Visualizing How COVID-19 Antiviral Pills and Vaccines Work
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Visualizing How COVID-19 Antiviral Pills and Vaccines Work at the Cellular Level

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Current Strategies to Tackle COVID-19

Since the pandemic started in 2020, a number of therapies have been developed to combat COVID-19.

The leading options for preventing infection include social distancing, mask-wearing, and vaccination. They are still recommended during the upsurge of the coronavirus’s latest mutation, the Omicron variant.

But in December 2021, The United States Food and Drug Administration (USDA) granted Emergency Use Authorization to two experimental pills for the treatment of new COVID-19 cases.

These medications, one made by Pfizer and the other by Merck & Co., hope to contribute to the fight against the coronavirus and its variants. Alongside vaccinations, they may help to curb extreme cases of COVID-19 by reducing the need for hospitalization.

Despite tackling the same disease, vaccines and pills work differently:

VaccinesPills
Taken by injectionTaken by mouth
Used for prevention Used for treatment only
Create an enhanced immune system by stimulating antibody productionDisrupt the assembly of new viral particles

How a Vaccine Helps Prevent COVID-19

The main purpose of a vaccine is to prewarn the body of a potential COVID-19 infection by creating antibodies that target and destroy the coronavirus.

In order to do this, the immune system needs an antigen.

It’s difficult to do this risk-free since all antigens exist directly on a virus. Luckily, vaccines safely expose antigens to our immune systems without the dangerous parts of the virus.

In the case of COVID-19, the coronavirus’s antigen is the spike protein that covers its outer surface. Vaccines inject antigen-building instructions* and use our own cellular machinery to build the coronavirus antigen from scratch.

When exposed to the spike protein, the immune system begins to assemble antigen-specific antibodies. These antibodies wait for the opportunity to attack the real spike protein when a coronavirus enters the body. Since antibodies decrease over time, booster immunizations help to maintain a strong line of defense.

*While different vaccine technologies exist, they all do a similar thing: introduce an antigen and build a stronger immune system.

How COVID Antiviral Pills Work

Antiviral pills, unlike vaccines, are not a preventative strategy. Instead, they treat an infected individual experiencing symptoms from the virus.

Two drugs are now entering the market. Merck & Co.’s Lagevrio®, composed of one molecule, and Pfizer’s Paxlovid®, composed of two.

These medications disrupt specific processes in the viral assembly line to choke the virus’s ability to replicate.

The Mechanism of Molnupiravir

RNA-dependent RNA Polymerase (RdRp) is a cellular component that works similar to a photocopying machine for the virus’s genetic instructions. An infected host cell is forced to produce RdRp, which starts generating more copies of the virus’s RNA.

Molnupiravir, developed by Merck & Co., is a polymerase inhibitor. It inserts itself into the viral instructions that RdRp is copying, jumbling the contents. The RdRp then produces junk.

The Mechanism of Nirmatrelvir + Ritonavir

A replicating virus makes proteins necessary for its survival in a large, clumped mass called a polyprotein. A cellular component called a protease cuts a virus’s polyprotein into smaller, workable pieces.

Pfizer’s antiviral medication is a protease inhibitor made of two pills:

  1. The first pill, nirmatrelvir, stops protease from cutting viral products into smaller pieces.
  2. The second pill, ritonavir, protects nirmatrelvir from destruction by the body and allows it to keep working.

With a faulty polymerase or a large, unusable polyprotein, antiviral medications make it difficult for the coronavirus to replicate. If treated early enough, they can lessen the virus’s impact on the body.

The Future of COVID Antiviral Pills and Medications

Antiviral medications seem to have a bright future ahead of them.

COVID-19 antivirals are based on early research done on coronaviruses from the 2002-04 SARS-CoV and the 2012 MERS-CoV outbreaks. Current breakthroughs in this technology may pave the way for better pharmaceuticals in the future.

One half of Pfizer’s medication, ritonavir, currently treats many other viruses including HIV/AIDS.

Gilead Science is currently developing oral derivatives of remdesivir, another polymerase inhibitor currently only offered to inpatients in the United States.

More coronavirus antivirals are currently in the pipeline, offering a glimpse of control on the looming presence of COVID-19.

Author’s Note: The medical information in this article is an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. Please talk to your doctor before undergoing any treatment for COVID-19. If you become sick and believe you may have symptoms of COVID-19, please follow the CDC guidelines.

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Misc

Explainer: What to Know About Monkeypox

What is monkeypox, and what risk does it pose to the public? This infographic breaks down the symptoms, transmission, and more.

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Explainer: What to Know About Monkeypox

The COVID-19 pandemic is still fresh in the minds of the people around the world, so it comes as no surprise that recent outbreaks of another virus are grabbing headlines.

Monkeypox outbreaks have now been reported in multiple countries, and it has scientists paying close attention. For everyone else, numerous questions come to the surface:

  • How serious is this virus?
  • How contagious is it?
  • Could monkeypox develop into a new pandemic?

Below, we answer these questions and more.

What is Monkeypox?

Monkeypox is a virus in the Orthopoxvirus genus which also includes the variola virus (which causes smallpox) and the cowpox virus. The primary symptoms include fever, swollen lymph nodes, and a distinctive bumpy rash.

There are two major strains of the virus that pose very different risks:

  • Congo Basin strain: 1 in 10 people infected with this strain have died
  • West African strain: Approximately 1 in 100 people infected with this strain died

At the moment, health authorities in the UK have indicated they’re seeing the milder strain in patients there.

Where did Monkeypox Originate From?

The virus was originally discovered in the Democratic Republic of Congo in monkeys kept for research purposes (hence the name). Eventually, the virus made the jump to humans more than a decade after its discovery in 1958.

It is widely assumed that vaccination against another similar virus, smallpox, helped keep monkeypox outbreaks from occurring in human populations. Ironically, the successful eradication of smallpox, and eventual winding down of that vaccine program, has opened the door to a new viral threat. There is now a growing population of people who no longer have immunity against the virus.

Now that travel restrictions are lifting in many parts of the world, viruses are now able to hop between nations again. As of the publishing of this article, a handful of cases have now been reported in the U.S., Canada, the UK, and a number of European countries.

On the upside, contact tracing has helped authorities piece together the transmission of the virus. While cases are rare in Europe and North America, it is considered endemic in parts of West Africa. For example, the World Health Organization reports that Nigeria has experienced over 550 reported monkeypox cases from 2017 to today. The current UK outbreak originated from an individual who returned from a trip to Nigeria.

Could Monkeypox become a new pandemic?

Monkeypox, which primarily spreads through animal-to-human interaction, is not known to spread easily between humans. Most individuals infected with monkeypox pass the virus to between zero and one person, so outbreaks typically fizzle out. For this reason, the fact that outbreaks are occurring in several countries simultaneously is concerning for health authorities and organizations that monitor viral transmission. Experts are entertaining the possibility that the virus’ rate of transmission has increased.

Images of people covered in monkeypox lesions are shocking, and people are understandably concerned by this virus, but the good news is that members of the general public have little to fear at this stage.

I think the risk to the general public at this point, from the information we have, is very, very low.
–Tom Inglesby, Director, Johns Hopkins Center for Health Security

» For up-to-date information on monkeypox cases, check out Global.Health’s tracking spreadsheet

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Misc

Mapped: The Most Common Illicit Drugs in the World

What are the most commonly used illicit drugs around the world?

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The Most Common Drugs in the World Share

Mapped: The Most Common Illicit Drugs in the World

Despite strict prohibitory laws around much of the world, many common illicit drugs still see widespread use.

Humans have a storied and complicated relationship with drugs. Defined as chemical substances that cause a change in our physiology or psychology, many drugs are taken medicinally or accepted culturally, like caffeine, nicotine, and alcohol.

But many drugs—including medicines and non-medicinal substances taken as drugs—are taken recreationally and can be abused. Each country and people have their own relationship to drugs, with some embracing the use of specific substances while others shun them outright.

What are the most common drugs that are considered generally illicit in different parts of the world? Today’s graphics use data from the UN’s World Drug Report 2021 to highlight the most prevalent drug used in each country.

What Types of Common Drugs Are Tracked?

The World Drug Report looks explicitly at the supply and demand of the international illegal drug market, not including commonly legal substances like caffeine and alcohol.

Drugs are grouped by class and type, with six main types of drugs found as the most prevalent drugs worldwide.

  • Cannabis*: Drugs derived from cannabis, including hemp. This category includes marijuana (dried flowers), hashish (resin), and other for various other parts of the plant or derived oils.
  • Cocaine: Drugs derived from the leaves of coca plants. Labeled as either cocaine salts for powder form or crack for cocaine processed with baking soda and water into rock form.
  • Opioids: Includes opiates which are derived directly from the opium poppy plant, including morphine, codeine, and heroin, as well as synthetic alkaloids.
  • Amphetamine-type Stimulants (ATS): Amphetamine and drugs derived from amphetamine, including meth (also known as speed), MDMA, and ecstasy.
  • Sedatives and Tranquilizers: Includes other drugs whose main purpose is to reduce energy, excitement, or anxiety, as well as drugs used primarily to initiate or help with sleep (also called hypnotics).
  • Solvents and Inhalants: Gases or chemicals that can cause intoxication but are not intended to be drugs, including fuels, glues, and other industrial substances.

The report also tracked the prevalence of hallucinogens—psychoactive drugs which strongly affect the mind and cause a “trip”—but no hallucinogens ranked as the most prevalent drug in any one country.

*Editor’s note: Recreational cannabis is legal in five countries, and some non-federal jurisdictions (i.e. states). However, in the context of this report, it was included because it is still widely illicit in most countries globally.

The Most Prevalent Drug in Each Country

According to the report, 275 million people used drugs worldwide in 2020. Between the ages of 15–64, around 5.5% of the global population used drugs at least once.

Many countries grouped different types of the same drug class together, and a few like Saudi Arabia and North Macedonia had multiple different drug types listed as the most prevalent.

But across the board, cannabis was the most commonly prevalent drug used in 107 listed countries and territories:

Country or territoryMost Prevalent Drug(s)
AfghanistanHeroin, opium
AlbaniaSedatives and tranquillizers (general)
AlgeriaCannabis (general)
ArgentinaCannabis (herb)
AustraliaCannabis (general)
AzerbaijanHeroin
BahamasCannabis (herb)
BahrainCannabis (general)
BangladeshAmphetamine
BelarusOpium
BelgiumCannabis (herb)
BoliviaCannabis (herb)
BruneiCannabis (herb)
BulgariaCannabis (herb)
Burkina FasoCannabis (general)
CanadaCannabis (herb)
Central African RepublicCannabis (herb)
ChileCannabis (herb)
ChinaMethamphetamine
Costa RicaCannabis (herb)
Côte d'IvoireCannabis (herb)
CroatiaHeroin
CyprusCannabis (general)
Czech RepublicBenzodiazepines
Dominican RepublicCocaine (powder)
EcuadorCannabis (herb)
El SalvadorCannabis (herb)
EstoniaCannabis (herb)
FinlandCannabis (herb)
FranceCannabis (hashish)
GeorgiaCannabis (herb)
GermanyCannabis (herb)
GibraltarCannabis (hashish)
GreeceSolvents and inhalants (general)
GuatemalaCannabis (herb)
HondurasCannabis (herb)
Hong KongHeroin, opium, opioids
HungaryCannabis (herb)
IcelandCannabis (general)
IndiaHeroin
IndonesiaCannabis (herb)
IranOpium
IrelandCannabis (herb)
IsraelCannabis (herb)
ItalyCannabis (general)
JapanMethamphetamine
JordanCannabis (hashish)
KenyaCannabis (herb)
LatviaCannabis (herb)
LebanonCannabis (hashish)
LiechtensteinCannabis (hashish)
LithuaniaSedatives and tranquillizers (general)
LuxembourgCannabis (general)
MacaoMethamphetamine
MadagascarCannabis (herb)
MalaysiaMethamphetamine
MaltaHeroin
MexicoCannabis (herb)
MoldovaCannabis (herb)
MongoliaMethamphetamine
MozambiqueCannabis (herb)
MyanmarHeroin
NetherlandsBenzodiazepines
New ZealandMethamphetamine, solvent and inhalants
NicaraguaCannabis (herb)
NigeriaCannabis (herb)
North MacedoniaMultiple types
NorwayCannabis (general)
OmanOpium
PakistanCannabis (hashish)
PanamaCannabis (herb)
PeruCannabis (herb)
PhilippinesCannabis (herb)
PolandCannabis (herb)
PortugalCannabis (general)
QatarCannabis (hashish)
RomaniaCannabis (general)
Saudi ArabiaMultiple types
SenegalCannabis (herb)
SerbiaBenzodiazepines
SingaporeMethamphetamine
SloveniaCannabis (general)
South AfricaCannabis (general)
South KoreaMethamphetamine
SpainCannabis (herb)
Sri LankaCannabis (herb)
SudanCannabis (herb)
SurinameCannabis (herb)
SwedenCannabis (general)
SwitzerlandCannabis (herb)
Syrian Arab RepublicCannabis (hashish)
TajikistanHeroin, opium
TanzaniaCannabis (herb)
ThailandMethamphetamine
TogoCannabis (herb)
Trinidad and TobagoCocaine (crack)
TunisiaCannabis (general)
TurkeyCannabis (herb)
TurkmenistanOpium
U.S.Cannabis (herb)
UKCannabis (herb)
UkraineOpioids
UruguayCannabis (herb)
UzbekistanCannabis (herb)
VenezuelaBenzodiazepines
VietnamHeroin
ZambiaCannabis (herb)

How prevalent is cannabis worldwide? 72 locations or more than two-thirds of those reporting listed cannabis as the most prevalent drug.

Unsurprisingly these include countries that have legalized recreational cannabis: Canada, Georgia, Mexico, South Africa, and Uruguay.

How Common Are Opioids and Other Drugs?

Though the global prevalence of cannabis is unsurprising, especially as it becomes legalized and accepted in more countries, other drugs also have strong footholds.

Opioids (14 locations) were the most prevalent drugs in the Middle-East, South and Central Asia, including in India and Iran. Notably, Afghanistan is the world’s largest producer of opium, supplying more than 90% of illicit heroin globally.

Amphetamine-type drugs (9 locations) were the third-most common drugs overall, mainly in East Asia. Methamphetamine was the reported most prevalent drug in China, South Korea, and Japan, while amphetamine was only the most common drug in Bangladesh.

However, it’s important to note that illicit drug usage is tough to track. Asian countries where cannabis is less frequently found (or reported) might understate its usage. At the same time, the opioid epidemic in the U.S. and Canada reflects high opioid usage in the West.

As some drugs become more widespread and others face a renewed “war,” the landscape is certain to shift over the next few years.

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