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Open letter from Protect Our Province BC to Premier David Eby, Minister of Health Adrian Dix and Provincial Health Officer Dr. Bonnie Henry, calling for broader access to Paxlovid for British Columbians:

Dear Premier Eby, Health Minister Dix, and Provincial Health Officer Dr. Bonnie Henry,

Protect Our Province BC is calling for an immediate increase in access to the antiviral medication, Paxlovid (Nirmatrelvir-Ritonavir) for the treatment of mild to moderate COVID-19. 

BC is currently at one of the most dangerous times of the pandemic with a triple surge of RSV, Influenza and COVID-19, all while our hospitals are in crisis.

At the same time, doctors in British Columbia have been notified that all monoclonal antibody agents are no longer effective against the newer Omicron subvariants.
Thankfully, studies are showing that Paxlovid is still effective against the Omicron subvariants.

And yet, in BC Paxlovid is being drastically under used. As of September 12, 2022, only 12,191 doses of Paxlovid have been prescribed out of the 73,533 doses provided by the Canadian Federal government. 

Amongst all provinces, BC has one of the most restrictive eligibility policies. Access to Paxlovid should never be determined by the province you live in. British Columbians should have equal access to COVID therapies as any other Canadians do. Currently they do not.

In BC, a fully vaccinated non-immunocompromised person needs to be age 70 or older, and have 3 or more medical conditions to qualify for Paxlovid. Most provinces have a much lower age limit, with no to only one medical condition as eligibility criteria.

BC’s own data supports a lower age of eligibility. 60-69 year olds have a higher total number of  ICU admissions exceeding those in the 70-79 years (Table Severe Outcomes: new hospitalizations and deaths, BC Covid-19 Situation Report, Week 48, Dec.3, 2022). 

By comparison, in Manitoba and New Brunswick, anyone 18 years and older with ONE or more risk for severe outcome qualifies. In PEI, anyone over the age of 50 qualifies, regardless of vaccination status and associated medical conditions.

In Ontario, Paxlovid is available to 18-59 year olds with at least one medical condition or with incomplete vaccination, or who are beyond six months of their last booster. 

As well, in Ontario, individuals are considered at high risk for disease progression, based on social determinants of health. This high risk group includes racialised people, those with cognitive or intellectual disabilities, people who use drugs, people with mental health conditions and people who are underhoused. BC does include Indigenous peoples but no other racialized communities. As for other social determinants of health, some were quietly added as eligible chronic conditions or co-morbidities on December 16 and are now part of BC’s Paxlovid eligibility criteria. 

This is why Protect Our Province BC is calling for the following immediate changes:

1. The government must increase the public’s awareness of Paxlovid as a medication that taken early can prevent hospitalization, death and most likely also Long COVID and Post Acute Sequelae of COVID. 
2. Lower the age criteria for Paxlovid eligibility to age 50, with no underlying conditions and regardless of vaccination status. New data is showing that age 50 is the immune inflection point for COVID-19 infections, as well Paxlovid has demonstrated significant reductions in hospitalizations and death in those aged 50 and older.
3. Increase the awareness among clinicians and the public of social determinants of health as risk factors for poor COVID-19 outcomes, and the need to factor these into Paxlovid eligibility.  In addition to Indigenous peoples include other racialized communities as Ontario has already done.
4. As in many other Canadian provinces, allow pharmacists to prescribe Paxlovid without a physician's prescription in order to increase accessibility.
5. Publicize the pre-emptive prescription for Paxlovid to all eligible patients, family physicians, specialists and pharmacists. Public Health knows who are the Clinically Extremely Vulnerable patients in BC, all of them should have a conversation with their family physician or specialist with an Action Plan in place should they get COVID.

There is emerging evidence that Paxlovid may help prevent Long COVID with a 25% reduction in Post Acute Sequelae of Covid (PASC) including heart disease, blood clots, liver disease, kidney disease and neurocognitive disorders. 

Better access to Paxlovid will prevent more workers from developing Long Covid and help BC’s labour shortages in healthcare as well as other industries. From WorkSafeBC data, as of November 30th, 15,007 COVID claims have been approved including 8,491 (57%) from health care workers. 

In BC, we are under-using a very effective treatment for COVID-19 which can potentially not only decrease hospitalizations, critical care admissions and deaths but also prevent Long COVID disability and the development of chronic diseases due to Post Acute Covid Sequelae. Given that our healthcare system can barely cope as it is, limiting further burden becomes imperative.