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For months, Joelle Ruppert has been one of the millions of Americans who resist the covid vaccine. Her reluctance, she said, was not so much that she opposed the new vaccines, but that she had never felt “constrained” by the evidence supporting their experimental use.
Nonetheless, after falling ill with covid last month, Ruppert, a preschool teacher in Florida, found herself desperate to try an investigational product that promised to alleviate her symptoms: an infusion with a potent lab-produced treatment known as the name of monoclonal antibody therapy.
“I was in bed; I felt so bad, like the longest flu of my life,” said Ruppert, 54, of Gainesville. “I was, like, whatever, give me any what.”
Ruppert and her husband, Michael, 61, who also contracted covid-19, are among thousands in the United States who have rushed in recent weeks to receive infusions of the powerful antibody cocktails that are reducing hospitalizations by 70% when administered promptly to high-risk patients.
The rush was fueled in large part by governors in southern states, where vaccinations are lagging behind and hospital admissions are skyrocketing with delta-variant infections. Republican governors. Ron DeSantis of Florida and Greg Abbott of Texas are among the leaders touting antibody treatments even though they minimize vaccination and other measures that health officials say may prevent disease in the first place.
Together, they have opened dozens of state-sponsored sites where monoclonal antibody therapy is offered, holding regular press conferences to endorse the potentially life-saving benefits, while continuing to resist broader public health measures such as mask warrants and vaccine passports.
“Anyone who has an above-average risk with covid, if you’re infected, this is something you can do early on and potentially really make a difference,” DeSantis said on Saturday when opening a monoclonal antibody infusion site in Manatee County. .
Since mid-July, the delivery of the antibody cocktail manufactured by Regeneron Pharmaceuticals has increased from 25,000 doses to 125,000 doses per week, with about half shipped to four states: Florida, Texas, Mississippi and the United States. Alabama, said Alexandra Bowie, a spokesperson for the company. Treatments use molecules produced in the laboratory to replace, enhance, or mimic the body’s natural antibodies that fight infection.
The sudden spotlight on antibody treatments shocked some public health experts, who struggled for months to create and maintain sites capable of delivering the therapy. Treatment is administered primarily by an intravenous infusion of a dose that lasts about 25 minutes, followed by one hour of observation of reactions.
Antibody cocktails, which must be given within 10 days of infection or exposure to covid, are effective for many patients, but “it is not a substitute for the vaccine,” said Dr Christian Ramers , head of population health and infectious. disease specialist at Family Health Centers in San Diego.
“It’s a backwards strategy,” Ramers said. “It’s so much better to prevent disease than to use expensive, cumbersome, difficult-to-use therapy. It makes no medical sense to look at monoclonal drugs at the expense of vaccines. It’s like playing defense without attacking.
The cost of Regeneron infusions: approximately $ 1,250 per dose. For now, the federal government is covering the costs.
The federal government also covers the costs of the covid vaccination, at around $ 20 per dose.
Hospitals and infusion centers also charge a high cost in terms of time and resources for the administration of monoclonal antibody therapy. Medicare has agreed to pay providers between $ 310 and $ 450 to perform it in health care facilities – and $ 750 for treatment in a patient’s home.
Some patients who receive treatment may be billed similar amounts for co-payments and administration costs, depending on hospital costs and what their insurance covers. DeSantis pointed out that treatment is provided free of charge to patients at sites operated by the state of Florida.
The Food and Drug Administration cleared two monoclonal antibody treatments for emergency use for covid in November, weeks after President Donald Trump credited the product to Regeneron for curing his infection. Since then, the use of a cocktail made by Eli Lilly has been discontinued because it was not effective against certain variants of the covid. In May, sotrovimab, a monoclonal antibody made by the pharmaceutical company GlaxoSmithKline, also received emergency clearance.
Treatment is authorized for people newly infected with covid at high risk of hospitalization and for high-risk patients who have been exposed to the virus. Eligible individuals include a large portion of the American public: overweight or obese people; those with diabetes, heart disease or other illnesses; and those with weakened immune systems.
Covid vaccines have also been authorized under an emergency use protocol. This week, the Pfizer-BioNTech vaccine received full approval for use in people 16 years of age and older.
Christina Pushaw, spokesperson for DeSantis, said criticism of efforts to promote monoclonal antibody therapy amounted to “a false choice.”
“Prevention and treatment are not mutually exclusive,” she said in an email. “Monoclonal drugs and vaccines save lives. The difference is that vaccines are preventative and cannot help someone who is already infected with covid-19. “
Some health officials have praised the attention paid to monoclonal antibody therapy generated by DeSantis and others, saying the treatment has been undervalued and underused. The federal government has shipped more than 1.3 million doses of monoclonal products to nearly 6,300 sites, according to the Department of Health and Human Services. So far, around 637,000 doses – less than half – have been used.
“It’s not about vaccination. This is a treatment for covid that can prevent patients from going to hospital, ”said Connie Sullivan, president and CEO of the National Home Infusion Association business group. “It’s not about politics. These are patients at risk.
Still, some unvaccinated people seem to view antibody treatments as a back-up plan for illness, several health officials have said.
At Pembroke Memorial Hospital in South Florida, Chief Nursing Officer David Starnes has overseen the treatment of more than 2,000 patients with antibody cocktails since December. At least 90% of patients have not been vaccinated – and the numbers keep rising.
“What’s amazing to me is that a vaccine we’ve been working on for 10 years, they’re scared of it,” Starnes said. “But this highly experimental cocktail? They’re ready to run over there the minute they’re sick to infuse it into their body. “
Even those baffled by the emphasis on monoclonal rather than vaccination in some states say this new focus on treatment has helped counter a basic public relations problem: Until recently, knowledge of treatments monoclonal drugs, often called mAbs, were weak, leaving patients at risk of missing the 10-day treatment window.
Utah, where less than half of residents are vaccinated, is one of the states that is mounting an intensive, coordinated effort to reach people on time. Officials of the Utah-based Intermountain healthcare system have assembled a team of volunteer healthcare professionals, dubbed the “mAb Team,” who analyze lists of newly positive patients and call on those who meet the criteria. eligibility to put them in contact with the treatment.
Dr Curt Andersen, family doctor and associate medical director at Intermountain Healthcare, said he was seeing lists of 70 to 80 patients every day due to the increase in the delta. “I spoke to this gentleman who was treated. Then his wife was treated. Then his mother, who was at very high risk, ”said Andersen. “On the phone he broke down in tears because we had this resource and he was so grateful.”
Ruppert, the Gainesville preschool teacher, said she too was grateful. She and her husband both felt better within days of being treated at UF Health Shands Hospital. The experience led her to rethink how to protect herself and her family against covid.
“Now that I’ve been there, I have a completely different perspective on this,” said Ruppert, who will be eligible for the vaccination in mid-October, 90 days after the antibody infusion. “I will most likely be vaccinated. “
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