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Even with new Pfizer pill, vaccines need to be first defense

CHICAGO --- With Pfizer’s announcement today that its new pill — Paxlovid — to treat COVID-19 was highly effective in preventing severe illness in at-risk people in a clinical trial, Northwestern Medicine experts stress vaccines are still the best defense against the virus and ending the pandemic.

Dr. Robert Murphy is an infectious disease specialist and executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine.

“With an 89% reduction in hospitalization or death, the Pfizer oral treatment is potentially a game changer. It’s still very preliminary data, though, and we don’t have any details about how old people were and whether they were vaccinated.  

“You still don’t want to get sick in the first place. And the pill is only for at-risk people with conditions like diabetes, obesity, underlying heart disease or those above age 60. A person with no underlying risk factors won’t be eligible for this once it gets approved.”  

The drug also needs to be taken with a small dose of ritonavir, used in AIDS drugs to increase drug levels, Murphy noted. 

“It’s a cumbersome regimen. You have to take 30 pills over five days. That’s a lot of pills. That includes two ritonavirs and four Paxlovids per day. It’s not like you pop one pill.”

“People still must continue to get vaccinated. Prevention is still the best way to go.”  

Dr. Benjamin Singer is an assistant professor of pulmonary and critical care at Northwestern University Feinberg School of Medicine.

“The Pfizer pill substantially reduced the risk of hospitalization and death among people with COVID-19 who were at high risk of developing severe disease. Having oral COVID-19 treatments (including Merck's oral antiviral pill announced last month) could increase the availability of at-home, effective therapies for patients newly diagnosed with COVID-19 who are at risk of becoming severely ill and ultimately reduce hospitalizations and deaths.

“In contrast with the vaccine — which works to prevent getting sick in the first place and decreases the risk of becoming severely ill among those with breakthrough infections — it is important to note that the patients in the Merck and Pfizer antiviral trials already had COVID-19 at the time they started taking the pill. It is unclear how many of these patients may go on to develop long-COVID symptoms or other complications of their illness. 

“By the time these patients knew they had COVID, they may have spread the virus to others, which the vaccine works to mitigate. Hence, the availability of oral antiviral medications should not discourage people from getting vaccinated, which remains the best way to protect yourself and limit transmission in our communities.”

Dr. Sadiya Khan is assistant professor of medicine in epidemiology at Northwestern University Feinberg School of Medicine.

“It’s great to have another promising therapeutic option that is an oral pill in the armamentarium to treat COVID-19 if we can’t prevent it. But prevention has to be first and foremost. As we roll out vaccines for 5-to-11-year-olds, vaccinating our children and continuing to vaccinate adults and adding boosters is the most effective way of protecting everyone in the population.”