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PEOPLE’S CHOICE
Our readers weigh in with their picks
for the top breakthrough this yearFor the first time since 2018, your
winner was our winner! This year’s
race for the People’s Choice award—
an annual honor chosen by Science
readers—was tight, with three finalists
running neck and neck in the last week
of voting on Twitter: ancient soil DNA,
CRISPR gene editing in the body, and
artificial intelligence–powered protein
structure predictions.
But after a final surge of support
for ancient soil DNA and more than
2100 votes cast, AI-powered protein
structure predictions—Science’s 2021
Breakthrough of the Year—kicked it in
to capture the gold.
This year’s breakthrough was itself
predicted in 2020, when it appeared as
a runner-up. Since then, the field has
exploded, with AI able to predict not
only protein structures, but also how
they form complexes and interact.Potent pills boost COVID-19 arsenal
Vaccines have had a starring role in the fight against COVID-19, but a new player is
joining them on stage: antiviral pills that prevent symptoms and death if taken early
in infection.
In the fall, drugmakers Pfizer and Merck & Co. touted positive clinical trial results
via press release. More antivirals are in trials, and existing generic drugs—including
the obsessive-compulsive disorder treatment fluvoxamine—may also prove useful.
Merck’s antiviral, molnupiravir, reduces the risk of hospitalization or death by 30% in
high-risk, unvaccinated individuals, according to final data submitted to regulators.
(That figure is lower than the 50% from an interim analysis.) Pfizer’s antiviral,
PF-07321332, reduces hospitalization by 89% if started within 3 days of symptoms.
The United Kingdom approved molnupiravir in November, and an advisory body
to the U.S. Food and Drug Administration has narrowly endorsed it; regulators
are also considering Pfizer’s treatment.
Scientists are quick to stress that antivirals can’t replace vaccination.
But they are still vital, and may become even more so if the new Omi-
cron variant causes a surge in breakthrough infections. Pfizer is running
another PF-07321332 trial in a group that includes vaccinated people, and
both Merck and Pfizer are testing whether the drugs can head off illness in
people who have recently been exposed.
Still, questions abound. Will the antivirals reduce transmission from in-
fected people? Can lower income countries access the supply they need? (Both
companies have pledged to sell the drugs in these places at a steep discount.) Will
there be side effects not seen in clinical trials? Despite uncertainties, scientists and
doctors are buoyed by the results—and pleased to have multiple therapies, which may
help keep the virus from becoming resistant to any one. —Jennifer Couzin-Frankel17 DECEMBER 2021 • VOL 374 ISSUE 6574 1429Merck’s molnupiravir cut the risk
of hospitalization or death from
COVID-19 by 30% in high-risk,
unvaccinated individuals.A researcher records
the locations of
sediment samples in
Mexico’s Chiquihuite Cave.Protein structure predictions 39%Ancient soil DNA 34%In vivo CRISPR 27%(^1)
(^2)
(^3)