Hundreds of thousands of COVID-19 antivirals are sitting on shelves across Canada

Health Canada has distributed enough of the antiviral Paxlovid to treat more than 700,000 people with COVID-19, yet the provinces have given only a fraction of that medication to patients. 

Paxlovid has been shown to significantly reduce hospitalizations and deaths among people most at risk from COVID-19, such as seniors and people with compromised immune systems. It's a combination of pills that can be obtained for free with a prescription and taken at home, but must be started within five days of symptoms appearing. 

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Research by CBC News finds that the provinces have dispensed less than 15 per cent of their Paxlovid supply since the medication was approved in January.

This low usage rate means hundreds of thousands of treatment courses are sitting unused across Canada. That's prompting questions about why more people aren't getting an antiviral that could help keep them out of hospital, especially with health systems across the country under strain.

'I was one of the luckiest people'

Paxlovid is "an incredible therapy," said Dr. Zain Chagla, an infectious diseases specialist who helps lead a COVID-19 outpatient clinic at St. Joseph's Hospital in Hamilton, Ont. 

"There certainly are people that are being hospitalized for COVID that unfortunately didn't have access to this treatment," he said in an interview.

"There's a bed crunch in the emergency rooms, we know there's a bed crunch on the [hospital] wards. Any person we can prevent from landing in one of these health care beds … is a win for the system." 

A key concern raised by medical professionals interviewed by CBC News is that too many Canadians who could benefit from Paxlovid simply don't know the medication is available.

Jim Catty, an 88-year-old in Toronto, had never heard of Paxlovid when he fell ill with COVID-19 in April. 

"I had pain in every muscle in my body," Catty said in an interview

A home care nurse who was caring for Catty's wife for unrelated reasons knew about Paxlovid. She contacted his doctor to arrange for a prescription. 

"I was one of the luckiest people in that I was well looked after," Catty said. "I had my medicine immediately, and I got well fairly fast."

When Paxlovid was first approved, at the peak of the Omicron wave of COVID-19, the supply was limited and the provinces put strict limitations on eligibility, making it unavailable to the vast bulk of the population.

More Canadians now eligible for Paxlovid

Supply is no longer a problem. In addition to the 730,000 treatment courses already shipped, the federal government has procured another 770,000 to be distributed by the end of the year, said a statement from the Public Health Agency of Canada.

Provincial health ministries have since widened their eligibility criteria, including as recently as last week when New Brunswick opened up Paxlovid to "anyone at risk of severe outcomes from the virus."

While the details vary from province to province, Paxlovid is now generally available to most seniors, as well as adults with compromised immune systems, who test positive for COVID-19, including on a rapid test.

Yet the uptake remains low. 

"Patients don't know this is an applicable therapy," said Chagla.

CBC News asked health officials in each province for data on their supply and use of Paxlovid. All but Ontario provided figures. Among the other nine provinces, about 13 per cent of the treatment courses received from Health Canada have been dispensed.  

Prince Edward Island has dispensed the largest share among the provinces, 76 per cent, while Newfoundland and Labrador has dispensed 27 per cent of its supply.

British Columbia has used roughly 12,000 of the 73,000 treatment courses it has received

A spokesperson for B.C.'s health ministry said in a statement that "this supply versus usage ratio does not necessarily reflect underutilization or lack of access to the treatment." 

Ontario's health ministry did not respond to repeated requests by CBC News to provide Paxlovid usage data.    

The medication can be obtained from more than 4,000 pharmacies around Ontario, but people need to contact their doctors first to get prescriptions. That hurdle has been removed in five other provinces, including Quebec, where pharmacists can prescribe Paxlovid directly.

"It's something that has really benefited a lot of patients," said Montreal pharmacist Daron Basmadjian in an interview. "It's really about getting the drug to the person as quickly as possible so they can start it and have the best possible outcome."  

Elizabeth Leung, a clinical pharmacy specialist at Unity Health in Toronto, says all provinces should consider allowing pharmacists to prescribe Paxlovid to make it easier for patients to begin the medication quickly.

Paxlovid "needs to be started within the first five days to have the best effect, and preferably within the first three days," said Leung in an interview. 

Calls to make more people aware of treatment

There's concern that people who could benefit from Paxlovid simply try to push through their bouts of COVID-19 and end up waiting too long before seeking the treatment.  

"It takes a lot from a patient standpoint to be able to access this," said Chagla, the infectious diseases specialist. "They have to recognize they have symptoms. Patients may not know how to test, and then finally, they may not know who to call if they have a positive test." 

It's prompting calls for the provinces to make people more aware of Paxlovid, in case fall and winter bring bigger waves of infection.

Two-thirds of the more than 190,000 people who've been hospitalized with COVID-19 across the country since the pandemic began have been aged 60-plus, according to Public Health Agency of Canada figures. 

A recent study from Israel published in the New England Journal of Medicine found significantly lower rates of hospitalization and death due to COVID-19 among people aged 65 and older who received Paxlovid compared with those who did not. 

That same study found the medication did not reduce COVID-related hospitalizations among healthy adults younger than 65.

Paxlovid is not for everyone. The antiviral treatment may interact negatively with other prescription drugs, such as medication for high blood pressure or high cholesterol. People are also urged to tell their health care provider if they have any liver or kidney problems before taking Paxlovid.