Even though France has already administered over 90 million doses of the four EU-approved Covid-19 vaccines, thanks in part to the ‘health pass’ system that has driven up both vaccination rates and President Emmanuel Macron’s approval ratings, the country’s legendary Pasteur Institute is still on the hunt for an effective Covid-19 treatment. On September 6th, the Institute announced it had signed up the first of what it hopes will be between 350-700 unvaccinated participants in a Phase II trial of Clofoctol, a rarely-used antiviral whose potential to prevent Covid-19 hospitalisations has made it a “national research priority.”
The Clofoctol trial offers a chance at redemption both for the Pasteur Institute and for France, whose failure to develop a homegrown Covid-19 vaccine came to be seen in some circles as a “national humiliation” for a country known for ground breaking medical advances. While the trial might at first glance seem out of place given Europe’s world-best vaccination rates, the deadly impact of the Delta variant on unvaccinated Covid patients in the EU and across the planet makes the availability of safe and effective treatment options a matter of continued urgency.
In the months since effective Covid-19 vaccines – such as the Pfizer/BioNTech and Moderna mRNA jabs and the AstraZeneca and Johnson & Johnson viral vector inoculations approved for use by the European Medicines Agency (EMA) – became widely available, the course of the pandemic has taken widely divergent paths among vaccinated and unvaccinated populations worldwide.
A tale of two pandemics
In France itself, public health officials have tracked discrepancies between vaccinated and unvaccinated hospitalisation rates as a means of driving home their message that vaccination is the key to controlling the pandemic. The numbers don’t lie: 80% of French Covid patients in intensive care are unvaccinated, while just 13% are fully vaccinated. While the unvaccinated population might be a small and steadily shrinking minority in much of Europe, vaccine acceptance still cannot be taken as a given for EU citizens writ large.
The Pasteur Institute, for example, appears to understand that the bulk of participants qualified to enroll in its upcoming Clofoctol trial are not in mainland France but instead in the country’s overseas territories, such as Guadeloupe and Martinique. Less than a quarter of eligible Martiniquais have been fully vaccinated, with Guadeloupe registering an even lower percentage. French officials ascribe much of the discrepancy between these islands and the rest of France to local beliefs in traditional medicine, combined with longstanding mistrust in the French state’s handling of public health issues impacting their communities.
In the EU’s easternmost member states, similar factors are keeping vaccination rates low. Only a third of Romanians and a fifth of Bulgarians have been fully vaccinated, despite the availability of doses. Dissuaded by rampant misinformation and distrust of public officials, central and eastern Europeans are declining to be vaccinated even as mortality rates rise; Bulgaria ranks last in vaccinations EU-wide despite seeing more than 19,000 Covid deaths since the start of the crisis.
Vaccine inequality outside of Europe, of course, is another story entirely. Among the 10 countries of the EU’s Southern Mediterranean region, only two – Israel and Morocco – have administered at least one dose to a majority of their populations. In Algeria, which received 604,800 donated Johnson & Johnson doses from the United States, 567,600 doses of Sinovac from China, and a further 57,600 doses of AstraZeneca from Denmark via COVAX late last month, only 11.20% of the population has received at least one dose thus far.
As a result, the country set new records for hospitalisations and Covid patients receiving oxygen last month, as hospitals were overwhelmed by a fourth wave and the Algerian health system as a whole found itself “on the brink of implosion.”
Given the number of patients who continue to find themselves in ICU wards, doctors, hospitals, and public health systems still need better options for treating Covid-19 alongside the vaccination campaigns aimed at preventing it. While the Pasteur Institute focuses on its early-stage candidate, other research bodies and companies are working to determine which treatments could improve outcomes for patients who have already been hospitalised.
Partner Therapeutics, a pharmaceutical company based in Massachusetts, has one such candidate: sargramostim, marketed as Leukine, an existing treatment used to stimulate the immune system and the production of white blood cells after bone marrow transplants. Since the start of the pandemic, Leukine has also demonstrated promise in improving the oxygenation rates of hospitalised Covid-19 patients. Over the course of clinical trials conducted by University Hospital Ghent in Belgium, researchers led by Dr. Bart Lambrecht built from an observation they had made during the first wave of Covid-19 – namely, that Covid sufferers in hospital lacked a type of white blood cell known as macrophages in their lungs – to determine whether Leukine could stimulate the production of macrophages in Covid patients as well.
Their results, published earlier this year, were strikingly positive, with 54% of patients receiving Leukine demonstrating oxygenation levels that had improved by at least a third, compared to just a quarter of patients treated without it. Further trials of Leukine in the United States have confirmed those initial findings, with a study conducted across 11 hospitals in the United States and supported by the US Department of Defence (DOD) finding 84% of patients who received Leukine demonstrated significantly higher oxygenation levels.
Drugs like Leukine, by addressing the most dangerous symptoms of Covid-19 infections and improving outcomes for patients already in the hospital, are an indispensable part of the global health community’s arsenal in the fight against the virus. While most of Western Europe has been able to resume normal life, the lived reality for patients – and doctors – across much of the rest of the planet is still far grimmer.
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