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Sotrovimab is a treatment showing promising results in the fight against COVID-19.

Clinical trials and overseas experience with a class of therapeutic drugs called monoclonal antibodies suggests that it can – but only when they are given early. COVID-19 patients treated in a trial of one such drug calledSotrovimab exhibited an 79 per cent relative reduction in hospitalisation and deaths. In March,the independent regulator halted patient recruitment because of “profound efficacy”. Even with small numbers,before the Delta outbreak,the statistics were persuasive.

The first of 7700 doses of Sotrovimab quietly slipped into Australia three weeks ago. We have waited some time. It now has Therapeutics Goods Administration provisional approval for vulnerable patients,such as the elderly and immunocompromised. It isbeing used in Shepparton,Victoria. What are the plans for NSW?

Sotrovimab is the latest and,possibly,best therapeutic monoclonal antibody to inhibit the COVID-19 virus attaching to human tissue. The US Federal Drug Authority authorised its emergency use in May. The headline cost is $US2100 a dose,and it’s free to vulnerable Americans.

President Trump was treated with,among other drugs,a duo of anti-COVID monoclonal antibodies labelled Regeneron,similarly authorised in America last November. The US National Institute of Health recommends either drug for vulnerable patients. Don’t mention them in the same breath as ivermectin or hydroxychloroquine.

Army personnel assist with the outbreak response in Shepparton.Credit:Justin McManus

With COVID on the march in America,antibody distribution has massively scaled up. The Texas state government has just established public antibody infusion centres.

Intravenous antibody infusions take an hour,in infectious patients. No small short-term imposition on overstretched health systems. Yet,one which could prevent a much greater hospital overload in the months which follow. Perhaps a treatment centre on an oval near a hospital should be considered.Like the precautionary Surge Centre in Canberra.

The United Arab Emirates,where Delta is prevalent,and logistics are military-grade,announced striking results,with no deaths among 6175 COVID-19 patients treated in July.

Nevertheless,and crucially,immunologists worry that indiscriminate use of a single antibody such as Sotrovimab might cause resistant variants to emerge and leak into the community. It is no substitute for vaccination. The ethical issues are obvious.

Monoclonal antibodies attack and disable unwanted targets. Think Herceptin for breast cancer,Keytruda for melanoma,Emgality for migraine and Humira for arthritis - all monoclonals,each created or modified for a very specific target. Each is a feat of structural molecular engineering.

It was Britain’s Cambridge scientist,Sir Gregory Winter,who devised and developed the generic technology that underpins monoclonal antibodies. At first,business failed to see their potential. And so,as he recounted in his 2018 Nobel address and at Sydney University in 2019,itwas seed-funding from the Australian racing industry which launched monoclonal antibodies to market. The deal was done on a boat on Sydney Harbour. He overheard a whispered comment “Let’s give Greg the money. Let’s see how the boffin trots”. Annual monoclonal revenues now well exceed $100 billion,to untold human benefit.

The Australian perspective has come full circle. Professor Daniel Christ is a former PhD student of Winter’s and is now at the Garvan Institute. He sees a way around this antibody resistance problem. And he looks to the experience in treating HIV infection with three different drugs which curbed that epidemic.

Since early 2020,his team has worked flat out to create monoclonals against COVID-19. They now have three antibodies which are more potent than Sotrovimab in vitro,When used together,they should be very resistant to mutation escape.

If these ventures succeed,Australians will have good reason to be thankful for investment in science.

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