Yes, We Need a Vaccine to Control COVID-19. But We Need New Treatments, Too.

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Editor’s note: This analysis was originally published by STAT on Aug. 5, 2020. 

Hopes for a relatively quick return to normalcy are riding high on promising news about COVID-19 vaccines. Nearly 200 vaccines are in development worldwide. And with six of them already being tested in Phase 3 clinical trials, the possibility exists that a vaccine could be ready by the end of the year

But we need to be realistic: A vaccine is not a silver bullet. Even if one (or more) is proven safe and effective, vaccines are notoriously difficult to make and distribute. People will continue to contract the virus because some won’t get vaccinated and because the vaccine may not be effective for everyone, particularly older populations at higher risk for illness and death. The annual flu vaccine, for example, reduces the risk for illness by only 40% to 60%, even in years when the vaccine is well matched to the circulating virus strain.

Ken Frazier, the CEO of Merck — a company with vast experience developing vaccines — has warned that those hyping the possibility of a vaccine by year’s end are doing a “grave disservice” by distracting from actions that can be taken now to prevent spread of the illness.

Among those actions are the much-needed, but frequently ignored, use of masks and physical distancing. To drive down COVID-19 deaths, and get back to seeing each other regularly in schools, offices, restaurants and stadiums, we need a diversified strategy that also includes new treatments.

Treatments are an essential part of the COVID-19 fight for two reasons. First, they are an indispensable tool for managing the pandemic before a vaccine is available (which could be a lot longer than anyone wants it to be). And second, even after a vaccine is available, treatments will be the essential backstop to manage illness resulting from imperfections in vaccine effectiveness and uptake.

So far, only two drugs have demonstrated a therapeutic effect against COVID-19 in randomized clinical trials: the antiviral remdesivir and the common steroid dexamethasone. Remdesivir reduced the recovery time for infected patients and dexamethasone reduced mortality for the sickest patients.

After several months of treating hundreds of thousands of COVID-19 patients, doctors have learned a great deal about the disease. They have shifted protocols, particularly around ventilator use, and are employing remdesivir and dexamethasone under emergency FDA approval. Survival rates in hospitals have improved.

The search for more effective drugs is belatedly underway. As of late July, scientists were examining nearly 300 potential treatments. The National Institutes of Health is preparing to launch large clinical trials of some of the most promising approaches, including studies of antiviral monoclonal antibodies, drugs that minimize out of control immune systems, and blood thinners to prevent problems caused by blood clots.

The potential payoff in expanding treatments is enormous.

An economic model that we and colleagues at the USC Schaeffer Center for Health Policy and Economics developed shows the importance of treatments in preserving hospital capabilities while reducing the number of deaths and the costs of care. A hypothetical treatment modeled loosely after Tamiflu, an antiviral medication used to treat the flu, that can cut the need for hospitalization by 50% would result in 285,000 fewer admissions for COVID-19 and up to 71,000 fewer deaths by the end of 2021, assuming that 20% of the population becomes infected and half of those with symptoms get the treatment.

A hospital-based treatment for COVID-19 that can reduce the length of stay and mortality by 30% could save up to 85,000 lives.

The health-related gains in these scenarios, including direct savings and a dollar value placed on reduced mortality, add up to between $57 billion and $106 billion over 18 months.

In addition to saving lives and boosting hospital capacity, an effective treatment could also increase people’s willingness to return to more normal levels of economic activity. Given the $7.9 trillion negative impact COVID-19 has had on the U.S. economy, if a treatment could offset the economic losses by even 5% (or almost $400 billion), the economic benefit would be nearly five to seven times larger than the health benefits in the model.

If an effective treatment could be found that prevents severe disease — or, even better, provides a cure — the urgent need to vaccinate millions of healthy people would diminish. The balance between public health and fully reopening the economy would be easier to achieve.

More realistically, we will need to manage COVID-19, and possibly other novel viruses, for years to come. A vital tool will be effective treatments. We must prioritize their development now. If we do, we will be rewarded with resilient health systems, a stronger economy and longer lives.