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- Tennessee recommends giving priority to unvaccinated residents for monoclonal antibody treatments.
- Vaccinated residents are behind them in the line, as they are less vulnerable to severe COVID-19.
- Monoclonal antibodies are rare because the Delta variant tears in unvaccinated areas.
Unvaccinated people in Tennessee now have priority access to one of the few COVID-19 drugs that have been shown to reduce hospitalizations and deaths: monoclonal antibody therapy.
The state government this week recommended that most vaccinated residents be the last to receive the treatment, which comes in the form of infusions or injections, the Tennessean reported on Monday.
The drugs are designed to mimic the body’s natural immune response by targeting certain coronavirus proteins and preventing them from entering our cells. The Food and Drug Administration cleared the first monoclonal antibody treatment for COVID-19 in November.
But drugs are scarce in Tennessee and the United States, as the Delta variant continues to spread in states with low vaccination rates. In Tennessee, where only 44% of the population is fully vaccinated, COVID-19 cases still exceed 5,000 per day.
As of September 13, the federal government had determined the number of monoclonal antibody treatments each state would receive based on that state’s number of COVID-19 cases and the amount of supply it uses each week. The government announced last week that hospitals can no longer order monoclonal antibodies directly from a wholesale supplier, AmerisourceBergen, due to shortages.
Tennessee therefore calls on healthcare workers to prioritize the most vulnerable, namely the unvaccinated, partially vaccinated, elderly and immunocompromised.
“It’s definitely an ethical dilemma,” Rodney Rohde, president of the Clinical Laboratory Sciences program at Texas State University, told Insider. “I pray and hope that no healthcare professional will ever be put in this situation.”
Rohde said Tennessee’s recommendation could potentially prompt other states to issue similar guidelines.
“It’s a mess when we get into legislation on who to deal with,” he added.
Vaccines offer better protection than antibody-based drugs
Debbie Bonnett administers a COVID-19 vaccine at a pop-up clinic at the Maple Leaf Bar in New Orleans on August 14, 2021.
Mario Tama / Getty Images
In a letter to Congress last week, seven Republican representatives from Tennessee called on the federal government to “do everything in its power” to increase the availability of monoclonal antibodies.
But disease experts point out that vaccines are the best approach. Injections reduce your risk of hospitalization by 71% to 93%, depending on which one you receive, according to a recent report from the Centers for Disease Control and Prevention. Recent studies also show that vaccines protect against serious illness for at least six months to a year.
While vaccines instruct the body to make a harmless viral protein and then develop antibodies against it, monoclonal antibodies help prevent people with mild or moderate symptoms from developing severe COVID-19 by preventing the virus from replicating. . Medicines should be administered within 10 days (ideally three to four) after the onset of symptoms.
“Monoclonal drugs essentially give you direct antibodies that are only passively protective – in other words, they work on that infection immediately at that point, but you are not protected in the long term,” Rohde said. “Vaccination is always critical in individuals because in theory you should get monoclonal drugs whenever you have a bad experience with a viral infection.”
In other words, he said, “an ounce of prevention is better than a pound of cure.”
Unvaccinated people have a greater medical need for antibody-based drugs
Patients wait for treatment inside the Regeneron Clinic at a monoclonal antibody treatment site in Pembroke Pines, Fla. On August 19, 2021.
Chandan Khanna / AFP / Getty Images
The United States has cleared three monoclonal antibody treatments for emergency use, GlaxoSmithKline, Regeneron and Eli Lilly. In a study of out-of-hospital COVID-19 patients, 3% of those who received Eli Lilly’s drug went to the hospital, compared to 10% of those who received a placebo. The Regeneron cocktail gave similar results. This suggests that monoclonal antibodies could reduce the risk of hospitalization by up to 70%.
The emergency clearance available to these three drugs is the same type as the Moderna and Johnson & Johnson vaccines. Pfizer’s vaccine, on the other hand, has been fully approved for general use in adults 16 years of age and older.
“A lot of the arguments people use for not technically getting the vaccine would also apply to these monoclonal antibodies,” Vivek Cherian, a doctor of internal medicine in Chicago, told Insider. “It’s a very, very new thing. It developed very quickly. She used modern science to make it happen. But people who don’t want to be vaccinated are ready to receive this treatment.”
People in the southern states seem to be particularly demanding antibody treatments. About 70% of orders for monoclonal antibodies in recent weeks have come from seven southern states, six of which have the lowest vaccination rates in the United States, MSNBC reported.
Since unvaccinated people are much more vulnerable to serious illness and death than unvaccinated people, it makes sense to give them first access to antibody-based drugs, Cherian said, even though the policy seems unfair to those vaccinated.
“If you feel like you are doing your part, your duty and your obligation to yourself, your family and society then you go to the hospital and they say ‘no’ because you did your due diligence , I understand why it can leave a bitter taste in someone’s mouth, ”he said. “But in general, it always seems like those most at risk, vaccinated or not, will still be qualified.”
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