We recognize there are challenges and deficiencies in current therapeutic strategies to combat COVID-19. In the absence of an effective anti-viral strategy that can be targeted at most global COVID-positive patients in the community, and additionally to prevent the continued spread of the pandemic, the bulk of concerted scientific effort and resources have to date been on the development of vaccines.

Vaccines: It is accepted that vaccines offer enormous benefit in disease prevention, reduction of symptoms, reduction in disease transmission and have played a very important role in the control of infectious diseases. Although vaccines for many diseases, such as polio for example, offer effectively lifelong immunity once administered in childhood, vaccines for seasonal virus-mediated diseases such as influenza are often less effective. This is in part due to the changeable nature of these viruses. For example, the US Centre of Disease Control & Prevention, has reported that annual influenza vaccination effectiveness is 40 – 60% for prevention of illness and 10 – 60% for prevention of more serious illness. According to the World Health Organization, there are currently 139 experimental vaccines in preclinical development and 28 in clinical trials.

We do not yet know how effective the experimental COVID-19 vaccines in development may prove to be in real-world use. Based on available evidence, it seems likely that immunity to coronaviruses similarly wanes over time and many experts have suggested that an influenza-like regimen of annual vaccination will be required. This suggests that, like influenza, widespread vaccination will not eliminate the need for other therapeutics, notably antivirals and anti-inflammatories.

At present, one direct-acting antiviral drug approved for treatment of COVID-19 in Australia is Remdesivir, marketed as Veklury. Remdesivir is an investigational nucleoside analogue that acts by inhibiting viral replication. A course involves intravenous therapy over 5-10 days. The Therapeutic Goods Administration has clarified that Remdesivir will not be available unless patients are severely unwell, requiring oxygen or high-level support to breathe, and in hospital care.

In addition, the Pfizer Paxlovid and Merck Molnupiravir oral treatments have also been provisionally approved by the TGA.