The toxic brew of politics and COVID-19

HEALTH AFFAIRS: Merck’s senior VP, Dr. Eliav Barr, tells the ‘Post’ about the challenge of public compliance and what’s next for the international pandemic.

 DR. ELIAV BARR, senior vice president and head of global medical affairs at Merck Research Laboratories in Pennsylvania. (photo credit: Merck)
DR. ELIAV BARR, senior vice president and head of global medical affairs at Merck Research Laboratories in Pennsylvania.
(photo credit: Merck)

The toxic combination of the global COVID-19 pandemic and a plague of distrust kept many countries from controlling the virus, according to Dr. Eliav Barr, senior vice president and head of global medical affairs at Merck Research Laboratories in Pennsylvania.

Israel-born Barr has been at the forefront of the development of his company’s early-stage treatment for COVID-19, an antiviral oral therapy known as Molnupiravir. He has also been a health professional for more than 30 years, including spearheading the development of Merck’s Gardasil vaccine which protects against the papilloma virus and has been found to prevent most cases of cervical cancer.

In an interview with The Jerusalem Post, Barr spoke about his company’s role in the war against the virus and its recently approved antiviral drug, the challenge of public compliance and what the next pandemic might look like.

Barr said the world worked swiftly and effectively to learn about COVID-19 and develop vaccines to help stop its spread, but “the bad news is that there is a political thing here. In some countries there is a belief that anything having to do with listening to the government is negative or a bad thing, and you should always resist mandates and rules. That has really hampered the ability to control the virus in a proper way.

“It is one thing to have personal freedom,” he continued. “It is quite another to impose risk on other people.”

 MOLNUPIRAVIR WORKS by stopping the virus from replicating. (credit: Merck) MOLNUPIRAVIR WORKS by stopping the virus from replicating. (credit: Merck)

This situation has been especially acute in the United States, where studies have shown that people’s political viewpoints influence the way they view the crisis.

A study by American researchers, published in October on PLOS One, found consistently that the more individuals described their political orientation as conservative, the lower they perceived their risk of infection. Similarly, the researchers said, political orientation was associated with health-protective behaviors like masking and vaccination. The more participants described themselves as conservative, the less they enacted health-protective behaviors.

A separate survey published in September by The Economist/YouGov found that nearly a quarter (22%) of unvaccinated Americans said that the reason they did not get the jab was that they do not trust the government.

“What went terribly wrong was the political element,” Barr said, “the intersection between anti-vaccine and anti-government thinking and the fact that some politicians felt they could exploit people’s fears.”

He added that health officials are also partially responsible for people’s hesitation, because they sometimes did not tell the whole truth either.

Such was the case when it came to masking in the first wave. Barr said health officials were worried that there would not be enough masks and that average Americans would hoard them, leaving medical staff unprotected. As such, the country’s health experts first said that masking was unnecessary for the general public. But then, when they asked people to wear a mask, people did not trust them.

Nearly 25% of American adults have said that they do not regularly wear a mask in public indoor settings, despite guidance from the US Centers for Disease Control, according to a Morning Consult poll published in the early fall.

“Being unethical, inconsistent or having a political agenda created this whole dynamic,” Barr explained.

BARR IS considered one of America’s top scientists, best known for spending eight years leading the development of the HPV (human papilloma) vaccine, which hit the market in 2006.

Merck – known as MSD in Israel – then continued doing research on the vaccine, rolling out a next-generation version seven years later. And most recently, a report published by The New England Journal of Medicine showed that the vaccine has started to reduce cancer rates.

“Up until then, all of the studies have looked at precancers, the abnormalities that women and men have that are high-risk for cancer, but not quite cancer,” Barr explained. “It takes like 20 years for cancer to develop. Now, in countries that adopted the vaccine right after licensure, we are seeing reductions in cervical cancer and other HPV-related cancers.”

If that vaccine took so many years to develop, then how come the Pfizer coronavirus vaccine took less than a year, and is it any good?

“The thing with COVID, is that there was a pandemic,” Barr said. “There was an immediate risk, immediate death, and so there was a lot of parallel work that was done.”

Additionally, the COVID disease develops fast. An infected individual can go from healthy to severe condition within 16 to 20 days, so the duration of the follow-up by researchers to see if the vaccine was working was shorter. Moreover, in the COVID vaccine, there was no need to look at the durability of the vaccine before it was licensed – something that is haunting citizens now, who are being asked to take three and maybe soon four shots.

“As long as it was working in the short term, that was good enough,” Barr said. “But the downside you can see now – the duration is very short, which means people have to get boosters every three months, or they are going to need a completely different kind of vaccine that gives you longer-term protection.”

He said the advantage of messenger RNA vaccines is that they can be produced fairly quickly. However, as fast as Pfizer and Moderna moved, not everyone was able to get a vaccine, and there are still deficits.

While in the developed world, a vaccine could be obtained almost anytime or anywhere, in places like India or Africa shots simply were not available.

To date, 58.1% of the world population has received at least one dose of a COVID-19 vaccine, according to the website Our World in Data, but only 8.4% of people in low-income countries have received at least one dose.

The result is Omicron and some of the other variants, Barr said.

“Unvaccinated populations with lots of transmission will create mutations,” he said. “Imagine if you could have had a magical moment and instead of making 100 million doses, you made 200 million doses of the vaccine and could distribute it evenly. We could have avoided some of the complications that happened later on.”

To help ensure there was no lack of supply of Merck’s Molnupiravir, which received emergency use authorization by the US Food and Drug Administration last week, Barr said that the company signed contracts with Indian manufacturers early on to develop a generic version of the drug and increase supply.

MOLNUPIRAVIR STOPS the virus from replicating. It should be administered within five days of the onset of symptoms and taken every 12 hours for five days.

Its authorization was based on a Phase III clinical trial that found Molnupiravir reduced the risk of hospitalization and death. Nine people died in the placebo group versus one in the Molnupiravir group, and 53 people were hospitalized in the placebo group versus 28 who received the treatment.

Israel has ordered the drug, and thousands of doses are expected to arrive in the next few weeks, despite its seemingly being overshadowed by Pfizer’s oral antiviral, Paxlovid, which landed in Israel on Thursday. Pfizer’s drug has a slightly superior profile of safety and efficacy, but Barr said he is not deterred.

“Having multiple choices is really important,” he said. “Just as you have seen the vaccine needs to have different options for different people, there are reasons why one might get one drug or another.”

At the same time, some doctors have accused Merck of trying to keep cheaper options off the market in favor of the newer and more expensive alternatives it is developing.

One such drug is ivermectin, which has been approved by the US Food and Drug Administration since 1987, and costs about $1 a day for treatment. Some scientists, including in Israel, believe it could help reduce the length of infection for people who contract coronavirus.

In August, Prof. Eli Schwartz, founder of the Center for Travel Medicine and Tropical Disease at Sheba Medical Center, released data on a randomized, controlled, double-blinded trial that he conducted to evaluate the effectiveness of ivermectin in reducing viral shedding among nonhospitalized patients with mild to moderate COVID-19. He found that nearly 72% of volunteers treated with ivermectin tested negative for the virus by day six, compared to 50% of those who received the placebo.

The study looked at culture viability, meaning how infectious the patients were, and found that only 13% of ivermectin patients were infectious after six days, compared with 50% of the placebo group – almost four times as many.

The study was never published in a peer-reviewed journal but instead on the preprint distribution website MedRxiv.

“There is a lot of opposition,” Schwartz said. “We tried to publish it, and it was kicked away by three journals. No one even wanted to hear about it. You have to ask how come when the world is suffering.

“This drug will not bring any big economic profits,” and so Big Pharma does not want to deal with it, he said.

But Barr said this accusation is simply not true. Merck began manufacturing ivermectin in the 1980s and still markets the drug for animal indications and for parasitic infections in humans.

“It is a great drug for the right virus. But we did an evaluation of ivermectin, what potency would be needed for getting good results for SARS-CoV-2, and you need to get levels that were pretty toxic to cells,” Barr explained. “The other thing that people who are proponents of ivermectin don’t talk about is that ivermectin has a narrow therapeutic index, meaning if you get too much of it, you can get pretty sick from it.

“The downside of the drug... is not just that it is not effective; it is also not safe in these settings,” Barr stressed.

He said that while there could be some small studies, like the Israeli study, which show positive results, there have been many really good placebo-controlled studies at this stage that point to the drug’s ineffectiveness.

He said he does not believe that anyone would be averse to the drug if it was effective and the benefits were defined, “but wishing and hoping is not a scientific strategy, and most of the data that those who like ivermectin point to are noncontrolled studies.

“The arguments by some of these folks are that the pharmaceutical companies want to make money, that it is generic, and that is why they don’t like it or don’t want to study it or whatever. Nothing of the sort.”

IN FACT, he said that governments and health professionals should already be looking for new options and preparing for the next pandemic, which he believes could strike in the near future.

“I am quite sure that somewhere in the next few years another coronavirus or another virus will show itself,” Barr cautioned, noting that he had predicted this pandemic.

COVID-19 is “what I feared because there is a lot of mobility in the world and a lot of crowding and encroachment on parts of the biosphere we have not touched before, a lot of colocalization of animals or exotic animals and people, and people who are immunocompromised in whom the virus can live for a while and mutate.”

He said the lesson from COVID for governments should be to get prepared for the next time. Officials are often focused on today, he said. “The pandemic is still here, but we have to be able to prepare for the future.”

While, in Israel, the comptroller has stressed that Israel was not prepared for coronavirus, Barr said he thinks the country did a lot right. He praised Israel’s health funds for their research, which he described as “a gift to the world.”

“Because all that work was done, and all the unique features of Israel as a country that has very rich ethnic diversity and yet a lot of population density, the ability to have electronic health records, the great intersection of hi-tech and medicine – all of that just made Israel the perfect spot to implement the vaccine and learn its dos and don’ts,” Barr said, as an example.

“There are very few countries that can do [health] as good as Israel,” he added. “That is good for Israelis. I wish we could have a similar system available in the US, but alas we don’t.”