Molnupiravir Hype illustrates America’s failure to prioritize prevention
Merck recently announced promising trial results for molnupiravir, a new oral antiviral for the treatment of COVID-19. While it is encouraging to note that we may soon have a new weapon in our arsenal to fight the pandemic, the drug must not distract us from the essential role of prevention. Time and time again during the pandemic, we have seen a decrease in the focus on prevention and an inordinate focus on treatment.
The COVID-19 pandemic has shown the value of strong public health systems and public health policies. Limiting the spread of highly contagious infectious diseases requires detection (exploration and interpretation of data), surveillance (testing and contact tracing), mitigation (social distancing and quarantines), prevention (vaccination and masking), treatment ( therapy) and ramp-up planning (improvement of medical infrastructure, provision of PPE, workforce planning, etc.). A good public health plan minimizes the number of active cases, so people don’t get sick and pass pathogens to others.
Yet in several states, leaders have politicized and turned against proven public health measures while touting treatments as the holy grail. Take Florida for example. Gov. Ron DeSantis (R) opposed mask warrants and even threatened to reimburse school districts that implemented mask warrants. He appointed a general surgeon – Joseph Ladapo, MD, PhD – who teamed up with the âdemon spermâ doctor and said, âThe vaccines depend on the person; they are nothing special compared to any other preventive measure. Both continue to downplay the benefits of wearing a mask and getting vaccinated – two of the most effective ways to control this pandemic. At the same time, DeSantis promotes monoclonal antibody treatment centers while continuing to overlook discussion of the important role of vaccination. I wouldn’t be shocked if, as a next step, he banned hand washing or subsidized the purchase of tobacco for asthmatics.
We have to stop here. We must stress that this is not a public health plan. I don’t know what it is, but it’s not a plan to help people in Florida deal with a pandemic. These ideas and policies are counterproductive and deserve derision.
Imagine a public health policy for polio that does not emphasize vaccines after one of the first effective polio vaccines – developed by Jonas Salk, MD – becomes available, but instead extols the virtues of iron lungs , crutches, wheelchairs and physiotherapy. If that had been the case, a polio public health meeting in the 1950s chaired by DeSantis and Ladapo might have looked like this:
Salk: This vaccine can prevent children from getting polio. We can administer the vaccine in schools and …
DeSantis: Slow down, Jonas, we’ve got iron lungs AND crutches. Maybe we could make a vending machine with crutches for everyone to have access to.
Ladapo: Yeah, great idea. The vaccines are nothing special.
Salk: Are you pro-virus?
Fortunately, such conversations weren’t a reality – people in the 1950s didn’t complain that public health messages emphasized the important role of the polio vaccine. My parents, who were young children at the time, complained about walking to school in heavy snow back and forth, but never once complained about the lack of crutches. When preventative measures like polio or COVID-19 vaccines are so effective on a large scale, political leaders and health providers need to encourage as many people as possible to get vaccinated.
Beyond protecting people from disease, public health policies that emphasize vaccinations even limit health care costs. Preventing people from needing a hospital or intensive care unit has obvious cost-saving benefits. The numbers tell the story:
- About $ 30 to $ 40 for each dose of COVID-19 vaccine (with the benefit of limiting infection at the population level and being highly effective in preventing hospitalization or death in the event of infection)
- $ 1,250 or more for each monoclonal antibody treatment (without benefit of long-lasting immunity or community protection, 70% effective in preventing hospitalization and death in people with mild COVID-19)
- $ 700 for a full course of the new antiviral molnupiravir (no benefit of long-lasting immunity or community protection, 50% effective in preventing hospitalization or death)
Add the fact that overcrowded hospitals postpone surgeries for people with cancer and literally drain resources like clean water, and we can see that treatment-first policies are not only stupid, but dangerous.
Public health messages should focus on prevention rather than therapy, and most of the time our patients are not unhappy with this. Our patients want our advice on diet, exercise and smoking cessation – tools for staying healthy – more than our opinion of the most effective pacemakers and stents. Patients agree with our efforts to convince them to have colonoscopies and to avoid the need for chemotherapy and colostomy bags. No one wants to get to the point where these interventions are needed.
The available COVID-19 treatments are a miracle for infected patients and should be widely available to people at an affordable cost, but they are a second line of defense. Vaccines are a miracle for everyone, can help prevent people from getting infected, and are widely available at no cost to the public. Keeping communities healthy by preventing disease should be a primary goal for any public health worker. Let’s continue to encourage each other to help our communities by wearing masks, washing our hands, getting tested and getting vaccinated.
Kenneth J. Stanley, MD, MBA, is board certified in family medicine and works as an emergency physician in rural Texas. He is also a volunteer for the Houston Health Department and a member of the Advisory Board of the Energy Industries Council.