It’s been about six months since pharmaceutical maker AstraZeneca launched a COVID-19 antibody treatment called Evusheld. It aims to prevent COVID-19 from infecting people with weak immune systems. For many of them, the COVID vaccine is not working. The government has authorized Evusheld for emergencies and is responsible for its purchase and distribution, as was the case with the introduction of COVID vaccines.
But there was a discrepancy between the amount of Evusheld the government was buying and the amount getting to patients, said Marcia Boyce, who suffers from a blood cancer called chronic lymphocytic leukemia. The drugs she takes for her condition suppress her immune system. After receiving the COVID vaccine, she was tested to see if she had any antibodies.
“For me personally, I had zero. So after the two vaccines and a booster shot, I still had no protection from COVID. I was upset,” Boyce said.
Evusheld works by releasing these antibodies directly. Boyce heard about it on a CLL Facebook group and then started one on Evusheld. “Everyone was talking about it and couldn’t wait to get it,” she said.
But it wasn’t available at her Illinois hospital. She started looking for it in Florida, where she spends her winters.
“In the beginning there were only four places in Florida that had it. I called them all, and they only did it for their patients,” Boyce said.
Eventually she found a small private clinic near Fort Lauderdale that could give her Evusheld doses. As it turned out, this clinic had received more Evusheld doses than any other provider in Florida, including some of the state’s largest hospitals.
dr Dorry Segev, a transplant surgeon at New York University, said it wasn’t an isolated case. “The launch of Evusheld was complicated, confusing and frustrating for many people.”
He said the math didn’t add up from the start. The Biden administration ordered 1.7 million doses for the more than 7 million Americans who are immunocompromised. However, according to some estimates, about three quarters of these Evusheld cans may have gone unused.
Segev blames a lack of range.
“There hasn’t been a centralized effort to educate patients and their providers, and as a result, many providers who care for immunocompromised people were unaware that this even existed,” he said.
In a statement, the U.S. Department of Health and Human Services confirmed it has “more Evusheld available than is requested by states and territories,” which is sending it to local hospitals and clinics. And a spokesman acknowledged that getting the treatment to people has been a challenge.
This unequal distribution has led some healthcare systems to ration treatment.
dr Daniel Kaul, a professor of infectious diseases at the University of Michigan, said his hospital first ranked patients based on who needed them most and set up lotteries.
“That obviously creates a whole new workflow to identify these patients and offer them to them in a random way,” Kaul said.
He added that this randomness helped ensure fairness “so maybe you don’t prioritize the people with the most education and therefore call and ask for it.”
Working in this new workflow is great for people like Dr. Aimee Payne, director of the Clinical Autoimmunity Center of Excellence at the University of Pennsylvania. She specializes in a rare autoimmune disease called pemphigus vulgaris, which can cause fatal blisters. Its treatment can wipe out a large part of the immune system, so the COVID vaccine does not appear to offer its patients complete protection.
“Some agreed immediately. Some of them had additional questions,” Payne said. “Some of them wanted to talk to their families about it. And then I would call her back a second time to discuss it.”
Things got more complicated in February when the Food and Drug Administration ruled that each recipient should receive two doses of Evusheld. Overnight, the number of people originally earmarked for aid was halved.
Health professionals are trying to help, including Nicholas Torney, a clinical pharmacist in Traverse City, Michigan. His team has created a toolkit “to help providers understand the who, what, where, when and why of this drug. And also for nurses and pharmacists in terms of actually ordering the medicines.”
AstraZeneca told Marketplace that it had more Evusheld on hand if the government wanted to buy it. The Biden administration says it needs funding from Congress to do so.
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