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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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The Cost of an EpiPen in Major Markets

This visualization compares EpiPen prices around the world, with the U.S. having the highest prices by far.

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worldwide, with the U.S. having the highest prices.

The Cost of an EpiPen in Major Markets

This was originally posted on our Voronoi app. Download the app for free on iOS or Android and discover incredible data-driven charts from a variety of trusted sources.

EpiPens are auto-injectors containing epinephrine, a drug that can treat or reverse severe allergic reactions, potentially preventing death.

The global epinephrine market was valued at $1.75 billion in 2022 and is projected to reach $4.08 billion by 2030. North America represents over 60% of the market.

EpiPens, however, can be prohibitively expensive in some regions.

In this graphic, we present estimated EpiPen prices in major global markets, compiled by World Population Review and converted to U.S. dollars as of August 2023.

Why are U.S. Prices so High?

The U.S. stands out as the most expensive market for EpiPens, despite over 1 million Americans having epinephrine prescriptions. After Mylan (now part of Pfizer) acquired the rights to produce EpiPens in the U.S. in 2007, the cost of a two-pack skyrocketed to $600, up from about $60.

CountryPrice (USD)
🇺🇸 U.S.300*
🇯🇵 Japan98
🇩🇪 Germany85
🇨🇦 Canada80
🇫🇷 France76
🇦🇺 Australia66
🇬🇧 UK61
🇮🇳 India30

*Per unit cost. Commonly sold as a two-pack, meaning total cost is equal to $600

Former Mylan CEO Heather Bresch defended the price hikes to Congress, citing minimal profit margins. Mylan eventually settled with the U.S. government for a nine-figure sum.

Notably, EpiPens are available at a fraction of the cost in other developed countries like Japan, Germany, and Canada.

Making EpiPens More Affordable

Efforts to improve EpiPen affordability are underway in several U.S. states. For instance, the Colorado House approved a $60 price cap on epinephrine, now under review by the state Senate.

Similar measures in Rhode Island, Delaware, Missouri, and Vermont aim to ensure insurance coverage for epinephrine, which is not currently mandatory, although most health plans cover it.

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