‘Too close for comfort’: demand for antibodies rises under unjabbed

Newsletter: The road to recovery

When Selene Rico contracted Covid-19, she was concerned because she has diabetes, which puts people at higher risk of developing a serious disease. But like hundreds of thousands of unvaccinated Americans, she went to a health center last month for an infusion of monoclonal antibodies and felt better within days.

“One of the nurses told me this was the same infusion President Trump got when he got Covid-19 and he got better,” Rico told the Financial Times.

“That was another reason why I felt confident going through the treatment: They’re not going to do anything crazy to the president.”

Demand for antibody treatments made by Regeneron and Eli Lilly has increased twentyfold since mid-July as a deadly wave of Covid-19 sweeps across the nation, government said data. U.S. sales of Sotrovimab, a similar product made by GlaxoSmithKline, tripled in August compared to July, the company said.

Growing awareness of the treatments, the opening of new antibody infusion centers and an increase in infections in states with low vaccination rates are driving demand and driving multi-billion dollar sales for manufacturers.

But it has also created a supply shortage in some states, sparking a debate over who should have access to the expensive antibody treatments and whether they are a replacement for people who don’t want the vaccines.

Last month, the federal government took over the distribution of its stock of antibody treatments from AmerisourceBergen over concerns about unfair dose allocation.

Facts shows that seven southern states received more than half the doses in the week of Sept. 13. Six of the states — Texas, Louisiana, Mississippi, Georgia, Alabama and Tennessee — had vaccination rates below the national average.

Florida and Texas governors, who both oppose vaccine mandates and praised antibody treatments, criticized the federal government’s policy change and directly ordered additional supplies of Sotrovimab to address an expected shortage.

“There was a delusional leadership that said, you know, monoclonal antibodies are great and vaccines aren’t that great. And that really tilted things in the wrong direction,” said Eric Topol, director of the Scripps Institute for Translational Institute.

“A lot of people who are anti-vax think they can just go get the antibodies when they get sick. But it doesn’t work that way.”

Bar chart of % of population fully vaccinated, with vaccination coverage in key states

Health experts warn that antibody treatments only work well if used shortly after a Covid-19 infection and cannot provide the type of long-term protection against the virus that vaccines offer. They can play an important role in preventing people who are most at risk of becoming seriously ill, but they should not be used as a first line of defense against the virus.

In addition to the risks of relying on Covid-19 treatments rather than vaccines to tackle Covid-19, the drugs also cost a lot more. The US government is spending $2,100 for each dose of Regeneron’s antibody cocktail — a combination of casirivimab and imdevimab — under a $2.9 billion contract agreed last month to help make up for the treatment shortage.

Pfizer initially charged the US government $19.50 for a single dose of its vaccine, while Moderna charged the US government about $15 per injection.

The World Health Organization has asked Regeneron to lower its prices and provide more equitable access to its antibody treatment worldwide.

“Ironically, the vaccine is generally much cheaper and more effective. But we are in the midst of the crisis and as long as the funds are there to pay for these drugs, we should be using them,” said Jason Gallagher, a clinical professor at Temple University School of Pharmacy.

He said it was understandable, albeit problematic, that so many people thought they could be lucky and avoid severe Covid-19 without a vaccine. Nevertheless, they still need to access potentially life-saving antibody treatments, Gallagher said.

But access to antibody drugs in some parts of the US is difficult due to strong demand.

Leonard Schleifer, chief executive of Regeneron, blames the shortage of supply on policymakers and health experts, who initially avoided promoting antibody treatments over concerns it would deter people from getting vaccinated.

“The world was very focused on vaccines and treatments were more or less ignored,” he told the Financial Times.

“We should have taught people that vaccines are the best first line of defense. But if you got sick and didn’t respond to the vaccine or, or you weren’t vaccinated, there was an effective treatment, especially if it was given early.”

Schleifer said that when the Delta wave hit in August, the number of treatments distributed by Regeneron in the US rose to 250,000 per week, from about 1,000 in June. The government needed to meet with the company as soon as possible to plan demand for 2022, he added.

Health experts say: development of antiviral pills by Merck could reduce demand for antibody treatments next year. Late-stage study data shows that molnupiravir reduces hospitalizations and deaths by 50 percent. But the pills still haven’t been approved for use by regulators, meaning they can’t address the current treatment shortages.

At the San Diego Family Health Centers, where Rico had her antibody infusion, supplies nearly ran out last week.

“It came too close for comfort last week with only 100 doses in the fridge,” said Christian Ramers, an infectious disease specialist at the center.

He said the center followed national guidelines that prioritized those most at risk from Covid, meaning unvaccinated people are first in line. But as a “public health-conscious person,” it just doesn’t make sense to use such a drug in people who could have avoided infection with a much cheaper shot, Ramers added.

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