As the world sees the Covid-19 death toll reaches nearly 15 million, the need for treatments that are safe and effective is more important than ever. While antivirals offer promising results in helping treat Covid-19, there are still pitfalls surrounding their overall efficacy and certainly these cannot be used as a preventive measure. Vaccines and antivirals are key to have in our tool boxes, but it’s important that we don’t put all of our eggs in one basket. The government should still be promoting these options (vaccines and antivirals), while also championing a method that has consistently worked as both a therapeutic and a preventive – monoclonal antibodies.

Monoclonal antibodies for Covid are generally natural molecules that have been harvested from the human body’s natural immune response to a specific target and then scaled up by modern manufacturing processes to allow broader use. Antivirals, on the other hand, are man-made chemical molecules that target viruses and work by disrupting how a virus can create more copies. Comparing the differences between the two can shape how we respond to and treat the inevitable future Covid-19 variants to come.

Therapeutic options

While both antibodies and antivirals can be used as therapeutics, it is imperative that governments, as well as physicians push for the best viable option available. Generally, monoclonal antibodies have demonstrated better overall efficacy than antivirals in clinical trials and also have shown significantly higher safety in clinical trials.  As we continue to see a cycle of new variants emerging every three to six months, the faster we can eliminate Covid, the more likely we are to prevent future variants. It is important to approach treating the virus with classes of drugs who can attack as many variants as possible, so once Emergency Use Authorization (EUA)or Food and Drug Administration (FDA) approval happens, they are no longer obsolete.

Monoclonal antibodies can target the Covid-19 virus specifically, whereas antivirals can also target healthy cells as they are not designed to kill the virus directly. When dealing with future variants, monoclonal antibodies serve as a better therapeutic due to their ability to specifically attack the foundation of the virus, which makes them highly effective and safe. With each variant of concern, having a treatment option that still can fight the virus despite changes in the virus’ RNA ensures high efficacy and a consistent therapeutic that can guarantee decreased risk of hospitalization and death.

The use of prophylactics

Monoclonal antibodies are unique as a class, as compared to anti-virals, in that they work effectively as a preventive measure against Covid-19. The scientific findings surrounding lower potential efficacy in antivirals has highlighted the need for an effective prophylactic for those who are at high risk or immunosuppressed. There are an estimated 25 million such individuals in the US alone. Monoclonal antibodies have been shown to fit this need for a safe, effective preventive measure given their high safety profile and also longer duration. Again, it is the antibody treatment’s ability to directly target the virus and the foundation that allow it to work highly effectively in a safe and long-acting nature. It can be used in a way very similar to a seasonal flu shot as a preventive measure.

As we saw with Omicron, vaccines and treatments cannot be guaranteed to work against all variants. By the time we produce new boosters to protect against current variants, another variant emerges and can possibly be more infectious than the last, bringing us back to where we started. Using monoclonal antibodies in conjunction with vaccines can provide the highest level of protection and hopefully put an end to what seems like the never-ending race to beat the newest variant.

The future of the pandemic

Over the last two years, we have seen the continuing unpredictability of the Covid-19 virus and the ramifications of not focusing on more “future-proofed” treatments. While the world continues to build immunity through infection and vaccines, we know that this method is not foolproof. Despite having been infected in the past, patients can continue to contract the virus as new variants show up and evade immunity. There are also large swaths of the population that are immunocompromised and are still at risk of severe disease or death, despite vaccination.  There are also patients who are unable to receive the vaccine as well under the medical guidance of their physicians. Those who are also unwilling to receive the vaccine also serve as hostswhere new variants can fester and mutate.

While the world may be tired of Covid-19, the virus’ track record shows that it has and can still disrupt our lives. Even with vaccines providing protection, in order to curb possible future variants and to protect our most vulnerable, the government needs to be investing heavily in monoclonal antibodies. Currently, monoclonal antibody treatments are generally difficult to obtain because of limited supply and distribution logistics. Whether they are acting as a therapeutic or preventive treatment, monoclonal antibodies can allow us to help contain the virus, where we might see the light at the end of the tunnel. If we want to move to a point where Covid-19 no longer disrupts day-to-day life, we need to fund and make monoclonal antibodies readily available to anyone who wants them.

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