Tennessee says vaccinated people should be last in line for antibody treatments to save them for the unvaccinated

Nurse Janet Gilleran prepares to treat coronavirus patient Mike Mokler with bamlanivimab, a monoclonal antibody, at Tufts Medical Center in Boston on December 31, 2020.
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Tennessee recommends prioritizing unvaccinated residents for treatment with monoclonal antibodies.
Vaccinated residents line up behind them as they are less prone to severe COVID-19.
Monoclonal antibodies are in short supply as the delta variant tears through unvaccinated areas.
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Unvaccinated people in Tennessee now have priority access to one of the few COVID-19 drugs proven to reduce hospital stays and deaths: monoclonal antibody treatment.
The state government recommended this week that most vaccinated residents should be in line for treatment in the form of infusions or injections last, the Tennessee 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 approved the first monoclonal antibody treatment for COVID-19 in November.
But drugs are scarce in Tennessee and the United States, as the Delta variant is more widespread in states with low vaccination rates. In Tennessee, where only 44% of the population is fully vaccinated, COVID-19 cases are still over 5,000 a day.
On September 1st, the federal government set how many monoclonal antibody treatments each state would receive based on that state's COVID-19 case count and how much supplies it consumes each week. The government announced last week that due to shortages, hospitals are no longer able to order monoclonal antibodies directly from a wholesaler, AmerisourceBergen.
Therefore, Tennessee urges health workers to give priority to the most vulnerable - namely, the unvaccinated, partially vaccinated, the elderly, and the immunocompromised.
"It's definitely an ethical dilemma," Rodney Rohde, chairman of the Texas State University clinical laboratory science program, told Insider. "I pray and hope that no doctor will ever get into this situation."
Rohde said Tennessee's recommendation could potentially lead other states to issue similar guidelines.
"It's a mess when we legislate who to treat," he added.
Vaccines offer better protection than antibody drugs
Debbie Bonnett gives a COVID-19 vaccine at a pop-up clinic in the Maple Leaf Bar in New Orleans on Aug. 14, 2021. Mario Tama / Getty Images
In a letter to Congress last week, seven Republican officials from Tennessee called on the federal government to "do everything in its power" to increase the availability of monoclonal antibodies.
But disease experts insist that vaccines are the better approach. The vaccinations lower your risk of hospitalization by 71 to 93%, depending on which one you get, 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 produce 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 stopping the virus from replicating. The medication must be given within 10 days (but ideally three to four days) of the onset of symptoms.
"Basically, monoclonals give you direct antibodies that only protect passively - in other words, they work immediately against this infection at this point, but you are not protected in the long term," said Rohde. "Vaccination is still vital for individuals because theoretically every time you had a bad experience with a viral infection you would have to be given monoclonal drugs."
In other words, he said, "An ounce of prevention is better than a pound of cure."
Unvaccinated people have higher medical needs for antibody drugs
Patients await treatment at Regeneron Clinic at a monoclonal antibody treatment site in Pembroke Pines, Florida on August 19, 2021. Chandan Khanna / AFP / Getty Images
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The US has approved three emergency monoclonal antibody treatments from GlaxoSmithKline, Regeneron and Eli Lilly. In a study of non-hospitalized 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. Regeneron's cocktail gave similar results. This suggests that monoclonal antibodies could reduce the risk of hospitalization by up to 70%.
The emergency approval for these three drugs is of the same type as the Moderna and Johnson & Johnson vaccines. The Pfizer shot is now fully approved for general use in adults aged 16 and over.
"Many of the arguments people use for not technically getting the vaccine would apply to these monoclonal antibodies," Vivek Cherian, an internal medicine doctor in Chicago, told Insider. "It's a very, very new thing. It moved very quickly. It used modern science to get there. But people who don't want to be vaccinated are willing to undergo this treatment."
People in the southern states in particular seem to be demanding antibody treatments. About 70% of monoclonal antibody orders in the past few weeks have come from seven southern states, six of which have some of the lowest vaccination rates in the US, MSNBC reported.
Since unvaccinated people are far more susceptible to serious illness and death than unvaccinated people, it makes sense to give them first access to antibody drugs, Cherian said, even if the policy seems unfair to vaccinated people.
“If you feel like you are doing your part, duty and obligation to yourself, your family and society, and then you go to the hospital and they basically say 'no' because you did your due diligence, I understand why that can leave a sour taste in the mouth, "he said." But in general it still seems that those at highest risk, vaccinated or not, continue to qualify.
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