Pfizer’s COVID-19 pill could have a real impact in Canada – if we can roll it out fast enough
After Canada approves a new treatment for COVID-19, Pfizer’s highly effective oral treatment Paxlovid, experts hope the much-researched pill can help control a devastating flare-up caused by Omicron – if rolled out quickly enough.
“I think it will be an effective tool in people at high risk if they can get tested fast enough that they can be in the window for therapeutic benefit,” said infectious disease physician and lead researcher Dr. Amesh Adalja. at Johns Hopkins Center for Health Security in Baltimore.
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“If you can get it to people fast enough to stop them needing hospitalizations, that basically solves the major problem we’re facing.”
But questions remain about whether provinces and territories will be able to get the drug to sick and vulnerable Canadians within the recommended five-day timeline, which will help ease pressure on hospitals until levels of COVID-19 are decreasing.
“Obviously this is a very promising development, but there is still work to be done,” Dr. Isaac Bogoch, an infectious disease physician and member of the Ontario task force, told CBC News Network on Monday. on the COVID-19 vaccine.
“It is fantastic that we have taken this first step. We also now, of course, have to distribute it to the provinces and have the provinces determine how this is going to be administered.
WATCH | Paxlovid shows great promise despite the logistical hurdles, says Dr. Isaac Bogoch:
Canada ‘drags its feet’ on deployment plan
Canada’s Chief Public Health Officer, Dr. Theresa Tam, said on Monday that the antiviral treatment – consisting of nirmatrelvir and ritonavir – will be in “high demand” and that officials anticipate the initial supply “will not won’t matter anywhere” as they work with provinces and territories to determine how best to roll it out.
Dr David Naylor, who led the federal inquiry into Canada’s national response to the 2003 SARS outbreak and co-chair of the federal government’s COVID-19 Immunity Task Force, recently said he was “very frustrated” with the pace of approval.
Canada needs a Paxlovid rollout plan involving both virtual and outpatient care, he said — a plan that can confirm a patient’s presence of the virus, assess the severity of their illness, prescribe the pill quickly and ensure that available doses reach those who need them most.
“As far as I know, we’re dragging our feet on that front as well,” he told CBC News. “Countless thousands of Canadians are seriously ill at home from COVID-19 and from what I see and hear, many feel abandoned.
Naylor said Canada can also develop helplines for those eligible for treatment, provide clear information about its benefits, and coordinate outpatient care to support patients at home — instead of assuming their situation isn’t. is “not relevant” unless they are hospitalized.
After several months of clinical trials, Pfizer reported in November that Paxlovid reduces the risk of hospitalization or death by 89% versus placebo in non-hospitalized high-risk adults with COVID-19.
Canada has pre-purchased one million doses of the drug, with the first batch of 30,000 to be distributed per capita and more to arrive in the coming days. This will undoubtedly trigger a rapid push to disperse treatment to those most at risk as soon as possible.
But getting this limited supply in time to ease the pressure on hospitals won’t be easy – and the impact is unlikely to be felt anytime soon.
“There will almost certainly not be enough supply to really have an impact on the population,” said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Mount Sinai Hospital in Toronto.
“Not that it’s not a good thing, not that we shouldn’t use it.”
WATCH | Health minister says 120,000 Paxlovid treatments expected by March; 30,000 already distributed:
Canada needs a ‘quick turnaround’ for Paxlovid
The drug will be most effective in people most at risk of severe disease, whether due to age, underlying health conditions, comorbidities or unvaccinated people.
High-risk patients must also take the drug within five days of the onset of symptoms – which Tam said highlights one of the “key challenges” of the much sought-after treatment.
“It should be used very soon after symptoms appear – the sooner the better – and really not after five days,” Bogoch said. “So you have to really think about how you’re going to get that to the people in need and really have that quick turnaround.”
There are “logistical hurdles” awaiting Canada with Paxlovid, Bogoch said, and provinces and territories must ensure “equitable access” to the drug — especially in communities that are disproportionately affected and underserved. -served.
An ideal deployment of Paxlovid would involve patients getting a rapid antigen or PCR test at home, calling a hotline or their family doctor for information about the drug, then having it distributed to their local pharmacy or delivered directly to them at home, Adalja said.
But finding those high-risk patients within the five-day window will be difficult, especially given that COVID-19 testing capacity is currently overwhelmed in much of Canada.
British Columbia provincial health officer Dr. Bonnie Henry recently told CBC News that she believes COVID-19 testing strategies should be redirected to symptomatic patients most at risk of illness. serious, in order to identify them and administer treatment in a timely manner.
“Changing our strategy for people who may need monoclonal antibodies or [Paxlovid], ensuring that we can quickly pass them on to people at risk of hospitalization and more serious illness,” she said. “That’s the emphasis we need to put on our testing right now.”
More real-world efficacy data needed
While clinical trials have shown the pill to be highly effective in preventing the worst outcomes of COVID-19, Bogoch said it’s important to remember that the data available to support the use of the drug has been published by Pfizer and have not yet been peer reviewed.
“We have great data from the pharmaceutical company, but this is all very early. And I think it would generate more confidence in the general public if we saw [it] peer review and more transparency on data,” he said.
“Having said that, everything we’ve heard about this pill sounds very promising.”
The clinical trial data for Paxlovid was so strong that an independent group of medical experts monitoring the trial recommended stopping it early, which is common practice when early results show such clear benefit.
Less than one percent of patients taking the drug in clinical trials required hospitalization and none died. In the placebo group, seven percent of patients were hospitalized and there were also seven deaths.
Study participants were unvaccinated, with mild to moderate COVID-19, and were considered at high risk for hospitalization due to health conditions such as obesity, diabetes or heart disease.
By comparison, however, Merck’s COVID-19 antiviral pill, Molnupiravir, was initially found to be 50% effective in the prevention of serious illnesses, hospitalizations and deaths – but this has dropped to 30 percent after more data became available.
“Obviously, over time, we will have more and more access to [Paxlovid], we will have a better understanding of how well it works,” Bogoch said. “But we can’t downplay the importance of that. It’s a big step forward.”