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COVID-19 continues to surge in India but Paxlovid is only a minor player

Apart from reducing hospitalisation for the most vulnerable group and its efficacy against Omicron variants, Paxlovid has also shown to decrease the chances of long COVID-19.

March 30, 2023 / 11:10 AM IST
Paxlovid is not included in India’s COVID-19 treatment protocol, which may be why the drug is not given to many patients.

Paxlovid is not included in India’s COVID-19 treatment protocol, which may be why the drug is not given to many patients.

India added 2,151 COVID-19 cases on March 29, the most in a single day in five months, while active cases in the country rose to 11,903, according to data released by the Union health ministry.

The cases are being recorded in Delhi, Maharashtra, Karnataka, Tamil Nadu, Gujarat, Kerala and Telangana. Higher test positivity rates have also been reported in many states and districts.

Yet, Paxlovid, the orally administered drug developed by Pfizer that prevents severe outcomes of SARS‑CoV‑2 infection, has remained a minor player in India so far.

Several generic versions of the drug are available in India, including those made by Hetero (Nirmacom), Zenara (Paxgen), and Azistra (Paxista) but they are said to be available mainly in hospital pharmacies in certain cities.

Swapneil Parikh, an internist and clinical researcher in Mumbai, said it’s high time their availability is widened so that those who need it can get it easily.

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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Many positives

Paxlovid consists of nirmatrelvir, which stops the virus from replicating, and ritonavir, which slows down nirmatrelvir’s breakdown to help it remain in the body for a longer period at higher concentrations. Three tablets (two nirmatrelvir tablets and one ritonavir tablet) are taken together orally twice daily for five days.

The drug has shown an 89 percent reduction in the risk of hospitalisation and death in unvaccinated people and benefits even those who are vaccinated. It has been shown to be effective against Omicron variants.

Also read | MC Explains I Why Bedaquiline going off patent in India in July may be a giant leap in the fight against TB

The medication is suggested for high-risk people aged 12 and above, with a body weight of at least 40 kg.

People with high risk of severe COVID-19 are those with underlying conditions such as cancer, diabetes, or obesity, and those who are 65 or older (more than 81 percent of COVID-19 deaths occur in this group).

The more underlying medical conditions a person has, the greater the risk of developing a severe case of COVID-19, the US Centers for Disease Control and Prevention said.

That’s why physicians and infectious diseases experts including Anupam Singh, based in Ghaziabad, say it would be useful to have Paxlovid easily available. However, he has not used it for any of his patients due to lack of availability.

Parikh said some generic versions of the drug are available in pharmacies of two major private hospitals in Mumbai and they may be inaccessible to patients who may be able to arrest the progression to a severe form of the disease if started on the course early.

“As the drug is contraindicated for hospitalised COVID-19 patients, it makes little sense to supply the drug to pharmacies inside hospitals,” he said.

Not in treatment protocol

Paxlovid is not included in India’s COVID-19 treatment protocol, which may be why the drug is not given to many patients.

Hetero and Zenara did not respond to Moneycontrol’s queries on the supply of the drug. However, executives in these companies said limited quantities of the drug are supplied to select hospitals.

Devashish Desai, an infectious diseases consultant with Ruby Hall Clinic, said it is unlikely India will require access to large stocks of this drug.

“Ever since the Omicron variant of SARS‑CoV‑2 and its sub-lineages became the predominant circulating variants, the severe form of COVID-19 has become rare,” he said.

The drug may still be of value for those at high risk of severe disease, but unless there’s an increase in such cases, demand is likely to remain low, he said.

Sumi Sukanya Dutta
Sumi Sukanya Dutta
first published: Mar 30, 2023 11:10 am