Drug manufacturer Merck on Monday requested emergency use authorization from the Food and Drug Administration for its antiviral medication, molnupiravir. While many have heralded this first-ever oral treatment for covid-19 as a game-changer, others are raising the concern that an easy-to-access treatment could further deter the unvaccinated from getting their shots.
I do not believe this is a reason to withhold treatment, though it is true that some prominent figures already tout treatments in place of vaccines. Texas gubernatorial candidate Allen West was recently hospitalized with covid-19 after refusing the vaccine. “I can attest that, after this experience, I am even more dedicated to fighting against vaccine mandates,” he tweeted Sunday. “Instead of enriching the pockets of Big Pharma and corrupt bureaucrats and politicians, we should be advocating the monoclonal antibody infusion therapy.”
Put aside for a moment that monoclonal antibodies, a covid-19 therapy delivered as an intravenous infusion or series of shots, are developed and manufactured by major pharmaceutical companies. There is clearly a certain segment of the population who, like West, would rather wait to fall ill than take preventive measures. Having better, more convenient treatments for the coronavirus could further deter such individuals from getting vaccinated.
Nevertheless, the possibility that some people would see these treatments as an excuse to remain unvaccinated is not a reason to hold back on effective treatment. Such logic would be unacceptable for any other aspect of medicine.
If someone had severe heart disease with multiple blocked coronary arteries, we wouldn’t think to deny them a quadruple bypass surgery that could save their life. It would have been better to catch their coronary artery disease earlier — and, in fact, there are many medications and less invasive therapies to treat hypertension, diabetes and early heart disease. But if a patient gets to the point of needing specialized, intensive care, our health-care system must provide it.
Wouldn’t it be best to avoid heart disease altogether through a healthier diet, regular exercise and smoking cessation? Absolutely. But many people are unable to change their lifestyles, and still others may have done everything right but still end up ill. Our medical system needs to intervene at every stage and treat the patient, no matter the cause of someone’s ailment.
Some might say covid-19 is different because it’s a communicable disease. Still, the same argument holds: We can’t incentivize prevention through denying treatment. Despite our best efforts, there will still be millions of Americans who remain unvaccinated. It’s unethical to deny them care, and there’s also a societal benefit to getting them early treatment should they become infected because fewer sick patients means less strain on the health-care system.
In addition, there will be vaccinated individuals who develop breakthrough infections. Everyone who contracts covid-19 should be able to access treatments that reduce the likelihood of progression to more severe disease — and death.
At the same time, it’s important to clarify that oral antivirals and monoclonal antibodies are treatments, not cures. Merck said in a news release that molnupiravir reduces the risk of hospitalization and death by 50 percent when taken early in the course of illness. Monoclonal antibodies appear to have similar efficacy in preventing mild, early symptoms from spiraling into severe illness. These treatments can make someone less sick, but they do not magically cure covid-19.
These treatments, too, are not without potential side effects. Some experts have expressed concern that molnupiravir could have an effect on human DNA, like chemotherapy agents. Though Merck denies this possibility, it is something that needs to be investigated further. Monoclonal antibodies can cause a whole host of symptoms, including severe allergic reactions and low blood pressure. Anyone refusing a coronavirus vaccine because it is “experimental” should be reminded that the vaccines have been given to hundreds of millions of people and that there is much more known about them than these treatments.
That brings us back to the key point: Although treatment shouldn’t be denied in the name of prevention, treatment does not take the place of prevention. The covid-19 vaccines are remarkably effective at warding off infection in the first place. They stop people from contracting the disease and therefore passing it on to others. Every effort must be made to increase vaccine uptake, including, as I’ve advocated for months, through vaccination requirements.
But just because prevention is paramount does not mean that treatment doesn’t have its place, too. As the United States moves on to the next stage of the pandemic, in which we learn to live with the virus, we need to accept that we can and must do both: focus on vaccination, masking and testing to prevent covid-19, while also making treatments available for those who are infected. As with all other aspects of medicine, prevention and treatment must go hand in hand.