High Demand for Drug to Prevent Covid in the Vulnerable, Yet Doses Go Unused
The treatment could be lifesaving for many who cannot get protection from the vaccine, but confusion about the drug has made some doctors slow to prescribe it.
Amanda Morris and
Sasha Mallett, Sue Taylor and Kimberly Cooley all have immune deficiencies that make them especially vulnerable to Covid-19, and all have tried to get the same thing: a new treatment that can prevent the disease in people who either cannot produce antibodies after receiving a coronavirus vaccine or cannot get vaccinated at all.
Ms. Cooley, a liver transplant recipient in Duck Hill, Miss., got the antibody drug, called Evusheld, from her transplant team at the University of Mississippi Medical Center with no trouble. But Ms. Taylor, of Cincinnati, was denied the treatment by two hospitals near her home. And Dr. Mallett, a physician in Portland, Ore., had to drive five hours to a hospital willing to give her a dose.
As much of the nation unmasks amid plummeting caseloads and fresh hope that the pandemic is fading, the Biden administration has insisted it will continue protecting the more than seven million Americans with weakened immune systems who remain vulnerable to Covid. Evusheld, which was developed by AstraZeneca with financial support from the federal government, is essential to its strategy.
But there is so much confusion about the drug among health care providers that roughly 80 percent of the available doses are sitting unused in warehouses and on pharmacy and hospital shelves — even as patients like Ms. Taylor, 67, and Dr. Mallett, 38, go to great lengths, often without success, to get them.
Because they have a weakened response to the coronavirus vaccine and may not be able to fight off Covid-19, many immunocompromised people have continued to isolate themselves at home and feel left behind as the country reopens. Evusheld, which is administered in two consecutive injections, appears to offer long-lasting protection — perhaps for half a year — giving it considerable appeal for this group.
For now, though, the drug is in short supply. Because it is authorized only for emergency use, it is being distributed by the federal government. The Biden administration has purchased 1.7 million doses — enough to fully treat 850,000 people — and had nearly 650,000 doses ready for distribution to the states as of this past week, according to a senior federal health official. But only about 370,000 doses have been ordered by the states, and fewer than a quarter of those have been used.
“There’s so many other people who are scrapping and driving for hours to get Evusheld,” Ms. Cooley, 40, said, “when in Mississippi it’s sitting on the shelves.”
Interviews with doctors, patients and government officials suggest the reasons the drug is going unused are varied. Some patients and doctors do not know Evusheld exists. Some do not know where to get it. Government guidelines on who should be prioritized for the drug are scant. In some hospitals and medical centers, supplies are being reserved for patients at the highest risk, such as recent transplant recipients and cancer patients, while doses in other areas of the country are being given out through a lottery or on a first-come, first-served basis.
Hesitance is also an issue. Some doctors and other providers do not know how to use Evusheld and are thus loath to prescribe it. The fact that it is an antibody treatment can be confusing, because most such treatments are used after someone gets Covid rather than for preventive care.
Adding to the confusion are revised Food and Drug Administration guidelines for Evusheld, released last month, that called for doubling the initial recommended dose after data showed the drug may be less effective against certain variants.