Felicity Cox Comment piece: Molnupiravir

Friday, 12th November, 2021

As a pharmacist and NHS leader, I read with interest about the development and approval of molnupiravir (sold under the brand name Lagevrio), the first pill to treat COVID-19. It is designed to treat symptomatic COVID-19 and has been approved by the UK medicines regulator. In clinical trials the pill, originally developed to treat flu, cut the risk of hospitalisation or death by about half. I noticed the claims by a rival that its experimental drug, Paxlovid, to be 89% effective but with the qualifying phrase ‘in high-risk cases’, however this is of course still in trials.

This caused me to reflect on some of the challenges of the last two years, as well as some of the challenges from back in 2009.

In the early days of the pandemic, I was part of the national group supporting trials of possible treatments for COVID-19. There was such disappointment when the early treatments failed and a wealth of relief when the ‘RECOVERY trial’ showed dexamethasone had benefits for critically ill patients. Then we had the challenge of identifying people to enter clinical trials of the Oxford vaccine, which was difficult immediately post-lockdown as transmission had been well suppressed.

The recent approval of molnupiravir reminded me of what a great institution the NHS is. We were the only health system in the world that had the infrastructure to support large scale trials. In the heat of the incident, we were also an easy partner to collaborate with due to our scale and co-ordinated command chain. We know the NHS can always improve, but our power of collaboration was truly demonstrated in this complex situation. Of course, this is something which has stood this patch in good stead and we must continue to build on this as we create the Integrated Care System (ICS).

Reflecting on the swine flu pandemic, which seemed catastrophic at the time, I thought about the first antiviral drug developed then. Tamiflu, which is still sometimes prescribed within the first day or two of symptoms, is now considered of limited benefit – sadly viruses can develop resistance to drugs. We know that COVID-19 mutates and presents new challenges but with the NHS’ national reach, good surveillance, and ability to do trials at scale, I hope that we can keep ahead of this virus.

Looking ahead to next week, we need to think broadly about self-care and support each other to keep active and healthy and protect us from many diseases. So on that note I think it is time to change for Zumba and take a screen break. Keep safe and let us know your best self-care tips as we head into Self Care Week.

By: Felicity Cox, Chief Executive Designate of the Integrated Care Board (ICB)

Listen to the latest episode of Inside Science on BBC Radio 4 for more on COVID-19 antiviral pills: https://www.bbc.co.uk/programmes/m0011c5m