
Effective therapeutics can help save lives
The COVID-19 pandemic has had a devastating impact on millions of people worldwide, causing debilitating illness, hospitalization, and more than 2.2 million COVID-related deaths worldwide coupled with severe disruption to providing proper treatment of other life-threatening illnesses. The effects of the pandemic have reached far beyond hospitals as people worldwide endured lockdowns, job loss, loneliness, isolation, and catastrophic economic losses that will reverberate for years.
Governments enacted these controls to try and contain the virus to save lives and allow hospitals and other healthcare resources to cope. Effective treatments that reduces the risk of death and allow patients to leave hospital sooner would further alleviate this pressure. Governments and populations will feel far safer and start to behave more normally if, and when, they know there exists a successful widespread immunisation programme, coupled with a range of highly effective treatment options that reduce the likelihood of people dying if they become infected. With such a powerful combination of offense and defense, severe social restrictions and lockdowns should no longer be necessary.
“SARS-CoV-2 could become an illness that we live alongside tolerably–in much the same way as we cope with seasonal flu”
Fostering an environment to assist with the funding, development, approvals and implementation of a range of effective therapeutic intervention options within the SARS-CoV-2 treatment landscape must now be a priority for healthcare professionals and governments alike. This path has so far received less attention, due to the understandable initial focus on vaccines. Effective therapeutics will be a critical driver in our quest to relieve illness, prevent death, reopen economies, reconnect with friends and loved ones, and get back to normal.