Calls to expand access to Covid antivirals in Australia splits experts and doctors

Doctors and experts are split over calls to expand the eligibility for leading Covid antiviral drugs Paxlovid and Lagevrio, with some saying access should be widened while others warn the medication isn’t right for everyone.

The federal health minister, Mark Butler, is encouraging doctors and patients to consider the drugs, which can be effective at lessening the virus’s symptoms if taken soon after contracting Covid.

But the Royal Australian College of General Practitioners says the drugs can have serious side-effects if taken alongside some common medications, and some of the nation’s leading authorities on Covid say more data is needed on who is getting sick.

“Lots of eligible people can’t take it because of the drugs they are on – it doesn’t mix well. I wouldn’t be able to take it, for example,” said Prof Mike Toole, associate principal research fellow at the Burnet Institute.

“There’s a long list of drugs that contraindicate it.”

Melbourne mum Danielle Cahill-Gray lives with asthma and inflammatory arthritis, which places her at higher risk of severe Covid. After testing positive, she used antiviral medication, which lessened her “awful” symptoms, but she only found out about the drugs after calling a hotline.

“I had no idea,” she said. “Instantly I felt a lot better. I felt I’d progressed a week in an hour. The feeling that an elephant was sitting on my chest was gone.”

Cahill-Gray now describes herself as a “one-woman publicity machine” for antivirals, which have been found to reduce the risk of hospitalisation and death from Covid.

“I think it kept me out of ICU,” she said. “I don’t think it’s advertised enough. It really does make such a vital difference to your recovery.”

Some health experts are calling for the eligibility of the oral antivirals to be expanded, with fears thousands could go to waste if more Australians don’t gain access.

The medications, taken after Covid diagnosis to lessen symptoms, are only subsidised under the Pharmaceutical Benefits Scheme for people aged over 65 with two high-risk factors, people over 75 with one high-risk factor, or any immunocompromised person, according to the federal health department.

Butler this week recommended doctors consider prescribing the antivirals to patients, and for patients to ask their doctors about the drugs, warning of an expected spike in Covid cases over winter.

Data tracking website CovidLive reported 332 deaths and more than 196,000 cases nationwide in the last seven days, including 42 deaths and over 30,000 cases on Thursday alone.

The drugs do “have some interactions with existing medications”, Butler said in an ABC interview this week, noting that people with risk factors that might qualify them for the drug could be on medication that clashes with Paxlovid and Lagevrio. This includes drugs used by patients with severely reduced kidney or liver function, along with a number of common medicines.

Toole said more data was needed on which people were being given the antivirals and what effect it had before eligibility is expanded.

Prof Catherine Bennett, chair in epidemiology at Deakin University, also called for more data on use of the drugs, saying eligibility should be expanded “only if people who aren’t getting it are going into hospital seriously ill”.

“It’s not just about whether we give them a subsidised medicine, it’s about whether they can take it,” she said.

“We should be analysing everyone who’s in hospital and ICU to understand if there’s even a way to intervene. We don’t know what the problem is yet. If we give everyone the antivirals, there’s very little benefit.”

But the Victorian branch president of the Pharmacy Guild of Australia, Anthony Tassone, said the PBS eligibility criteria “must be changed” to prevent doses from being discarded.

“These medicines can help reduce the risk of hospitalisation and death from Covid-19 … but at present the criteria are limiting access for those people who need them,” Tassone said.

“There’s a real concern that if something isn’t done, and done soon, we could see a significant amount of doses needing to be discarded, as they’ll be past their expiry date.”

Australia was one of the first countries to grant oral treatments approval for Covid-19 treatment in January. But while 1.3m courses of oral antivirals are now available, just over 55,000 have been administered.

Butler said the Pharmaceutical Benefits Advisory Committee, which decides which drugs will be subsidised under the PBS, would “continue monitoring the eligibility criteria” for the antivirals and “may recommend changes”.

“Any expansion of eligibility will be considered by PBAC at its next meeting, in early July, which will consider the potential benefits and harms of these medications,” he said.

The RACGP vice-president, Dr Bruce Willett, said it was important to “enhance community awareness” around Covid-19 antivirals while ensuring the most vulnerable had access to them.

“That’s why the Royal Australian College of GPs welcomed the government’s new campaign to boost antiviral awareness,” Willett said. “We must, however, tread carefully when considering whether the PBS restrictions should be eased.”

Willett said any decisions should be guided by experts, and the PBAC’s recommendations were more lenient than the National Covid-19 Clinical Evidence Taskforce.

“I’m sympathetic to patients who have been turned away when asking for these drugs and I’m also mindful that some GPs believe the PBS restrictions aren’t lenient enough,” Willett said.

The shadow health minister, Anne Ruston, said there were “significant quantities” of Paxlovid secured by the former Coalition government, and said she respected the PBAC’s advice on eligibility.

Jordon Steele-John, the Greens’ health spokesperson, called on the health department to give clearer communications to doctors on who was eligible for the drug and how to access it.

“With winter upon us and our hospital system overstretched, the Pharmaceutical Benefits Advisory Committee needs to conduct a benefit-risk assessment, and appropriately expand the eligibility criteria so that people are less likely to experience severe Covid-19 symptoms,” he said.