Medical science must go hand in hand with the social sciences to effectively control Covid-19 and other pandemics

We are in a particularly difficult stage of the pandemic. Although effective in reducing hospitalizations and serious illness, our best vaccines fail to prevent infection. While Paxlovid is an effective line of defense in the treatment of breakthrough infections with Covid-19 to those most critically at risk, we have yet to explore the potential of prophylactic drugs.

Prevention is always better than cure. Especially when more than a third of patients with Covid-19 will develop long-term symptoms, and some will experience severe enough symptoms to be disabling for many months, if not years.

HIV is another infectious disease that has escaped an effective vaccine, but after many years of research and investment in drug development, it is no longer a death sentence. I have long argued that drug developers need to learn from HIV research and focus on developing combinations of low-molecule antiviral drugs to prevent and treat Covid-19.

However, it is not enough to just focus on developing prophylactic drugs. Medications will become ineffective if there are fluctuations in medication intake or low levels of adherence to treatment regimens. With each global health crisis, it is clear that we need both medical solutions and public health-oriented behavioral and social change programs to implement them. Public health policymakers and officials need to work with social scientists to create educational and informational initiatives and restore trust in institutions. We must also ensure equity and access to preventive treatments, especially in health deserts and low socio-economic areas. No population is safe until we are all.

A recent study on the real effectiveness of pre-exposure prophylaxis in men at high risk of HIV infection in France shows how even a highly effective drug like PrEP can be weakened by a lack of adherence to treatment.

Pre-exposure prophylaxis (PrEP) for HIV has shown high efficacy in clinical trials, but there are fewer efficacy studies when prescribed in real life to different populations. The authors of this study used a comparable, embedded case-control study among adult men at high risk of HIV infection between 1 January 2016 and 30 June 2020, with data from the French National Health Data System. Men who had recently been diagnosed with HIV before 31 December 2020 were individually compared with up to five controls for age, socioeconomic status, place of residence, calendar year and duration of follow-up.

Among a total of 46,706 individuals, 256 patients with HIV infection were identified and compared with 1,213 controls. PrEP users account for 29% of cases and 49% of controls. The actual effectiveness of PrEP was found to be 60% overall, extending to 93% for high PrEP consumption and 86% excluding periods after PrEP discontinuation.

The effectiveness of PrEP is significantly reduced in people under 30 years of age and in those with low socio-economic conditions. Both groups showed low PrEP consumption and high levels of PrEP discontinuation.

Although this study shows that the effectiveness of PrEP appears to be lower in real conditions than reported in clinical trials. Lower efficiency seems to be related to compliance. Strengthening efforts to improve the monitoring of PrEP compliance is essential to ensure higher efficiency of PrEP in a real environment.

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