As the omicron wave peaked in the U.S. last month, the first-line treatment for high-risk patients with early COVID-19 dangled out of reach for most. Only a trickle of the new Paxlovid pill from Pfizer Inc. was reaching hospitals and pharmacies.
Now, as cases plummet nationwide and the company continues to deliver hundreds of thousands of doses ordered by the federal government to pharmacies, Paxlovid is starting to look downright plentiful. Doctors and health officials in New York, Boston, Colorado and other areas where the omicron wave has receded report that supply seems to be meeting the softening demand.
“We’ve seen such a rapid decline in COVID cases that it’s not as needed anymore,” said Asif Merchant, who chairs the Massachusetts Medical Society’s committee on geriatrics. “Having the availability three or four weeks ago would have made a tremendous amount of difference.”
The Biden administration has hailed Paxlovid as a “game changer” that will help shift the country into the next phase of the pandemic, making COVID-19 easier to live with because highly effective early treatments for high-risk patients are widely available. The pills, which must be used within five days of symptom onset, are estimated to cut the risk of hospitalization or death by almost 90%. But their manufacture takes months.
At Mount Sinai South Nassau in Oceanside, New York, hospitalized COVID-19 patients have dropped to just eight this week from 122 at the peak of the latest surge, said Aaron Glatt, who chairs the Department of Medicine. While Paxlovid was “extremely hard to get” in the weeks after it reached the market in December, “it’s much more easily available now” — though only at designated pharmacies, not every corner drugstore.
The supply suffices for now, though another major surge could overwhelm it, warned Scott Dryden-Peterson, medical director for COVID-19 outpatient therapy at Mass General Brigham, a Massachusetts hospital system that serves 1.5 million patients.
“Our supply is fragile,” he said, and cannot be quickly increased because of a complex manufacturing process. Paxlovid can help many high-risk people, he said, but “if we let the epidemic get anywhere close to where it was a few weeks ago, they will not be protected. They will not have access anymore. So it is a fine line until enough supply comes out.”
Pill profusion
The federal government tracks Paxlovid on a public-facing website that specifies which pharmacies have it. U.S. supply is expected to fully ramp up around April, to at least 2 million courses available per month, with the full order due by the end of September.
The U.S. has ordered 20 million courses of the pill in all, along with 3 million courses of Merck’s COVID-19 pill, molnupiravir, which is less effective and recommended for use in narrower circumstances. Pfizer has already reached $22 billion in Paxlovid contracts for this year, and could make a lot more, according to the company’s top executives. China approved Paxlovid last weekend.
Another addition to the COVID-19 treatment arsenal: A new monoclonal antibody from Eli Lilly & Co. — bebtelovimab — that won emergency authorization on Feb. 11 and appears to work against omicron. The federal government has ordered as many as 600,000 courses. Another monoclonal antibody, sotrovimab from GlaxoSmithKline Plc and Vir Biotechnology Inc., also fights omicron. Federal guidelines list Paxlovid as preferred.
“You have more of the drug and very few cases — that’s the best place you could possibly be,” said Mount Sinai’s Glatt, who is also spokesman for the Infectious Diseases Society of America.
Unraveling restraints
The plentiful supply contrasts with the dire shortage several weeks ago, said Dryden-Peterson from Mass General Brigham. Back then, his system had to keep all distribution centralized and decided which patients would get it by lotteries that factored in their risk levels. “Patients and clinicians alike learned that these treatments were extremely scarce and only the highest-highest-risk people should get them,” he said.
The drug is recommended only for patients at high risk, but the category is so broad — including being overweight — that it would apply to most Americans. One key remaining challenge, Dryden-Peterson said, is testing patients promptly when they have symptoms so Paxlovid can be taken within five days.
Around the country, Dryden-Peterson said, health systems initially had to make sure the drug went only to patients who needed it most, “and now we’re trying to unravel some of the restraints on those things.”
Colorado’s Paxlovid supply — about 1,300 doses every two weeks — is exceeding demand, according to the state health department. The state is also expanding its list of providers who can prescribe the pills beyond hospitals to pharmacies and clinics. In Idaho, too, health officials say demand for Paxlovid exceeded supply last month, but has softened in February.
In New York City, Paxlovid supply is “ample” relative to the rate doctors are prescribing it, according to Alto, a telehealth pharmacy partnering with the city to distribute anti-COVID-19 medications.
Though Paxlovid has only emergency approval, that interim status doesn’t put off many patients who need it, even those who resist vaccines, said Glatt from Mount Sinai. “They beg for it,” he said. “They ask for it.”
