With a breathtaking act of selfishness the US has cornered the market on remdesivir, the Covid drug, leaving the rest of the planet without it. So is a vaccine our only hope?
Wait a minute. We do have dexamethasone, the ubiquitous, cheap-as-chips drug that was recently shown to cut mortality in severely ill patients needing oxygen through a ventilator by a third, and by a fifth in patients receiving simple oxygen.
So do we have a winner? Something that can tide us over till we have a vaccine? I’m beginning to think so.
Dexamethasone is old, well-tested, well-established and there’s no patent, so its price remains low and it’s available to all.
On the other hand, remdesivir, whose patent is held by US pharma company Gilead, can pitch its price as high as the market will stand.
What are we pinning our hopes on? Oxford University’s RECOVERY trial, recently released into the public arena because the results are so promising. This trial began in March and is examining several potential Covid-19 treatments at 175 NHS hospitals. Patients taking 6mg of dexamethasone a day for a maximum of 10 days were compared to the usual standard of care.
Dexamethasone reduced deaths in patients on ventilators from 41% to 27%, and from 25% to 20% among patients needing oxygen.
Of the ventilated patients, 94 of the 324 taking dexamethasone and 278 of the 683 receiving standard care died, a difference of around a third. Among patients receiving oxygen, 275 of the 1,279 taking dexamethasone and 650 of the 2,604 on standard care died, a reduction of a fifth.
However, dexamethasone seemed to make no difference in patients who needed neither ventilators or oxygen.
Carl Heneghan, director of the Centre for Evidence-Based Medicine at Oxford University, said: “Given the fact this is a cheap, available drug, and given the size of the effect, to me it is clear there is strong evidence to make this treatment available to the right patients admitted to intensive care”.
World Health Organisation director general Tedros Adhanom Ghebreyesus said: “The next challenge is to increase production and rapidly and equitably distribute dexamethasone worldwide, focusing on where it is needed most. Demand has already surged following the UK trial results”.
So there’s a good chance that dexamethasone could be distributed worldwide, including the developing world where there’s price sensitivity which might prevent its use. So we can balance President Trump’s selfish act over remdesivir with a generous one over dexamethasone.