COVID-19 Medical Countermeasures on a National Scale

In the last day, there have been 3.4 million new cases of SARS-CoV-2/COVID-19 across the world. According to the World Health Organization (WHO), there have been over 340 million cases and 5.5 million deaths globally since the pandemic began. In the United States, the Centers for Disease Control and Prevention (CDC) estimate a total of 70 million cases and 862,494 deaths, with over 700,000 new cases occurring daily.

One challenge in any outbreak, but especially a pandemic involving a novel pathogen, is in relation to medical countermeasures. Members of President Biden’s COVID Taskforce, Drs. Luciana Borio, Rick Bright, and Ezekiel Emanuel, recently wrote on a national approach to medical counter-measures (MCM) in JAMA. Ensuring the United States has adequate responses to biological threats, regardless of origin, is critical, and establishing a national approach to medical countermeasures is often one of the most complicated pieces. Consider developing things like vaccines and therapeutics that can protect against a variety of known and unknown threats we may face in the future. No easy task, right?

In this Viewpoint, the authors emphasized that “US needs a strategy for a “new normal” of living that includes COVID-19. This “new normal” will occur when total respiratory viral infections, hospitalizations, and deaths inclusive of those from COVID-19 are no higher than what typically occurred in the most severe influenza years before the current pandemic. Integral to achieving and sustaining this “new normal” are both faster development and more efficient deployment of vaccines and therapeutics. While COVID-19 has ushered in new vaccine platforms, repurposed existing therapies, and stimulated rapid development of monoclonal antibody and oral antiviral treatments in record time, much remains to be done to ensure these life-saving medicines are accessible to all.” They emphasized that a next generation of COVID-19 vaccines will be critical to help reduce not only severe disease and death, but also infections and the ability to spread the disease. Genomic sequencing and surveillance is a critical piece to this though, which is something the United States has struggled to do enough. As such, the authors pushed for more of these efforts, but also the need for the U.S. government to facilitate further vaccine development, but also alternative dosing and administration approaches—considering things like viral-vectored, protein vaccines, etc. Moreover, there is a desperate need to address supply chain hurdles and vaccine hesitancy, which should be considered during conversations regarding medical countermeasures.

In terms of therapeutics, the authors noted that, “a more effective response to COVID-19 will require rapid development of efficacious oral antiviral treatments. Molnupiravir and Paxlovid were recently authorized by the FDA. Molnupiravir has a relatively low effectiveness and there are questions about potentially serious adverse effects, such as mutagenicity and birth defects. Paxlovid, a novel oral protease inhibitor combined with an existing protease inhibitor, seems more effective with fewer safety concerns. As is the case with monoclonal antibodies, the clinical benefits of these drugs may be limited due to inadequate coordination between testing and treating patients within the health care system and severely limited supply. Further, the use of antiviral agents warrants close monitoring for emergence of viruses resistant to treatment. The US government should accelerate development, production, and procurement of COVID-19 drugs that are easier to manufacture and administer.”

Further emphasizing that our distribution places should also consider outpatient settings. As the authors noted, the United States has made great progress but there is still much work to be done.