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Even as this winter’s omicron wave is subsiding, more than 2,000 people in the United States are still being hospitalized with COVID-19 every day. This population is largely unvaccinated, with medical conditions that increase their risks. Some of these hospitalizations could have been prevented with early COVID treatments, such as pills and monoclonal antibodies, purchased and distributed free by the government.
But data on COVID treatment usage, shared with NPR by the U.S. Department of Health and Human Services, indicates that millions of COVID treatments are on unused shelves.
“We are still in a public health emergency,” Dr Derek Eisnor, who leads the government’s distribution of COVID drugs, said on March 16 in a call with national health organizations. He urged health care leaders to try and get the drugs to communities that have a claim for them rather than letting them go to waste.
“It is assumed that there is not enough [these drugs] around, but when you look at the numbers there seems to be a lot going on: it just isn’t being used, “says Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security.” They clearly aren’t. reaching people at rates high enough to have their maximum impact. “
Currently, the federal government distributes four outpatient COVID treatments that can help stop the progression of COVID infections when taken within five to seven days of symptom onset and one preventive therapy for immunocompromised people. State health departments and some suppliers can order these drugs, and they are now available at drugstores, infusion centers, and health clinics across the country.
But states and healthcare professionals report that less than half of the treatment supply they have ordered as of October 2021 has been used.
Health experts initially expected the drugs to fly off the shelves. “I thought [utilization] it would be much higher, ”says Dr. Phyllis Tien, an infectious disease physician at the University of California, San Francisco, who is part of the NIH’s COVID-19 Treatment Guidelines Panel. doctors were prioritizing who would take them, he says, to help preserve access for people with greater medical needs.
Reported usage rates may underestimate the total doses used; sites should report daily or weekly usage numbers to the government, but not all of them do. However, the tariffs are used by the government to make decisions about distribution policies, and Tien says they keep track of what he is seeing on the ground.
“When a patient comes to us and is COVID positive and has some mild symptoms, we offer them some of these drugs if they meet the criteria,” he says. “But some of them don’t want to take the drugs. Others may want the drug, but they are out the window in terms of access to it.”
Unused drugs risk being expelled
Usage rates vary by product, based on data collected by HHS.
Two treatment options, recommended as alternative therapies only when no other options are available, have the lowest use rates. Bebtelovimab is a monoclonal antibody injection authorized last month with “insufficient data” on key outcomes, according to NIH treatment guidelines; only 2% of the amount ordered from suppliers was used, according to HHS data.
The other with very low usage is molnupiravir, a pill course generally only recommended when other, more effective options are not viable; only 14% of the doses sent were used.
Evusheld, a preventive monoclonal antibody vaccine that helps protect immunocompromised people from infections, is not widely used: only 54% of the 848,000 available doses have been sent and only a quarter of those ordered have been used.
Even the most highly recommended treatments are not used. Hundreds of thousands of doses of sotrovimab are stored in the refrigerator – this monoclonal antibody infusion treatment is nearly 80% effective in preventing hospitalization from COVID-19 for high-risk individuals. Likewise, hundreds of thousands of courses of Paxlovid, a highly effective pill that reduces the risk of being hospitalized with COVID by nearly 90%, are gathering dust on pharmacy shelves. For both of these treatments, less than half of the courses distributed were reported as being used.
HHS’s Eisnor, speaking to health professionals in mid-March, said he was troubled by reports that some pharmacies had asked if they could trash remaining stocks of unexpired COVID pills. “We ask that you use all resources to facilitate [redirecting supply]perhaps moving the product out to a neighboring state or jurisdiction or territory if necessary, “he said.
What prevents people from using drugs
These drugs are currently prioritized for people at high risk of COVID-19 (although sites and suppliers have discretion as to who qualifies). Given the prompt supply and low usage rates, Tien says it may be time to expand the drug’s availability to low-risk people who might still benefit from the drug.
“I had a situation last week where a young man who … had COVID called their doctor about Paxlovid and was denied,” says Tien: The patient had a risk factor for COVID, but their doctor did not think he was qualified for the drug, based on age and vaccination status. “There are some people who want it and get rejected, and then there are others who perfectly meet the criteria and don’t want it,” notes Tien.
Health experts point to a litany of other factors contributing to the low use of COVID treatments. “There is a lack of awareness from [patients and] providers, “says Adalja,” and the challenges of understanding how to use them appropriately. “COVID pills must be administered within five days of symptom onset and can be complicated to prescribe: for example, Paxlovid can interfere with medications commonly taken and molnupiravir not recommended for patients who are pregnant or trying to conceive.
Hence, it can be difficult to know which pharmacies have the pills in stock or which infusion clinics have appointments available. A patient must be able to quickly find a doctor, get a diagnosis and a prescription, and be able to access treatment – all within days.
“It is multifactorial why these drugs are underused,” says Adalja. “All of these things are likely to play a role in the discrepancies between what was ordered and what was actually administered.”
The Biden administration launched the Test to Treat initiative this month to fill those gaps. “We know the challenges of patients getting therapeutic treatments,” said Dr. Meg Sullivan, acting medical director of the Office of the Assistant Secretary for Preparedness and Response at HHS, in a call with physicians. March 12. The program aims to improve access to rapid tests and strengthen public and provider awareness of available COVID treatments and how to obtain them.
But the administration says their ability to support an ongoing COVID drug pipeline may soon be hampered by a lack of Congressional funding. Senior administration officials told reporters on March 15 that they could run out of monoclonal antibody treatments by May and Evusheld by the summer.
Because these therapies are currently licensed for emergency use only, they are not available on the commercial market and the government is the only buyer, says Adalja. It also means that they cannot be advertised by drug companies, which likely contributes to a lack of awareness of these treatments by providers and the public.
“It’s a bad situation when these drugs are not used, when we have people hospitalized and dying from COVID,” says Adalja. But she doesn’t find this surprising, as life-saving COVID vaccines are also expiring on pharmacy shelves and being launched every day. “That’s how this pandemic went,” she says. “Many of the medical countermeasures have not been able to be used optimally.”