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JAMAICAN medical professionals have given mixed reactions to US pharmaceutical company Merck's announcement that it has developed a pill to treat the novel coronavirus, which causes the disease COVID-19.On October 1 Merck had said it would seek authorisation of its oral drug Molnupiravir for COVID-19 after it was shown to reduce the chance of hospitalisation for newly infected patients by 50 per cent.A simple pill to treat COVID-19 has been sought since the start of the pandemic last year, therefore Merck's announcement was hailed as a major step towards that goal.Wire services had reported Dr Anthony Fauci, chief medical advisor to US President Joe Biden, as saying, "The data are impressive." He also highlighted that the trial results showed there were no deaths among patients who received the drug compared to eight deaths in the placebo group.The US has procured 1.7 million courses of Molnupiravir - should it be greenlighted - with the option to buy more, and global health agency Unitaid said it was working with a partnership called Access to COVID-19 Tools Accelerator (ACT-Accelerator) to secure supply for low- and middle-income countries.A report by Agence France Presse stated that in a late-stage clinical trial, Merck and its partner Ridgeback Biotherapeutics evaluated data from around 770 patients, roughly half of whom received either a five-day course of the pill, while the other received a placebo.All the patients had lab-confirmed COVID-19, with symptoms that developed within five days of them being assigned to their respective groups.Of the patients who received Molnupiravir, 7.3 per cent were hospitalised by day 29, compared to 14.1 per cent of those on a placebo - a relative risk reduction of around 50 per cent.Efficacy was said to hold up against variants of concern, including Delta, and the drug had a good safety profile.Asked for a response to Merck's announcement, president of the Pharmaceutical Society of Jamaica Dr Winsome Christie said that if the pill is declared safe for use by the Ministry of Health and Wellness, she has no problem with it being administered to Jamaicans."If the drug is proven to be safe I am certain people will take it, because then the ministry will approve it to be used in the population. If it is not approved, then whether people believe it's good or not is beside the point, because the ministry has to protect the health of the Jamaican populace," she said.Dr Christie added that as long as Molnupiravir passes clinical trials, gets emergency authorisation and is proven beyond a doubt, then there would be good uptake. "I am certain people will use it because everybody wants to be cured of COVID-19, but at the moment now [what we have] is the vaccine. You will have people who don't want to take the vaccine, so as a health professional, cover those people too - so I don't have a problem with that."A similar point was raised by Medical Association of Jamaica President Dr Brian James who argued that Molnupiravir would even be preferred by anti-vaxxers to fight the novel coronavirus."At this time, this drug is still in the experimental stage of development. The trials have shown promise so far and if, after appropriate consideration, the US FDA grants its approval, I would have no reason to object to its use. It might find usefulness in persons for whom the vaccine is contraindicated. It seems that the anti-vaccination movement has no fundamental problems with any drug as long as it is not a vaccine. It even appears that many have a specific aversion to the COVID-19 vaccine, and have no issues with other vaccines. I therefore believe that many would welcome it without question," said Dr James.However, he had concerns about the possible cost and efficacy of the pill in comparison to the vaccine."The cost is prohibitive for many Jamaicans and the trials are showing a 50 per cent effectiveness in preventing hospitalisation and death. The vaccines are nearly 100 per cent effective in this regard. Another concern is that this drug is a treatment and not a preventive intervention. This means one takes it when one is having symptoms. It is unclear whether it reduces the incidence of long COVID or heart or lung damage," he said.Meanwhile, Dr Guyan Arscott said the country already has one of the lowest vaccination levels in the Caribbean and it might therefore be unwise to start considering the use of Molnupiravir."We are about 9.4 per cent [vaccinated]; everywhere else in the Caribbean is at least 20 per cent. What we need is minimum distraction from vaccination. We already have confusion with a drug Ivermectin out there, where some of the Jamaicans are confusing these drugs with the vaccines," he said."Vaccine is a completely different thing from any tablet and so they think that if you're taking this tablet, you don't have to take the vaccine. We cannot afford any distraction right now," he said."How could we go and confuse people about a tablet that we don't even know anything about?" he questioned.But even though Dr Arscott expressed uncertainty about the potential use of Molnupiravir, he did say it could be used much later when more of the population is fully inoculated against the novel coronavirus."If it comes onto the market as a treatment later on when we have vaccinated our people up to a reasonable level, then so be it. But I think this is a very unfortunate move to come and cause more confusion and more people to turn away and less people to get vaccinated," he said."This tablet is to treat you when you are sick, and we want to prevent people from getting sick. We are in trouble and we need to vaccinate the people like it's going out of style," he argued.At the same time, Dr Winston Davidson, professor of public health and health technology at the University of Technology, Jamaica, argued that the claim by the drug maker is made on the basis of a commercial rush to judgement."The process of validation is patently self-serving and not worthy of recommendation at this time. Our experiences with many drugs, over the past 50 years at least, have had very mixed results. Some have even ended up in tragedy, such as the so-called wonder drug Thalidomide. Even the claims of early HIV drugs shattered the hopes and dreams of many of our families, friends, and loved ones. Basic tried and proved public health principles and practice are best to achieve best outcomes for our people. These include fundamental disease-preventive measures such as vaccines and disciplined, lifestyle exposure-avoidance measures," he explained.He added that sometimes claims can undermine the credibility of the scientific community, breed higher levels of public cynicism and irrational scepticism, and reinforce fantastic and incredulous conspiracy theories."...Vaccine and lifestyle change practices, including the good old quarantine when necessary, continue to be, by far, the best practice for the prevention and most efficient and effective management of diseases and conditions. Prevention is always better than cure. Let the Jamaican people, indeed the people of the world, continue to focus on the tested, tried, and proven public health measures we are presently practising."There are no treatment silver bullets for curing COVID-19 now or on the immediate horizon. Indeed, Merck has made no such claim that their new drug being presented to the market is indeed a silver bullet," he said.Health experts overseas have stressed that if approved, the drug is not a miracle cure and should complement highly effective vaccines, rather than replace them.Molnupiravir belongs to a class of antiviral drugs called polymerase inhibitors, which work by targeting an enzyme that viruses need to copy their genetic material, and introducing mutations that leave them unable to replicate.The drug was initially developed as an inhibitor of influenza and respiratory syncytial virus, two other important acute respiratory infections, by a team at Emory University.