We live in a pandemic world filled with rapidly evolving solutions to the crises we are presented with. The newest of these solutions is antiviral pills to help treat COVID-19 in those with mild to moderate symptoms. This solution has long been desired by doctors around the world as an alternative to intravenous (administered by injection into the veins) treatments for COVID-19. Not only is it less costly than most other methods of treatment but it does not require hospital care and can be administered at home.

These pills are administered in a fashion similar to how Tamiflu is administered to treat the flu, swallowed twice a day for five days in varying quantities. They are not methods of preventing COVID-19 but rather treatments administered soon after diagnosis of COVID-19 via a positive test followed by symptoms. There are some restrictions to who can receive these medications based on age and one’s health history but for the most part, these pills will be relatively accessible to the population.

Currently, there are two versions of antiviral pills for treating COVID-19 on the market, one developed by Pfizer and the other by Merck labs. The one developed by Pfizer is called Paxlovoid and the one by Merck is Molunpirivar. These two drugs have varying levels of effectiveness and accessibility that can be looked at before making a decision on which one to receive.

Paxolvoid: The Pfizer Pill

Paxolvoid is the first FDA pill to be approved as an antiviral treatment. It was approved in mid-December for those 12+, allowing even children to have access to the treatment. It has seen a high rate of success in treating COVID-19 thanks to its effective chemical combination that is consumed in the form of three pills a day twice a day for five days.

The antiviral treatment has been able to effectively treat mild to moderate COVID-19 in extensive clinical trials, reducing hospitalization and death by 88% in COVID-19 patients. In comparison to a placebo group where patients with COVID-19 faced a 6% hospitalization and mortality rate, patients with COVID-19 who were administered Paxolvoid failed to recover only 0.8% of the time. Paxolvoid usage has contributed to a clearly high rate of recovery in COVID-19 patients with minimal side effects for the most part.

Paxolvoid is made with two potent drugs that give it a high rate of effectiveness. It is made of nirmatrelvir and ritonavir, both of which work to inhibit the enzyme that helps the COVID-19 virus replicate and gave Paxolvoid its success in treating COVID-19. However, this miracle composition of drugs is also quite difficult to make, requiring numerous steps that span over the course of months. This then creates a limited supply chain for the drug that I discuss a bit later.

Currently, the United States has bought 10 million packs of the drug for 5.3 billion dollars, each pack averaging at around $530. This is no cheap solution to COVID-19 and the higher cost can be directly attributed to the tedious process of making Paxlovoid and the profit model on the medication.

Molunpirivar: The Merck Pill

The Molunpirivar drug was approved by the FDA shortly after the Paxolvoid drug but with more hesitancy. It was approved for administration in only those 18+ due to its more nuanced side effects and lower effectiveness, especially against the Omicron and Delta variants. The Molunpirivar drug incorporates itself into the RNA of the virus to inhibit viral replication instead of addressing enzyme inhibition. This and other properties of the drug make it quite different from Paxolvoid.

Unlike Paxolvoid, though, Molunpirivar has only reduced hospitalization and death in patients with COVID-19 by around 30%. Despite higher rates of success in earlier trials, as newer variants rose to prominence, Molunpirivar’s effectiveness continued to decrease. Its 30% effectiveness rate is much lower than the 85% effectiveness rate of intravenous monoclonal antibody treatments that are typically used to treat COVID-19.

Alongside the lower effectiveness rate, Molunpirivar is associated with more side effects than Paxolvoid, especially in the reproductive system. It has a high risk of causing birth defects if administered in pregnant women and needs to be administered alongside contraceptives for all people of childbearing age. Due to these side effects, Molunpirivar usage is limited to situations where other FDA-approved treatments are not available or accessible.

Molunpirivar is taken as four pills twice a day for five days straight for a full COVID-19 treatment. The United States has currently purchased 3.1 million packs of Molunpirivar for 2.2 billion dollars, each pack averaging around $700 in cost. This is relatively more expensive than Paxolvoid despite the lower treatment efficacy.

The Demand for Antiviral Pills Outdoes Supply
For the most part, though, you probably won’t get a choice which one you receive considering how low the current stock of both drugs is. As the Omicron variant causes a recent spike in cases, municipalities are being forced into rationing doses of both these drugs. This situation is escalated by the fact that two of the three former antibody treatments used to treat mild to moderate COVID-19 infections, REGENCOV, and the bamlanivimab and etesevimab joint treatment, are now much less effective against the Omicron variant.

The process of making both these drugs due to the complex chemical composition is also difficult, with a 5 to 8 month manufacturing time required for each batch. Despite the large quantities of both drugs being ordered by the United States, only a few hundred thousand are currently reaching the market monthly and the full millions of purchases will only finish development around summer. Currently, though, the demand for antiviral pills is much greater than any available supply.

Some states are distributing these new antiviral pills in a widespread fashion, so all areas have at least some stock, while others are concentrating the distribution of the pills in areas hit hardest by the surge in COVID-19 cases. Either way, the current distribution of these pills is very limited despite the high demand.

Whether you will receive either of these treatments in the near future if affected by COVID-19 or you just choose to stay informed for when they become more widespread like Tamiflu, they remain important medical advancements to remain aware of.