Tag: #Diverse

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International & World

‘Eye of the storm’: Diverse east London grapples with virus

Road cleaners work in the town centre of Ilford in London, Friday, Jan. 29, 2021. In parts of east London, the pandemic is hitting much harder than most places in the U.K. The borough of Redbridge had the nation’s second worst infection rate in January, with an estimated 1 in 15 residents thought to be infected. (AP Photo/Frank Augstein)

 

LONDON (AP) — Taxicab driver Gary Nerden knows colleagues who got seriously ill from COVID-19. He knows the area of east London where he lives and works has among the highest infection rates in the whole of England. But since he can’t afford not to work, he drives around picking up strangers for up to 12 hours a day, relying on a flimsy plastic screen to keep him safe.

“I’ve got people telling me they won’t wear a mask, saying they’re exempt,” said Nerden, 57. “I’ve got diabetes, I have to look after myself. I wipe the handles, the seat belt, after every customer, but that’s all I can do, really.”

Nerden and his wife, a hospital administrative worker, live in the outer London borough of Redbridge, which in mid-January had the country’s second-highest rate of residents testing positive for the coronavirus: 1,571 cases per 100,000 people. Official figures estimated that at one point, 1 in 15 people there had COVID-19 — even after the government imposed a third national lockdown to control a fast-spreading, more contagious variant of the virus.

Redbridge and its surrounding areas, which lie on a commuter belt between the capital’s northeast and coastal Essex, have been dubbed the “COVID triangle” because they all topped England’s worst infection rates in recent weeks. While case rates have come down significantly, local leaders said the situation remained critical and the borough was still “in the eye of the storm.”

They say the area’s large number of essential workers in public-facing jobs, combined with dense housing and high levels of poverty, contribute to why the virus has hit it much harder than most places in the U.K. Those factors also make fighting the pandemic there particularly challenging.

“We have some of the most front-line workers here in the community: the taxi drivers, the NHS (National Health Service) workers, the train drivers going into central London, the commuter workers, the cleaners,” Redbridge Council leader Jas Athwal said.

“People are taking their chances — is it about feeding my children, or risking myself with COVID? And of course, they need to feed their children,” Athwal added. “All that accounts for the excess number of virus infections, the deaths, because people are having to go out to do their job.”

Many of those lower-income workers with high exposure to the virus are from ethnic minority backgrounds, who are among the most at-risk — as well as the hardest to persuade to get vaccinated. Redbridge’s population is among the most diverse in the country, with large Indian, Pakistani and Bangladeshi communities and fewer than 40% of residents identifying as white British.

Numerous studies have shown that the pandemic is causing disproportionate serious illness and deaths among ethnic minorities and those from poorer households. In the U.K., Public Health England found that after accounting for factors like age and sex, people of Bangladeshi heritage were dying from COVID-19 at twice the rate of white Britons. Black people and other Asian groups also had a 10% to 50% higher risk of death.

Experts say that is due to a combination of factors. People from minority groups are more likely to live in crowded housing and to take poorly ventilated public transport to go to work. They are also more likely to have long-term conditions like heart disease and diabetes that increase their risk of becoming seriously ill if they catch the virus.

Khayer Chowdhury, a Redbridge councilor of Bangladeshi descent, said many Asian households in the borough are multigenerational families living together under one roof, giving the virus greater opportunity to spread.

“Our diversity makes us unique, but it also makes us vulnerable,” he said.

Britain has lost more than 100,000 lives to the coronavirus, the worst death toll in Europe.

“Here in the community, everybody knows somebody who’s passed away,” Athwal said. “The fear is finally starting to hit home.”

Officials say a small but increasing number of people are breaking restrictions, partly because of fatigue with lockdown rules. Enforcement officers have broken up gatherings and “car meets,” shutting down and fining clubs and restaurants for hosting parties. On a recent weekday, a large team of police officers patrolled the main shopping street, which bustled with a steady stream of people despite the government’s “stay at home” message.

But the bigger challenge is on the vaccination front. Several U.K.-based studies have suggested that vaccine take-up rates for both the coronavirus and other jabs among Black people and minorities are significantly lower than that in the general population. Some researchers say that’s caused by longstanding distrust of authorities and disengagement from public health messages, and exacerbated by anti-vaccine posts on social media.

Full Coverage: Coronavirus pandemic

Local resident Salman Khan and his wife said they were not sure they would have the jab if offered, because the pandemic has made them question “whether the government and the news is telling the truth.”

Dr. Anil Mehta, a local doctor, said health officials are making every effort to reach the poorest and hardest to reach communities. This week he is offering vaccine shots out at homeless shelters, hoping to inoculate the area’s many refugees and those sleeping rough. He said he’s also taken up the role of “myth-buster,” trying to dispel misinformation and conspiracy theories.

“People believe in all sorts of things — this is affecting fertility, or against Black Lives Matter,” Mehta said. “There is a lot of hesitancy, whether they want it, whether they trust us. That’s our battle at the moment.”

___

Follow all of AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic, https://apnews.com/hub/coronavirus-vaccine and https://apnews.com/UnderstandingtheOutbreak

 

— Associated Press

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For Edit

Even as Trump cut immigration, immigrants transformed U.S.

The past four years have seen a steep reduction in immigration. But the country is becoming ever more diverse.

To grasp the impact of the latest great wave of immigration to the United States, consider the city of Grand Island, Neb.: More than 60 percent of public school students are nonwhite, and their families collectively speak 55 languages. During drop-off at Starr Elementary on a recent morning, parents bid their children goodbye in Spanish, Somali and Vietnamese.

“You wouldn’t expect to see so many languages spoken in a school district of 10,000,” said Tawana Grover, the school superintendent who arrived from Dallas four years ago. “When you hear Nebraska, you don’t think diversity. We’ve got the world right here in rural America.”

The students are the children of foreign-born workers who flocked to this town of 51,000 in the 1990s and 2000s to toil in the area’s meatpacking plants, where speaking English was less necessary than a willingness to do the grueling work.

They came to Nebraska from every corner of the globe: Mexicans, Guatemalans and Hondurans who floated across the Rio Grande on inner tubes, in search of a better life; refugees who fled famine in South Sudan and war in Iraq to find safe haven; Salvadorans and Cambodians who spent years scratching for work in California and heard that jobs in Nebraska were plentiful and the cost of living low.

The story of how millions of immigrants since the 1970s have put down lasting roots across the country is by now well-known. What is less understood about President Trump’s four-year-long push to shut the borders and put “America First” is that his quest may prove ultimately a futile one. Even with one of the most severe declines in immigration since the 1920s, the country is on an irreversible course to becoming ever more diverse, and more dependent on immigrants and their children.

The president since the moment he took office issued a torrent of orders that reduced refugee admissions; narrowed who is eligible for asylum; made it more difficult to qualify for permanent residency or citizenship; tightened scrutiny of applicants for high-skilled worker visas and sought to limit the length of stay for international students. His policies slashed the number of migrants arrested and then released into the country from nearly 500,000 in fiscal 2019 to 15,000 in fiscal 2020.

The measures worked: “We are going to end the decade with lower immigration than in any decade since the ’70s,” said William Frey, a senior fellow at the Brookings Institution, who analyzed newly available census data.

The president-elect, Joseph R. Biden Jr. has pledged to reverse many of the measures. He has vowed to reinstate Deferred Action for Childhood Arrivals, known as DACA, an Obama-era program that allowed young adults mainly brought to the United States illegally as children to remain, and to resume accepting refugees and asylum seekers in larger numbers.

He has also said he would introduce legislation to offer a path to citizenship for people in the country illegally.

The foreign-born population grew by 5.6 million in the ’80s, 8.8 million in the ’90s and 11.3 million in the 2000s.

By the time Mr. Trump took office, this contemporary wave of immigration had lifted the foreign-born population to 44.5 million, representing 13.7 percent of the population, the biggest share since 1910. Among them were about 11 million undocumented immigrants.

During his first week in office, the president introduced a travel ban to halt the entry of people from many Muslim countries and paused refugee resettlement, citing terrorist threats.

As Central American migrants fleeing violence and poverty showed up at the border by the busload, his administration introduced policies to deter them, including the separation of migrant children from their parents.

He was able to do it by bypassing a Congress that has long been deadlocked on immigration reform, issuing a series of executive orders and proclamations that rapidly shut the door on immigration despite a flurry of legal challenges.

“Trump has demonstrably proven that you don’t need a grand deal to tackle immigration and border security,” said James Carafano of the Heritage Foundation, a conservative think tank.

Average net migration shrank by 45 percent between 2017 and 2019 from an average of 953,000 during the previous seven years, as fewer immigrants arrived and more left, according to a Center for Immigration Studies analysis of census data.

There will be an even more precipitous decline recorded by the close of 2020 following visa restrictions imposed by the president amid the coronavirus pandemic.

“This year is truly unprecedented in how dramatic and fast this decline in immigration has been,” said David Bier, an immigration analyst at the libertarian Cato Institute. “Outside of wars and the Great Depression, we have never seen a level of immigration like we are seeing right now.”

Mr. Trump put much of the focus on disparaging refugees and immigrants as drains on public coffers and championing a wall on the southwestern border.

Yet all the attention on the border ignored the much more significant growth in immigration that was happening elsewhere in the country.

The number of immigrants of Asian origin grew by 2.8 million in the nine years ending 2019, more than from any other region. The biggest gains were among Indians and Chinese; the number of Mexicans dropped by 779,000.

Many of the recent immigrants have settled in parts of the country where there is a low concentration of foreign-born people, including in states that voted for Mr. Trump in both 2016 and 2020.

Among them are Shikha Jaiswal, a nephrologist, and her husband, Nihit Gupta, a child and adolescent psychiatrist, who came to the United States from India to complete their residencies and are building their careers in a medically underserved area of West Virginia.

Small-town America has come to rely on a pipeline of foreign doctors. “People have been very kind and grateful at the same time, making it a very rewarding experience,” Dr. Jaiswal said.

The children of immigrants who are already here will continue to make the United States more diverse: The 2020 census is expected to show that more than half of people under 18 are people of color.

“The mainstream now increasingly includes people who are nonwhite, particularly from immigrant backgrounds,” said Richard Alba, a sociology professor at the City University of New York Graduate Center.

The movement of the baby boom generation out of the labor force amid a plummeting birthrate is accelerating the trend and intensifying the need for new immigrant labor to pay the Social Security and Medicare bills for retiring Americans.

“It’s not that native-born kids can’t take the boomers’ jobs; it’s that there are not enough of these kids to take them,” said Dowell Myers, a demographer at the University of Southern California who researches the subject.

That diversity is already being reflected in the higher rungs of the work force.

For much of the second half of the 20th century, white workers held a virtual monopoly on the best-paying positions. But by 2015, among top-earning workers under 50, about a third were nonwhite, mainly Latinos or Asians of immigrant origin, according to research by Mr. Alba, who predicts that their share will only grow.

A study released last month found that nearly 30 percent of all students enrolled in colleges and universities in 2018 hailed from immigrant families, up from 20 percent in 2000.

“When you start having cohorts of college graduates that are so diverse, it’s going to change the work force, which means more people from diverse backgrounds moving into positions of authority and high remuneration,” Mr. Alba said. “There’s no going back.”

 

— NYT: Top Stories

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Healthcare

Merck to present new data from the company’s diverse HIV portfolio and pipeline at HIV Glasgow 2020

Researchers Will Present Week 96 Data from Phase 2b Study Evaluating Islatravir in Combination with Doravirine, and Phase 1/1b Data for MK-8507, an Investigational NNRTI for the Treatment of HIV-1 Infection

Company Plans to Advance MK-8507 into Phase 2 Evaluating its Efficacy and Safety in Combination with Islatravir as a Once-Weekly Oral Regimen

KENILWORTH, N.J.–(BUSINESS WIRE)–$MRK #MRK–Merck (NYSE: MRK), known as MSD outside the United States and Canada, announced today that nine abstracts from the company’s diverse HIV portfolio and pipeline will be presented at the 2020 International Congress on Drug Therapy in HIV Infection (HIV Glasgow 2020, October 5-8, 2020). During the congress, researchers will present new data from Merck’s HIV development program, including 96-week results from efficacy and safety analyses from the Phase 2b study of islatravir (Merck’s investigational nucleoside reverse transcriptase translocation inhibitor (NRTTI)) in combination with doravirine (PIFELTRO™) in adults with HIV-1 infection who had not previously received antiretroviral treatment. Additionally, Merck will share results from Phase 1/1b studies of MK-8507, an investigational oral non-nucleoside reverse transcriptase inhibitor (NNRTI) under development for once-weekly oral administration in combination with islatravir. These and other data, including 144-week results from the Phase 3 DRIVE-SHIFT study evaluating the effect of switching from a stable antiretroviral therapy (ART) regimen to DELSTRIGO™ (doravirine/lamivudine/tenofovir disoproxil fumarate), will be shared via oral and poster presentations during the virtual congress.

“Merck remains at the forefront of research to develop new medicines for people living with HIV. The new data we will present at HIV Glasgow 2020 from our HIV research programs – for doravirine, islatravir, and now MK-8507 – demonstrate our sustained innovation and unwavering commitment to help address the global burden of HIV,” said Dr. Joan Butterton, vice president, infectious diseases, Global Clinical Development, Merck Research Laboratories. “Our plans to evaluate MK-8507 as a potential partner with islatravir, as well as the ongoing clinical trials of islatravir and doravirine, illustrate the diversity of candidates in our HIV pipeline and our quest to transform the way HIV is treated.”

Select abstracts in the HIV Glasgow 2020 program include:

  • Islatravir in combination with doravirine maintains HIV-1 viral suppression through 96 weeks. Oral Presentation O415. Abstract 4913173. J.M. Molina et al.
  • Renal safety through 96 weeks from a phase 2 trial (P011) of islatravir and doravirine in treatment-naïve adults with HIV-1. Poster Presentation P048. Abstract 4919993. F. Post et al.
  • Analysis of protocol defined virologic failure through 96 weeks from a phase 2 trial (P011) of islatravir and doravirine in treatment-naïve adults with HIV-1. Poster Presentation P047. Abstract 4913025. C. Orkin et al.
  • Long-term treatment safety and efficacy following switch to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF): Week 144 results of the DRIVE-SHIFT trial. Poster Presentation P037. Abstract 4922614. P. Kumar et al.
  • Single doses of MK-8507, a novel HIV-1 NNRTI, reduced HIV viral load for at least a week. Oral Presentation O416. W. Ankrom et al.
  • Safety, tolerability and pharmacokinetics following single- and multiple-dose administration of the novel NNRTI MK-8507 with a midazolam interaction arm. Poster Presentation P099. Abstract 4913210. W. Ankrom et al.
  • Islatravir Selects for HIV-1 Variants in MT4-GFP cells that Profoundly Reduce Replicative Capacity in PBMCs and Reduce Susceptibility to Islatravir but not NRTIs. Poster Presentation P120. Abstract 4920686. T. Diamond et al.

For more information, including details around the virtual programming, please visit the HIV Glasgow 2020 website.

Indications and Usage for PIFELTRO and DELSTRIGO

PIFELTRO is indicated in combination with other antiretroviral (ARV) agents for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to doravirine.

DELSTRIGO is indicated as a complete regimen for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of DELSTRIGO.

Selected Safety Information about PIFELTRO and DELSTRIGO

Warning: Posttreatment Acute Exacerbation of Hepatitis B (HBV)

All patients with HIV-1 should be tested for the presence of HBV before initiating ARV therapy. Severe acute exacerbations of HBV have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued products containing lamivudine or tenofovir disoproxil fumarate (TDF), which are components of DELSTRIGO. Patients coinfected with HIV-1 and HBV who discontinue DELSTRIGO should be monitored with both clinical and laboratory follow-up for at least several months after stopping DELSTRIGO. If appropriate, initiation of anti-HBV therapy may be warranted.

PIFELTRO and DELSTRIGO are contraindicated when co-administered with drugs that are strong cytochrome P450 (CYP)3A enzyme inducers (including the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, and phenytoin; the androgen receptor inhibitor enzalutamide; the antimycobacterials rifampin and rifapentine; the cytotoxic agent mitotane; and the herbal product St. John’s wort (Hypericum perforatum)), as significant decreases in doravirine plasma concentrations may occur, which may decrease the effectiveness of DELSTRIGO and PIFELTRO.

DELSTRIGO is contraindicated in patients with a previous hypersensitivity reaction to lamivudine.

Renal impairment, including cases of acute renal failure and Fanconi syndrome, have been reported with the use of TDF. DELSTRIGO should be avoided with concurrent or recent use of a nephrotoxic agent (e.g., high-dose or multiple NSAIDs). Cases of acute renal failure after initiation of high-dose or multiple NSAIDs have been reported in patients with risk factors for renal dysfunction who appeared stable on TDF.

Prior to or when initiating DELSTRIGO, and during treatment, assess serum creatinine, estimated creatinine clearance, urine glucose, and urine protein in all patients. In patients with chronic kidney disease, also assess serum phosphorus. Discontinue DELSTRIGO in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome. Discontinue DELSTRIGO if estimated creatinine clearance declines below 50 mL/min.

In clinical trials in HIV-1 infected adults, TDF was associated with slightly greater decreases in bone mineral density (BMD) and increases in biochemical markers of bone metabolism. Serum parathyroid hormone levels and 1,25 Vitamin D levels were also higher. Cases of osteomalacia associated with proximal renal tubulopathy have been reported with the use of TDF.

Immune reconstitution syndrome can occur, including the occurrence of autoimmune disorders with variable time to onset, which may necessitate further evaluation and treatment.

Because DELSTRIGO is a complete regimen, co-administration with other antiretroviral medications for the treatment of HIV-1 infection is not recommended.

Co-administration of PIFELTRO with efavirenz, etravirine, or nevirapine is not recommended.

If DELSTRIGO is co-administered with rifabutin, take one tablet of DELSTRIGO once daily, followed by one tablet of doravirine (PIFELTRO) approximately 12 hours after the dose of DELSTRIGO.

If PIFELTRO is co-administered with rifabutin, increase PIFELTRO dosage to one tablet twice daily (approximately 12 hours apart).

Consult the full Prescribing Information prior to and during treatment for more information on potential drug-drug interactions.

Because DELSTRIGO is a fixed-dose combination tablet and the dosage of lamivudine and TDF cannot be adjusted, DELSTRIGO is not recommended in patients with estimated creatinine clearance less than 50 mL/min.

The most common adverse reactions with DELSTRIGO (incidence ≥5%, all intensities) were dizziness (7%), nausea (5%), and abnormal dreams (5%). The most common adverse reactions with PIFELTRO (incidence ≥5%, all intensities) were nausea (7%), dizziness (7%), headache (6%), fatigue (6%), diarrhea (6%), abdominal pain (5%), and abnormal dreams (5%).

By Week 96 in DRIVE-FORWARD, 2% of adult subjects in the PIFELTRO group and 3% in the DRV+r group had adverse events leading to discontinuation of study medication.

By Week 96 in DRIVE-AHEAD, 3% of adult subjects in the DELSTRIGO group and 7% in the EFV/FTC/TDF group had adverse events leading to discontinuation of study medication.

In DRIVE-FORWARD, mean changes from baseline at Week 48 in LDL-cholesterol (LDL-C) and non-HDL-cholesterol (non-HDL-C) were pre-specified. LDL-C: -4.6 mg/dL in the PIFELTRO group vs 9.5 mg/dL in the DRV+r group. Non-HDL-C: -5.4 mg/dL in the PIFELTRO group vs 13.7 mg/dL in the DRV+r group. The clinical benefits of these findings have not been demonstrated.

In DRIVE-AHEAD, mean changes from baseline at Week 48 in LDL-cholesterol (LDL-C) and non-HDL-cholesterol (non-HDL-C) were pre-specified. LDL-C: -2.1 mg/dL in the DELSTRIGO group vs 8.3 mg/dL in the EFV/FTC/TDF group. Non-HDL-C: -4.1 mg/dL in the DELSTRIGO group vs 12.7 mg/dL in the EFV/FTC/TDF group. The clinical benefits of these findings have not been demonstrated.

In DRIVE-SHIFT, mean changes from baseline at Week 48 in LDL-cholesterol (LDL-C) and non-HDL-cholesterol (non-HDL-C) were pre-specified. LDL-C: -16.3 mg/dL in the DELSTRIGO group vs -2.6 mg/dL in the PI + ritonavir group. Non-HDL-C: -24.8 mg/dL DELSTRIGO group vs -2.1 mg/dL in the PI + ritonavir group. The clinical benefits of these findings have not been demonstrated.

In DRIVE-AHEAD, neuropsychiatric adverse events were reported in the three pre-specified categories of sleep disorders and disturbances, dizziness, and altered sensorium. Twelve percent of adult subjects in the DELSTRIGO group and 26% in the EFV/FTC/TDF group reported neuropsychiatric adverse events of sleep disorders and disturbances; 9% in the DELSTRIGO group and 37% in the EFV/FTC/TDF group reported dizziness; and 4% in the DELSTRIGO group and 8% in the EFV/FTC/TDF group reported altered sensorium.

The safety of DELSTRIGO in virologically-suppressed adults was based on Week 48 data from subjects in the DRIVE-SHIFT trial. Overall, the safety profile in virologically-suppressed adult subjects was similar to that in subjects with no ARV treatment history.

Serum ALT and AST Elevations: In the DRIVE-SHIFT trial, 22% and 16% of subjects in the immediate switch group experienced ALT and AST elevations greater than 1.25 X ULN, respectively, through 48 weeks on DELSTRIGO. For these ALT and AST elevations, no apparent patterns with regard to time to onset relative to switch were observed. One percent of subjects had ALT or AST elevations greater than 5 X ULN through 48 weeks on DELSTRIGO. The ALT and AST elevations were generally asymptomatic, and not associated with bilirubin elevations. In comparison, 4% and 4% of subjects in the delayed switch group experienced ALT and AST elevations of greater than 1.25 X ULN through 24 weeks on their baseline regimen.

There is a pregnancy exposure registry that monitors pregnancy outcomes in individuals exposed to PIFELTRO or DELSTRIGO during pregnancy. Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263. Mothers infected with HIV-1 should be instructed not to breastfeed if they are receiving PIFELTRO or DELSTRIGO due to the potential for HIV-1 transmission.

About Islatravir (MK-8591)

Islatravir (formerly MK-8591) is Merck’s investigational nucleoside reverse transcriptase translocation inhibitor (NRTTI) currently being evaluated in clinical trials for the treatment of HIV-1 infection in combination with other antiretrovirals, as well as for pre-exposure prophylaxis (PrEP) of HIV-1 infection as a single investigational agent, across a variety of formulations.

Our Commitment to HIV

For more than 30 years, Merck has been committed to scientific research and discovery in HIV, and we continue to be driven by the conviction that more medical advances are still to come. Our focus is on pursuing research that addresses unmet medical needs and helps people living with HIV and their communities. We remain committed to working hand-in-hand with our partners in the global HIV community to address the complex challenges that hinder continued progress.

Our Commitment to Infectious Diseases

For more than 100 years, Merck has contributed to the discovery and development of novel medicines and vaccines to combat infectious diseases. In addition to a combined portfolio of vaccines and antibacterial, antiviral and antifungal medicines, Merck has multiple programs that span discovery through late-stage development. To learn more about Merck’s infectious diseases pipeline, visit www.merck.com.

About Merck

For more than 125 years, Merck, known as MSD outside of the United States and Canada, has been inventing for life, bringing forward medicines and vaccines for many of the world’s most challenging diseases in pursuit of our mission to save and improve lives. We demonstrate our commitment to patients and population health by increasing access to health care through far-reaching policies, programs and partnerships. Today, Merck continues to be at the forefront of research to prevent and treat diseases that threaten people and animals – including cancer, infectious diseases such as HIV and Ebola, and emerging animal diseases – as we aspire to be the premier research-intensive biopharmaceutical company in the world. For more information, visit www.merck.com and connect with us on Twitter, Facebook, Instagram, YouTube and LinkedIn.

Forward-Looking Statement of Merck & Co., Inc., Kenilworth, N.J., USA

This news release of Merck & Co., Inc., Kenilworth, N.J., USA (the “company”) includes “forward-looking statements” within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. These statements are based upon the current beliefs and expectations of the company’s management and are subject to significant risks and uncertainties. There can be no guarantees with respect to pipeline products that the products will receive the necessary regulatory approvals or that they will prove to be commercially successful. If underlying assumptions prove inaccurate or risks or uncertainties materialize, actual results may differ materially from those set forth in the forward-looking statements.

Risks and uncertainties include but are not limited to, general industry conditions and competition; general economic factors, including interest rate and currency exchange rate fluctuations; the impact of the global outbreak of novel coronavirus disease (COVID-19); the impact of pharmaceutical industry regulation and health care legislation in the United States and internationally; global trends toward health care cost containment; technological advances, new products and patents attained by competitors; challenges inherent in new product development, including obtaining regulatory approval; the company’s ability to accurately predict future market conditions; manufacturing difficulties or delays; financial instability of international economies and sovereign risk; dependence on the effectiveness of the company’s patents and other protections for innovative products; and the exposure to litigation, including patent litigation, and/or regulatory actions.

The company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in the company’s 2019 Annual Report on Form 10-K and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov).

Please see Prescribing Information for PIFELTRO (doravirine) at: https://www.merck.com/product/usa/pi_circulars/p/pifeltro/pifeltro_pi.pdf; and Patient Information for PIFELTRO (doravirine) at: https://www.merck.com/product/usa/pi_circulars/p/pifeltro/pifeltro_ppi.pdf

Please see Prescribing Information for DELSTRIGO (doravirine/3TC/TDF) at: https://www.merck.com/product/usa/pi_circulars/d/delstrigo/delstrigo_pi.pdf and Patient Information for DELSTRIGO (doravirine/3TC/TDF) at: https://www.merck.com/product/usa/pi_circulars/d/delstrigo/delstrigo_ppi.pdf

Contacts

Media:

Pamela Eisele

(267) 305-3558

Sarra S. Herzog

(201) 669-657

Investors:

Peter Dannenbaum

(908) 740-1037

Michael DeCarbo

(908) 740-1807

October 1, 2020