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In Tennessee, frontline patients for Covid-19 monoclonal antibody treatment are likely the ones who landed in the emergency room because they did not get the vaccine.
An extraordinary demand coupled with the need for the federal government to cap shipments of these rare drugs has forced health officials in Tennessee to recommend limiting treatment to unvaccinated patients with the worst cases of Covid-19.
But it raises ethical questions, public health experts said, about who should get this treatment and who shouldn’t.
“For example, if a patient who had a heart transplant had received the vaccine but is still at risk of severe Covid-19 infection was denied access to antibody treatment that could have reduced the severity of his infection, how is that fair? asked Dr. Sadiya Khan, epidemiologist at Northwestern University Feinberg School of Medicine.
Tennessee’s senior health official Dr. Lisa Piercey agreed that the state’s “logical” move is unlikely to be popular.
“Clinically, it makes sense,” Piercey said on Friday, The Tennessean reported. “But the doctor in me is thinking about all those ‘what if? What if there is an elderly person at very high risk, but they are not technically considered to be immunocompromised? Don’t get it, but an unvaccinated 22 year old with asthma – do they get it? “
According to Tennessee’s recommendations, immunocompromised vaccinated people will also be eligible for treatment, Piercey said.
Tennessee, which follows guidelines from the National Institutes of Health, appears to be the first state to recommend limiting monoclonal antibody therapy to unvaccinated or vaccinated but immunocompromised Covid-19 patients.
“If we had enough to give this to everyone at risk of hospitalization, that would be ideal,” said Dr. Karen Bloch of Vanderbilt University Medical Center at Tennessean. “But with this limited resource, it makes sense to identify those most at risk. Outside of politics, the unvaccinated fall into this category. “
Treatment with monoclonal antibodies decreases the severity of symptoms of Covid-19, and with more cases of the highly infectious delta variant, demand has skyrocketed.
But in recent months, 70% of the country’s supply has gone to seven southern states: Alabama, Florida, Texas, Mississippi, Tennessee, Georgia and Louisiana.
All except Louisiana are led by Republicans who have opposed mandatory vaccination against Covid-19. And all but Florida have below average Covid-19 vaccination rates.
“The recent increase in COVID-19 cases has caused a substantial increase in the use of monoclonal antibody drugs, especially in areas of the country with low vaccination rates,” said Dr Daniel Skovronsky, scientific and medical director of Eli Lilly and Company. in a recent statement.
Tennessee’s vaccination rate is 44.1%, which is one of the worst in the country, according to the latest statistics from the Mayo Clinic.
Last week, the Biden administration ordered more doses from the two main suppliers, Regeneron and Eli Lilly and Company, and informed state officials that it would start capping drug shipments to ensure that there is enough for the rest of the country.
“Our offer is not unlimited,” White House spokeswoman Jen Psaki said. “And we think it should be fair among states across the country. “
The move drew immediate criticism from Republican governors in Florida, Mississippi and Texas (Ron DeSantis, Tate Reeves and Greg Abbott).
DeSantis, in particular, touted expensive monoclonal antibody treatments (around $ 2,100 per dose) but refused to impose much cheaper vaccines (between $ 10 and $ 20 per dose) or proven safety measures like the wearing masks.
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