Years of sometimes confusing messaging on Covid has left half the people eligible for antiviral treatment unaware of it
A potentially life-saving antiviral treatment that can reduce the severity of Covid in an infected person has flown under the radar for many of the people it would help most.
It’s the sign of a new phase of the pandemic, where the statistically milder Omicron variant has been linked to more deaths in New Zealand than the original variant ever was.
Despite the free availability of Pharmac-approved antiviral treatment PAXLOVID, which can slow or stop the virus, more than half of at-risk people such as the immunocompromised and older people were in the dark about its availability.
And with the treatment needing to begin within the first five days of infection, it’s not adequately reaching the vulnerable groups who are also sometimes more likely to have low health literacy or access issues to healthcare.
Research helmed by PAXLOVID manufacturers Pfizer and Talbot Mills found 54 percent of people who identified as Māori and Pasifika and were over the age of 50 had low knowledge of the treatments.
Pfizer New Zealand medical director Dr Krishan Thiru said what was most troubling was that while there was a widespread lack of awareness of the treatment amongst New Zealanders, those most at-risk weren’t any more aware.
“Most New Zealanders are not aware, but in particular at-risk people also have a low level of knowledge,” he said. “You might expect them to know more as they are seeing doctors more, but their level of awareness is around the same as general public.”
Thiru said the obliviousness towards such treatments prevented quick action on the part of the recently-infected.
“It’s critically important that everyone is aware that these treatments exist because time is of the urgency,” he said. “If these antiviral treatments are to be used - and effectively - they need to be commenced within five days of Covid.”
But with the Omicron variant, at least in its original form, there has been widespread reportage of a milder onset of symptoms, often resembling the common cold.
Thiru argues if people don’t know about antiviral treatment - a potentially life-saving weapon in their arsenal - they will be less likely to get to a doctor with time to spare.
“For those people who are at risk - and we believe there’s about one million of them - for those people, if they know about antiviral treatment and contact their doctor early enough, it provides a strong second line defence.”
Daniel Hirst, Te Whatu Ora Health NZ group manager for care in the community, said at least 42,708 courses of Covid antiviral medicine have been dispensed since April 4 this year, including 28,091 PAXLOVID and 14,617 molnupiravir.
"Since April 2022, Te Whatu Ora has been working with Pharmac to make it easier for more people to access these medicines when needed," he said. "Pharmac has extended the access criteria three times since the medicines became available in April - on 5 May, 18 July and 14 September."
He noted dispensing of antiviral medicines had increased by 44.3 percent in the week of October 10-16 as opposed to the week before.
however, the Pfizer findings didn't tell us enough about how the study was conducted to ensure the researchers reached those most in need of antivirals.
"However, Te Whatu Ora and Manatū Hauora were pleased to see the Pfizer material indicates that 80 percent - or more - of survey respondents were aware that Covid-19 antiviral treatments are currently available in New Zealand free of charge for certain people," he said. "The fact this isn’t yet 100 percent helps show why we need to continue the campaign work mentioned here."
This campaign work involves Te Whatu Ora and Manatū Hauora working to raise awareness among at-risk groups that these medicines are available to eligible people and can improve health outcomes and the Department of Prime Minister and Cabinet and Te Puni Kōkiri launching public information campaigns about antiviral medicine this week.
Trials of PAXLOVID found the five-day, pill in the morning and pill at night treatment reduced the risk of hospital admission or dying from Covid by up to 86 percent compared to placebo in non-hospitalised, high-risk adult and unvaccinated patients treated within five days of symptom onset.
The two pills in the treatment work together to keep a key enzyme blocked that the virus needs to make more of itself.
“Once the virus gets in your body it relies on a certain enzyme to replicate,” Thiru said. “For most people their immune system is likely to be able to overcome the virus, but for some people it may not be able to, and this is essentially like an antibiotic.”
The New Zealand Government announced it had secured another 40,000 treatment courses of PAXLOVID in September of last year, bringing the total up to 100,000 by the time Medsafe gave provisional consent for the supply and use of the drug in March.
At the time, health minister Andrew Little said the pill was an important measure to mitigate the pressures the pandemic has put on the healthcare system.
“The first shipment of Paxlovid has arrived in New Zealand ahead of schedule and will start being offered to those most at risk from next week, protecting people from getting seriously ill and the health system from being overwhelmed,” he said.
But although the drug is now available free to almost a million New Zealanders, including unvaccinated people over 50, Māori and Pasifika over 50 or anybody over 65, if people don’t know about it they may not show up to a health professional in time.
Thiru said while Pfizer had worked with the New Zealand Government to support its educational efforts, he felt there was a larger sense of personal responsibility at play in this phase of the pandemic.
“My personal opinion is over the course of the pandemic we are moving to this phase of what I suppose is personal responsibility where members of the public and the community are asked to take control of their own health and be aware of treatments that are available.”
Thiru said people who believed they may be eligible should talk to their pharmacist or health professional and act fast at the first sign of symptoms.
“The view is that Omicron is a mild infection or will be asymptomatic,” he said. “For the vast majority, that is true - but it’s not true for the people that are at risk.”
Te Whatu Ora Health NZ stressed people should talk to health professionals before trying to get hold of antivirals.
"Covid-19 antiviral medicines can come with side effects and cannot be taken with some other medicines and treatments," Hirst said. "Even if someone is eligible, the medicines may not be right for them. People who think they may be eligible should talk to their doctor, nurse practitioner or pharmacy to work out if Covid-19 antiviral medicines could be right for them."
