The second decade of this century will be remembered as the decade of COVID craziness if we aren’t careful. There is madness all around and very little of it is caused by the virus itself. From vaccine frenzy to vaccine denial, it is difficult to tease out what should be done next.
On one end of the spectrum, the large pharmaceutical companies and diagnostic laboratories are capitalizing on vaccine production and testing capacity. And there is some unintended collusion from some public health agencies that are now recommending four and hinting at further booster doses with shortening intervals between them, despite no real difference in mortality in those who were previously vaccinated. At the other end of are the vaccine deniers who are dying with “sorry” in their last gasp.
In the middle, most of us are swimming through a series of COVID mini tsunamis. It is not uncommon, as the virus mutates, for people to test positive more than once . . . or even many more times. Everyone knows someone who has tested positive or is suffering from long COVID. The impact on the global environment is only just unfolding now – workforce scarcity, production hitches, transportation shortages, inflation, plastic pollution and so on it goes.
What is the answer? Well, there is one obvious one. Stop producing vaccines and encouraging prolonged work absence, and instead start distributing more antiviral compounds. Not a palatable answer for the vaccine and testing marketers, who are turning handy profits on these products. The development of antiviral agents is a long, laborious, and often unprofitable exercise. It takes approximately 13-15 years and 2 billion USD to develop a new antiviral drug from an antiviral agent. Easier to stick to vaccines and tests.
However, the rapid rate of mutations and adaptions makes the continuation of a vaccine-based or even a single antiviral drug approach unsustainable.
The imperative to develop innovative drugs with broad-spectrum antiviral activities is here now. Despite the constant threat of viral outbreaks, antiviral development is still in its infancy. There are more than 200 human viral diseases that lack approved antiviral treatments and every week a new pox if found. Currently, there are only 179 approved antiviral drugs, and they represent less than 5% of the over 4000 medicines approved by the FDA.
A well-worn and relatively more cost-effective method of improving the antiviral landscape has been to recycle old antiviral drugs, just as older anticancer agents are now used for a range of arthritic conditions. An experimental antiviral agent may be combined with an older agent to minimize the possibility of resistance.
Optimizing the mode of delivery also minimizes the possibility of resistance and adverse effects. Manufacturers have a penchant for pills because they are relatively cheap to make and transport, and keep stable and sterile. However, pills may not be the best route to treat a virus, such as COVID, that predominantly attacks the respiratory system. An aerosol, like those used successful against asthma, may be more effective and less dangerous. Similarly, an intravenous preparation may be more appropriate for a virus that attacks the cardiovascular system.
The complexity of our cells is unfathomable, just as the way antibiotics work would have been unfathomable to most of us over a hundred years ago. The imperative to push for effective, sustainable treatment approaches to our future of viral tsunamis is not.