Add low awareness to the problems ailing the rollout of the COVID-19 antiviral pills.

Among non-hospitalized, high-risk patients with COVID-19, 66% were aware of treatments, 36% sought them out and less than 2% are receiving them, according to a survey posted on medRxiv ahead of peer review. 

In March 2022, researchers recruited 1,159 people from 37 states who were positive for SARS-CoV-2 on PCR tests. They asked whether respondents knew about or had taken effective treatments for the virus, such as monoclonal antibodies, Pfizer’s antiviral pill Paxlovid or its rival, Merck’s oral antiviral molnupiravir. Some 241 individuals were older than 65, putting them at risk for severe outcomes.

The researchers, both from UCLA, said more public outreach is needed to raise awareness of the benefits of treatment for the virus. “Our findings demonstrate that increased awareness and use of antivirals among those at risk for severe disease due to COVID-19 are urgently needed among individuals that test positive for SARS-CoV-2,” they wrote.

The study comes on the heels of the Biden administration’s rollout of a program designed to expand access to the pills. The program includes an awareness campaign, complete with an online test-to-treat locator and a call center (1-800-232-0233) to provide help in more than 150 languages.

Among other steps designed to make Paxlovid and molnupiravir available more widely, pharmacies have been enabled to order the treatment directly from the federal government. The plan could raise the number of locations where the drugs are available, from 20,000 to more than 30,000.

Another plank aims to significantly up the number of test-to-treat facilities, where eligible patients can receive a COVID test, followed by a prescription and then the prescribed medicine. 

Paxlovid, authorized for use in patients 12 years of age and older who test positive for COVID and are at a high risk for developing a severe case, is the more effective of the two antiviral pills. While the government bought 20 million doses from Pfizer and worked with the company to expedite delivery of the pills, many pharmacies have not yet been able to stock it due to supply concerns. 

These days, however, stimulating demand for the considerable federal stockpile seems to be the bigger issue. Through the first half of April, the U.S. has distributed around 1.5 million Paxlovid courses – but pharmacies still have over 500,000 available. That’s out of more than 3.5 million courses earmarked by month’s end. 

To hear White House COVID coordinator Dr. Ashish Jha tell it, concerns about supply no longer exist. Rather, health officials need to simplify the process of getting it to COVID patients.

“We’ve got to turn those pills into prescriptions and into things that patients can get so they can get better,” he told NPR.

Exactly who is able to get the pills remains another sticking point. Large swaths of the country had no test-to-treat pharmacies or health centers listed as of April 14, Kaiser Health News reported.

At the same time, the website of the program’s largest participant, CVS Health, had significant technical issues that made booking an appointment difficult. Nationally, CVS MinuteClinics make up more than half of all test-to-treat locations, according to the federal data.

Meanwhile, access issues extend onto the global stage as well. Some public health agencies are claiming Pfizer strong-armed them into maintaining a veil of secrecy around the pricing of COVID-19 antiviral pill Paxlovid. According to a Geneva Health Files exposé, the drugmaker pressured UNICEF to agree to non-disclosure requirements that would keep information on Paxlovid cost under wraps.

UNICEF, which is a procurement partner for the World Health Organization’s ACT Accelerator program, recently inked a supply deal with Pfizer for up to 4 million courses of treatment. But the agency said it’s still negotiating certain aspects of the contract, including the transparency of commercial terms and price in low- and middle-income countries.

Sources alleged further opacity in the Paxlovid deal, namely that UNICEF did not take into account other partners of the ACT Accelerator before bilaterally finalizing the agreement with Pfizer. Other agencies in the accelerator include the World Health Organization, Global Fund and Unitaid. 

In a statement, WHO pointed to the lack of Paxlovid price transparency in such deals as one of a number of hurdles “turning this life-saving medicine into a major challenge for low- and middle-income countries.” 

And one professor of law who is associated with discussions at the ACT Accelerator said that “a negative precedent” is being set with respect to transparency for public resources spent in procuring COVID-19 therapeutic.