CareTalk Podcast – Will Merck’s Pill Save Us From COVID?

Merck’s new drug Molnupiravir showed high effectiveness against COVID-19 in late-stage trials. John and David speculate about what this means for the fight against COVID. 

 

David Williams:

Welcome to CareTalk, America’s home for incisive debate about healthcare business and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

and I’m John Driscoll, the CEO of CareCentrix. David, what do we have to talk about today?

David Williams:

John, there’s a new drug coming out for COVID and we want to know what we should know about it.

John Driscoll:

Why are we worried about drugs? I mean, don’t we have vaccinations?

David Williams:

We do have vaccinations, John, and this is just one more tool that we have. We have prevention and then we also have treatment because some people aren’t vaccinated, they’re going to get sick. They need treatment. Some people who are vaccinated are still going to get sick with a breakthrough infection.

John Driscoll:

David, it’s treatment, it’s testing, and it’s vaccines. They’re all part of one story. Will you please get it together? I mean, if we’re going to actually beat this COVID thing, we’ve actually got to not just run warp speed in one direction with vaccines, which turned out to be not as popular as we’d hoped, but really think about this pandemic response, honestly, this healthcare response as a sort of a multi-threat vehicle.

We’ve got this virus, that’s taking us down in multiple vectors. I think we need testing to go with our vaccines. That’s how we’re going to beat this thing. COVID’s not going away. We’re going to have to find a way to live with this puppy and if we’re going to do that, actually, therapeutics, treatments, drugs, not the drugs that you take, David, but the ones that can actually solve or slow down COVID are going to be necessary.

David Williams:

So, John, I think you’re sort of beating around the bush because nobody wants to try to pronounce the name of this new merch drug. I’ll take a shot of that. Molnupiravir. That’s what they’re calling it.

John Driscoll:

God bless you. Whatever the drug is called it’s a pretty exciting drug because you can get treatment in a lot of different ways to care for COVID. People have heard about the monoclonal antibody treatments. That is one of the most effective ways to early on in the illness to prevent, I think it’s a 70% reduction in hospitalizations and death for those people who take that monoclonal antibody treatment, but that’s been sort of the only breakthrough therapeutic and it’s pretty amazing.

And if you get it early on, you really can have a revival and beat this response because what it does is it stimulates the bodies response. It basically stimulates your response, David, to the, your antibody response. It can SIM stimulate and stimulate those antibodies that can beat the virus so you’re basically leveraging your immune system through in a drug that you get through an infusion. They pump it into your veins and then your veins start to pop and you end up beating this thing. This simple oral regime of taking a drug, that would be, if you could pop a pill, don’t have to go to the hospital, that would be pretty cool.

And that’s allegedly what this Molnupiravir, I can pronounce it, drug from Merck can really solve for it. And it’s, in fact, it’s better than the Regeneron monoclonal antibodies because why, David?

David Williams:

Well, John, first of all, because it’s an oral drug, so it’s easy to take and it stops the virus from replicating. So if you take it early on what the virus does is you just have a few copies of the virus. It’s not going to hurt you, but it’s when it really starts to replicate fast is when it’s a problem for you causing symptoms and also where it spreads faster.

So if you can take it in the first couple days of symptoms appearing, it’s probably going to be Tamiflu for the flu and it should work quite well. Now it’s better in the sense of it being easy to take, but it’s shown at least in the trial, about 50% reduction in hospitalization and death. So it’s not necessarily better, but it’s easier to get to people.

John Driscoll:

Well, but you’re missing, oh, but it is, David. You’re missing a key component of its strategy. It’s not designed… Most of the anti-COVID drugs have been focused on the very symptomatic spike protein, the shape of the protein and the shape sequence and the the programming of the virus are attacked by the MRNA vaccines and the monoclonal antibodies are really focused on these spike proteins as well.

The cool thing about the Merck drug, it’s sort of terminating the replication process. It doesn’t have to be just the spike protein version of COVID. It could be a different variation of it. To some degree we’re starting to build therapeutics or defenses in depth for not just where COVID is today, but where it’s going to be in the future. But what is the key problem here, David? What are we missing with vaccines and the Merck drug and the Regeneron drug? What’s the key component that’s missing?

David Williams:

I feel like you’re giving me a little quiz question there, John, but I think the way that we need to do is actually having them.

John Driscoll:

I’m giving you a test. What’s missing? Test.

David Williams:

Now this actually, having a drug like this, if we think ahead toward where the pandemic and the virus go, we will have testing for different reasons. Before we had testing, because we need to know where is the virus? We need to do contact tracing, and there’s no treatment or vaccine. Now, if there’s a drug that can work early on, as soon as you have a sniffle or something you want to be tested, so you can know, boom, “Should I be taking this drug right away?” So we’ll have testing. It’ll be important, but it’ll be for a little bit of a different use case.

John Driscoll:

But it’s actually even more important than you’re suggesting. It’s not a nice to have. If you’re going to actually get the best out of this monoclonal antibody drug, where they pump you full of a drug that creates the kind of superpower or COVID killer response in your immune system aimed directly at that viral enemy, or you’re going to take the Merck drug that stops that virus from replicating by snipping its ability. It’s [inaudible 00:06:12] ability to replicate. You reduce the supply of potential replication.

All of that requires that you take the drug in the first few days after you’ve got COVID. And the challenge is, and what’s really undermined our ability to contain this mother pandemic is because so many people spread it before the are symptomatic. And so testing is the path, David. Testing is the needed partner for these therapeutics.

And so I actually think that as we come to live with the coronavirus that is tied in very similar form to colds in general, we’re going to get really comfortable with tests. They don’t have to be the shove a bazooka up your nose kind of version PCRs.

But I do think that you’re going to see, or rather we have to and hope to see and hope can hope to stimulate through this podcast, even more interests in long-term support of COVID testing and COVID testing supplies.

David Williams:

John, we talk a lot about public health measures, about testing and vaccines. We’ve talked a little bit about treatment, but why have we been talking about treatment so little up until this point?

John Driscoll:

I think that vaccines are magic and they have been, whether it’s smallpox, or mumps, measles, or rubella, we have been very effective leveraging vaccines to make highly contagious diseases and damaging diseases go away or be completely contained. And I think the belief was that the miracle would be to get a vaccine up. And I unfortunately think that the therapeutics, the drugs that care for you and could make this survivable, manageable and can prevent severe illness, particularly that horrible long COVID syndrome that we sort of drifted away or let those drift back in terms of priority and testing didn’t even get in the race.

And so you’ve got sort of a one-legged stool, but I do think that these therapeutics suggest that we are actually going to be able to develop drugs that allow us to contain this thing, because it’s not going away. It’s going to continue to evolve. Vaccines are not going to be so widespread either in the US. I think we’re not leading any of the G20 countries. I think we’re number 50 in the world.

And while our hospital rates of COVID and infections are dropping pretty fast, our vaccination rate relative to the other top 50 countries in the world is not going up very fast, but these drugs suggest that even with a low vaccination rate that we could actually contain and manage and live in a COVID world.

David Williams:

John, one of the things that’s interesting to look at is how COVID treatment has evolved overall during the pandemic. So we’re talking about these new drugs that are purpose built for COVID. But before that you had, just based on some anecdotal information, a lot of use of azithromycin and hydroxychloroquine, and then what you see in the literature is that there’s been a big increase in drugs that actually work and that includes dexamethasone. Something from went from about 1% of patients in California as of June of 2020, all the way up to 67 and a half percent of patients at the end of the year.

John Driscoll:

Is dexamethasone that steroid you take before you go to the trainer?

David Williams:

That I take before I go to the trainer, John?

John Driscoll:

Well, it’s a steroid, so-

David Williams:

Look in the mirror. There’s different types of steroids. No, it’s not that one. It’s a common-

John Driscoll:

What does it do?

David Williams:

Well, it basically is tamps down, it tamps the immune response, which is one reason that people thought it would be weird to use it. But actually what it does is it prevents the inflammatory cytokine storm, which would overwhelm patients and was killing them. So it really seems to be that that effect much overwhelms the effect it would make it harder for your body to fight off infection.

So it’s been very effective and that’s shown by the fact that it’s really being used by for most patients and super cheap also, John, which goes to our previous points about drug pricing is, “Hey, this drug actually works really well and it’s cheap.”

And then there’s Remdesivir which works somewhat. And the use of that went from about 5% to about 63% during that same timeframe. So you do see changes in practice.

John Driscoll:

What does Remdesivir do?

David Williams:

Well, Remdesivir, it basically, I’m not sure they know exactly how it works, but what they had shown before was that it reduced the amount of time that’s somebody spent in the hospital. And that was a big factor and a real reason that people wanted to use it because the hospitals are filling up. So if you could take people out of the hospital faster, even regardless of whether it impacted your likelihood to survive COVID it actually still had value to the health system. So that’s why that one was used, but it’s not like the first thing that people line up for now.

A lot of interest also would happened in ventilation with intubating patients, putting them on mechanical breathing, which was what was happening a lot during the start of the pandemic. If you remember, we were worried about having enough ventilators and then it turns out, “Hmm, maybe you don’t want to ventilate people so much.”

John Driscoll:

And so David, what is all this mean for the regular public? I mean, I think it’s great that we’re telling people that the pharma companies are still productive. We’ll give them a pass this week on overcharging everyone, since they’re bringing another breakthrough therapeutic and care tool to the marketplace, but what does this really mean to the average person?

David Williams:

I think What it means is you can see a path to going from the pandemic to something where this is just another virus that’s circulating and we can do things about it. So the virus itself, we’re kind of getting used to it. So people have either had it, or they’ve been vaccinated so they’re less likely to be affected by it. You’re going to have drugs available if in fact you do get sick. There are things that we don’t have to do so much.

So you won’t have to do, so right now masking is a big thing. My expectation is that at some point down the line within the next year masking won’t be you so important. You’ll still be doing things like having better ventilation. You’ll still want to take good public health measures, get vaccinated and do testing, but it should mean overall probably less polarization and more getting back toward a normal that’s much more like the old normal than a new normal.

John Driscoll:

Yeah. I think that you’re way too optimistic in terms of the politics going away and people holding hands at the bus station and sort of skipping to school. That strikes me as a bunch of bologna and I don’t even eat bologna. And so I think what it allows us to do, we’ve invested, we invest a trillion dollars a year in our healthcare industrial complex, and it is really encouraging that those dollars, and by the way, most of the research for all of these drugs was funded initially by the NIH and by the federal government, so take that pharma companies.

But they’ve done a really nice job at developing the later stage drugs that can help us solve this. I think the reality is in a world of zoonotic-like viruses, viruses that skip from animals to people, where we are having to live much more closely with wildlife than we would like, particularly in parts of the developing world, the viruses are going to keep coming.

We used to think this was a 50-year plague, 1918, the sixties and now. But I think that what we’re seeing, particularly with the rapid replication and change from alpha and beta to delta, the new version of this COVID virus that we do need a multi-threat defense against a multi-threat virus, not just because of this virus, but because of others that are likely to show up on our doorsteps, whether they’re engineered by your friends the Chinese, or they’re just simply the accidental interaction between humans and animals that that gets out of control.

David Williams:

Well, John, maybe I’m too optimistic. I hope you’re too pessimistic. I’m going to leave you with another optimistic idea, which is the idea of treatment as prevention. So you see this with HIV, people that are high risk of HIV, actually take medication designed to treat HIV in order to prevent getting the infection in the first place. And the same may be true of COVID.

This new Merck drug and others that are under development from Pfizer, Roche and others may actually be useful for prevention. Let’s say if you’re, even if you’re vaccinated and you’re going into an area that has a lot of COVID like a foreign country, or if you’re a healthcare worker, maybe someone who’s high exposure, maybe you’re actually going to take this drug and it’ll be another form of prevention. So, yeah, there’s optimism for you, John. I didn’t know my friends were the Chinese. I’m happy I have a billion new friends.

John Driscoll:

More than a billion. I think that what you’re going to find, David, is hopefully as well, an appreciation for the profound importance of government investments in these, both the treatments in the early science, like on monoclonal antibodies, on that drug that you can’t pronounce for Merck. A lot of that early work and research was funded by the government. And frankly, warp speed was a great example of how government can work.

Perhaps one of the other silver linings here is we can acknowledge that government can succeed, particularly partnering with the private sector if we’ve got the right social and public health goals and the resources of the federal government, we can sort of do anything. The vaccine being created as fast as it was. The gene, the genomic code being read in a month once we had access to the data from Wuhan.

We really live in an age of miracles and if those miracles can keep happening and we can adapt the approaches on testing treatment of drug design to other drugs. My goodness, I mean, this could be an incredible 10 to 20 years of progress from a health perspective. And David, at your ripe old age of 70 you could you live another 20 or 30 years with these drugs.

David Williams:

Well, John, as Huey Lewis famously said, “I want a new drug.” He should be happy now. And that’s it for yet another version of CareTalk. This episode focusing on drug treatments for COVID 19. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. Thank you for listening and please subscribe.