People with Covid-19 could soon be taking a new antiviral medication to help keep them out of hospital. But what exactly is it? And when will it be made available in New Zealand?

At the moment, our primary line of defence against Covid-19 is vaccination. And for the foreseeable future, that will remain the case. Coupled with existing health measures like mask wearing and contact tracing, vaccinations are the main way we can keep Covid-19 out of the community while slowly reconnecting with the world.

But this week the government announced plans to bolster our Covid-19 response, with what could prove another string to the bow. An initial purchase agreement will see thousands of doses of a new antiviral medication winging their way to New Zealand sometime in the future. The drug hasn’t even properly hit the market overseas, but it’s already being touted as capable of lessening Covid-19 symptoms for those who already have the virus – and potentially slashing hospitalisations and deaths. 

What’s all this then? 

Molnupiravir, a drug produced by the US pharmaceutical company Merck and Co. 

Molnu… what?

Piravir. 

It’s loosely similar to the name of Thor’s hammer – that’s called Mjölnir. Much like how the hammer strikes down Thor’s enemies, the pill is meant to strike down the coronavirus. I swear I’m not making up that connection.

Merck’s head of research and development, Dean Li, said: “Our prediction from our in vitro studies and now with this data is that molnupiravir is named after the right [thing]… this is a hammer against SARS-CoV-2 regardless of the variant.”

Sure. But what is it? 

It’s an antiviral pill originally developed to treat the regular influenza. About a year ago Merck started clinical trials to see whether the drug could instead help with Covid-19 infections. 

If authorised, Molnupiravir looks set to become the first oral antiviral treatment for Covid-19.

So this one’s not a horse dewormer?

Nope, unlike supposed Covid-19 treatment ivermectin – beloved by conspiracy theorists, fringe groups and shock jocks – molnupiravir was specifically developed for use by humans rather than animals. Claims that molnupiravir is repackaged ivermectin are demonstrably false. 

Is it hydroxychloroquine, then?

No! That’s a debunked Covid-19 treatment, originally endorsed by the likes of Donald Trump. While hydroxychloroquine is an anti-malaria drug that proved useless at treating Covid-19, molnupiravir has undergone a year of clinical trials to show its efficacy.

Right, so how effective has it been?

Very, by all accounts. Molnupiravir has been called a “gamechanger” due to the fact it can reduce the chances of newly diagnosed Covid-19 patients needing hospitalisation by about 50%. Coupled with vaccinations, molnupiravir could be what we need to ensure our hospitals aren’t overwhelmed when we open the borders. 

It’s also likely to lower the Covid-19 death rate. During clinical trials, 14.1% of patients in the placebo group were hospitalised or died compared with 7.3% who took a five-day course of the drug.

How many doses has the government bought?

Sixty thousand. That might not seem like enough based on how many piles of cheap flu medication are stacked up at Chemist Warehouse, but it’s just the initial order. The government signalled a future order could be made. 

“I am hopeful that there will be further announcements to come in the future as… negotiations conclude,” said Jacinda Ardern. 

I want it now! Can I get it?

No. Sit down. The deal was just an advance purchase agreement. Before you can go out and buy molnupiravir, it needs to be approved by our drug regulator Medsafe. That means, just like the Covid-19 vaccine, it will be tested to ensure it is safe for distribution. The Medsafe approval process can take a while but it means you don’t need to “do your own research” once something has been made available. 

At this stage, the results of the clinical trial haven’t been peer reviewed so it’s a good thing we have our own approval process in place.

Fine, I’ll wait. But does this mean I can take molnupiravir instead of the vaccine?

Not at all. The line the government keeps using is that meds like molnupiravir are simply one additional tool in our Covid-19 toolkit. To provide the best protection from Covid-19, several items from that toolkit need to be combined. Announcing the molnupiravir purchase earlier this week Ardern said: “I ask all New Zealanders to get vaccinated as the best protection from the virus and so we can regain our way of life with as few restrictions as possible.”

Who will be treated with molnupiravir? 

Molnupiravir will reportedly be used for people with mild to moderate cases of Covid-19. That should stop some people from getting sick enough that they require hospitalisation, but just like regular flu medication it won’t stop everyone from needing additional help.

Have any other countries joined the molnupiravir waitlist?

Yup! Australia’s ordered about 300,000 courses while Singapore has signed a supply and purchase agreement. According to Reuters, Thailand, South Korea, Taiwan and Malaysia been in talks to buy doses as well.