When I woke up this morning, the first thing on my mind, was Paxlovid. It’s not exactly a trending topic anymore, and you may not have heard much about it lately. But something didn’t sit right with me, so I did what I always do: I followed the science.
Remember when Paxlovid was touted as the next big breakthrough in COVID therapeutics? Pfizer’s oral antiviral combination — nirmatrelvir with ritonavir — was hailed as a game-changer. In 2022, their original EPIC-HR trial reported an 89% reduction in hospitalisation or death in high-risk, unvaccinated adults. Wall Street took notice. The media praised it. The drug was fast-tracked, stocked up, and prescribed around the world.
Hammond, Jennifer, et al. "Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19." New England Journal of Medicine 386.15 (2022): 1397-1408.
But that was then. Now? Its use is declining, especially in the UK. Clinicians are quietly pulling back, and public health agencies are no longer promoting it with the same urgency. Why?
Because it’s not working — at least, not like it used to.
The Hidden Shift: Vaccinated Patients and a New Kind of Problem
Here’s the catch: the EPIC-HR trial only involved unvaccinated adults. But today, the majority of people getting COVID are vaccinated — and many are boosted. So the assumption was made: “If it worked in the unvaccinated, it should work in the vaccinated too.” Pfizer ran a follow-up trial (EPIC-SR), now including vaccinated individuals with or without risk factors.
And then came the snag.
