The initial shock of Omicron is over, and it appears that the covid-19 cases are declining globally. Moreover, vaccine availability and its acceptability are improving. It almost looks as if the covid-19 epidemic will end in many places. But it is too early to make any conclusions. Emerging data suggest that covid-19 still poses a significant risk, and it will continue to be one of the leading causes of morbidity and mortality in 2022. Not only that, it may make a sudden and unpredictable comeback in many places.

Cases of covid-19 might be declining, but the chances of rebound are high

Cases of covid-19 are indeed declining sharply and globally. However, it is still causing a significant number of infections. The number of infections is almost close to what it used to be about a year back, in mid-2021.

Although the number of people affected by covid-19 in spring and early summer of 2022 remains moderately high, the number of covid-19 related deaths is relatively low. There are many reasons for low covid-19 associated mortality from vaccination, and improved treatment, to low mortality associated with prevalent variants like Omicron.

However, one should be careful in interpreting all the data. For example, the WHO covid-19 dashboard shows that about 6 million plus people died by May 2022 due to covid-19 since the pandemic's beginning. However, at the same time, WHO suggests that actual deaths are perhaps twice more and are close to 15 million. Such a significant difference is due to the fact that many infections and deaths go unreported in developing economies.

Considering that covid-19 is highly mutative, it is quite likely that new variants may keep emerging. Thus, the probability is high that the infection may rebound in autumn 2022.

We might see localized eruptions of infection in the near future

There are already early signs of it that instead of a sudden upsurge in the cases worldwide, we are more likely to witness epidemics in one or another region. There are many reasons for that, such as the use of medications, different levels for vaccination, varied approach to a booster dose, genetic differences between the people, and more.

It is pretty clear that despite the declining number of covid-19 cases, it will not disappear completely. The recent upsurge of the infection in Shanghai indicates what lies ahead. We are more likely to witness localized and significant upsurges of the infection.

However, due to a better understanding of the infection, there are also greater chances that most countries would be able to control the spread of infection. Thus, in early May, covid still continues to be a significant health threat in South Korea, Italy, Germany, France, North America, and some other nations. However, by autumn picture may be pretty different.

Evolving approach to preventing and managing covid-19

When it comes to preventing and managing covid-19 infections, apart from vaccines, perhaps the pharma industry will start playing a more significant role.

Unlike 2021, there are now few pharmacological options that can help prevent covid-19 spread. Additionally, covid-19 treatment is now supported by greater evidence, and thus medical experts know what works and what does not.

Covid-19 causes biphasic illness. The first phase, which may last as long as a couple of weeks, is about increasing the viral load. It causes symptoms reminding viral respiratory tract infections. During this early phase, a person can readily infect others. However, there are low chances of hospitalization or fatal outcomes during this phase. During this first phase, antiviral drugs are pretty good at preventing the progress of the disease.

Early initiation of antiviral drugs during this phase may help reduce infection severity and prevent the spread of infection. However, antivirals help if started quite early, within 2-5 days of the beginning of symptoms. The drugs that may help during this phase are nirmatrelvir and ritonavir combo, Molnupiravir, Sotrovimab, and Remdesivir.

It is evident that life-threatening illness occurs in the second phase. In this phase that starts after 10 to 14 days, viral load is relatively low due to the initiation of the immune response. However, severe illness ensues mainly due to a cytokine storm or hyperinflammatory response. Thus, there is little benefit from antiviral drugs during this phase, and greater focus is on controlling the cytokine storm.

During this phase, drugs that may help control cytokine storm work well and help reduce mortality. Thus, treatment with corticosteroids, IL-6 receptor blockers, Baricitinib, casirivimab and imdevimab combo, ruxolitinib, and tofacitinib combo may help. In addition, there is weak evidence that ivermectin and convalescent plasma may also have a role in this phase of the disease.

Now, WHO guidelines are against the recommendation of treatments like early initiation of convalescent plasma, hydroxychloroquine, and the use of the lopinavir-ritonavir combo.

Continued covid-19 epidemic, along with reduced mortality, means a greater need for drugs to manage the post-covid syndrome

When discussing covid-19 disease management, it is also essential to consider post-covid therapy options. WHO guidelines primarily focus on saving lives and treating acute infections. However, there are many pharmacological drugs needed in the post-covid phase. Those affected by covid-19 are at a greater risk of cardiovascular events and report chronic fatigue, brain fogginess, and various other health issues.

It means that there would be a continued higher demand for some cardiovascular drugs like anticoagulants. Additionally, covid-19 would also result in greater need for anti-inflammatory drug therapy, antibiotics, vitamins, mineral supplements, and more.

How would covid-19 affect the pharma market in the second half of 2022

Covid-19 would continue to influence the pharma market in many ways. Each pharma company would need to fine-tune its business strategy according to its core strengths.

Despite some decline in vaccine requirements, long-term demand will remain stable in the coming years. Additionally, one can expect consistent demand for biologicals to control cytokine storms like IL-6 receptor blockers. It is pretty likely that some new biologicals may also get regulatory approvals in the coming months.

There will be a considerable increase in the demand for antiviral drugs as doctors would try to curb the infection in its early stages as vaccines cannot be expected to prevent disease in all cases. Thus, drugs like nirmatrelvir and ritonavir combo, molnupiravir would see a consistent demand.

Problems with biologicals and antivirals are that they are produced by a limited number of companies. Moreover, most of these drugs are challenging to manufacture, and more importantly, they are protected by patents. Thus, for most players in the emerging markets, who specialize in generics, it would be good to focus on supporting drugs like antibiotics, analgesics, hypnotics, antithrombotic agents, anticoagulants, adrenergic and dopaminergic agents, corticosteroids, and more. Additionally, there would be a consistently higher demand for anxiolytics and vitamin supplements.

To sum up, covid-19 mortality is expected to decline, but not the infection rates. Thus, covid-19 will continue to shape the pharma market for the foreseeable future. Therefore, apart from vaccines and monoclonal antibodies, there would be a higher demand for antiviral agents and supporting drugs. Additionally, doctors would focus considerably on managing post-covid syndrome.

About the Author:

Dr. Preet Pal S.B. is a physician (M.D. Medicine, Kazakh National Medical University) specializing in diabetes (Fellowship in diabetes), a lifetime member of the Indian Medical Association. Dr. Preet has vast business development experience in the ex-soviet republics/CIS region (Ukraine, Kazakhstan, Uzbekistan, Russia, Kyrgyzstan, Azerbaijan, and so on). Dr. Preet is a  multilinguistic. He has held senior management posts in various healthcare/pharmaceutical companies like SEARLE – central Asia (now a subdivision of Pfizer), Shreya life sciences, AGIO pharma, Indian Immunological Limited (Human and veterinary biologicals). 

Dr. Preet is also a prolific writer and loves sharing my experiences. He firmly believe that an approach towards emerging markets differs considerably from developed markets. The bigger part of the global population resides in emerging markets. Yet, regretfully, most market reports remain focused on the developed markets. Even if they focus on emerging markets, they often use insights gained from developed markets.