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Covid-19: UK becomes first country to authorise antiviral molnupiravir

BMJ 2021; 375 doi: (Published 04 November 2021) Cite this as: BMJ 2021;375:n2697

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Re: Covid-19: UK becomes first country to authorise antiviral molnupiravir

Dear Editor

Molnupiravir might be effective but logistics will be a challenge. It needs to be used early in the course of Covid-19, thus implying that it cannot really be targeted. It might be needed by 40,000 new Covid-19 patients each day, currently receiving no treatment prior to intensive care. The government's purchased stock might last for little more than ten days, and the cost of £500 per shot (stated by Forbes) is not insignificant, up to £20million per day.

I wonder if NICE will be as dismissive of Molnupiravir as it was of calcifediol, the activated and rapid-acting form of vitamin D more than a year ago. Calcifediol was obviously a beneficial treatment of which we have been denied despite complete safety and a price only one thousandth that of Molnupiravir.

The declining effectiveness of vaccines is almost certainly due to the exhaustion of already low levels of vitamin D by the intense immune process stimulated by vaccination. Vaccines need good immunity, which requires good blood levels of vitamin D as calcifediol, 25(OH)D. What we need now is an urgent need for the roll-out of vitamin D to boost the effectiveness and safety of vaccines and to improve the defensive immunity of the population. It is overdue, being needed early in 2020.

Competing interests: No competing interests

12 November 2021
David S Grimes
Physician, retired