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Evusheld, COVID drug for the immunocompromised, is out of stock: Hits

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Evusheld, COVID drug for the immunocompromised, is out of stock: Hits

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Evusheld is a licensed treatment to prevent COVID-19 in people who are severely immunocompromised or have had serious adverse reactions to vaccines.

Peter Bostrom/AstraZeneca


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Peter Bostrom/AstraZeneca

Evusheld, COVID drug for the immunocompromised, is out of stock: Hits

 | Top stories

Evusheld is a licensed treatment to prevent COVID-19 in people who are severely immunocompromised or have had serious adverse reactions to vaccines.

Peter Bostrom/AstraZeneca

Dr. Vivian Cheung takes steroids to manage a rare genetic condition. The drugs suppress his immune system, putting him at high risk of becoming seriously ill from COVID-19. It also means his body didn’t really make any antibodies in response to two shots of the Moderna vaccine.

Cheung is a pediatrician and researcher. Before the pandemic, she flew weekly from her clinic at the National Institutes of Health in Maryland to her lab at the University of Michigan. Now she hasn’t been to her lab for two years. “Except for work, I don’t go out at all,” she says, “I haven’t been to a grocery store in over a year.”

Last month, the FDA cleared Evusheld, a monoclonal antibody combination from pharmaceutical company AstraZeneca designed to protect patients like Cheung. For those who don’t respond well to vaccines, Evusheld injections place anti-COVID proteins directly into their bodies.

AstraZeneca’s analysis – completed last year – showed the drug reduced the risk of contracting COVID-19 by 77%, and protection from a single treatment to two injections lasted at least six months. Early data suggests it may perform less well against the omicron variant, but should still offer some protection.

This gave Cheung hope, at a time when doctors say they see the omicron wave causing a wave of serious infections in immunocompromised people. “Like a lot of people, I thought, ‘Wonderful. Finally, I will have coverage against COVID-19,” Cheung said.

But the medicine is scarce. The federal government controls distribution. It has shipped approximately 300,000 doses to healthcare providers and ordered a total of 1.2 million doses to date. About seven million people in the United States could benefit from the drug.

The US Department of Health and Human Services, which is managing the process, did not respond to questions about supply and distribution.

The scarcity has forced some doctors to hold a lottery to decide who will get it.

At Massachusetts General Hospital in Boston, initial shipments of Evusheld covered less than 1% of their immunocompromised patients — and came with little guidance on how to fairly use a limited supply, says Dr. Camille Kotton, director clinic of transplantation and infectious diseases of the immunocompromised host. So the hospital devised a three-tier system to categorize patients by medical need – and to give higher-tier patients an equal chance.

“We put everyone’s name in a lottery,” she explains. “If people literally get their name drawn in the lottery, we bring them in for an injection.”

The Mayo Clinic, in Rochester, Minnesota, has a similar system — with five tiers and random selections within them, says Dr. Raymund Razonable, who leads their monoclonal antibody treatment program. “It’s basically luck,” he says, “They just happen to be randomly picked by the computer system.” Razonable says it will likely take Mayo Clinic months to sift through the list of several thousand people at their most vulnerable level.

Jackson Memorial Hospital in Miami, Florida, one of the largest transplant centers in the southeastern United States, waited weeks to receive its first shipments of Evusheld. Florida first bypassed major hospitals and sent its first doses to a small private clinic, Stat News and the Miami Herald reported.

“Unfortunately, the initial allocations in my state did not go to the largest transplant or cancer center…despite the fact that Miami-Dade County is the center of a large transplant population,” says Dr. Michele Morris , an infectious disease that cares for organ and stem cell transplant patients at Jackson Memorial Hospital and Sylvester Cancer Center. The hospital received its first delivery of Evusheld in mid-January. “We don’t have enough to protect all at-risk patients, but we do,” Morris said. The hospital distributes its limited supply by notifying clinicians of the most immunocompromised patients first.

The government provides Evusheld to states based on their total adult population. The approach does not prioritize where the need is greatest.

“Colorado, Washington, Massachusetts – these places are really struggling to get enough supplies,” says Dr. Anne Zink, Alaska’s chief medical officer and president-elect of the Association of Health Officials of States and Territories. Demand can be high in these areas because populations requiring complex medical care are often concentrated near the specialized care centers that provide it.

Alaska, however, is having “the opposite experience,” Zink says. “We didn’t have the same request, we didn’t have to go through a lottery system. In fact, we try to reach out to oncologists and say, ‘Do you know this exists?’ Because we have supplies and we believe more people need to be reached.”

Zink says the country’s fractured healthcare system leads to inequity. People who know where to go and what to ask for are the most likely to survive.

Back in Maryland, Dr. Vivian Cheung did a lot of research to get her Evusheld vaccines. She called the state health department and got a list of all the places that received doses. She faxed doctors’ notes to various hospitals and zeroed in on the University of Maryland hospital, which had the most doses. “I started literally calling co-workers who worked there, asking friends to call co-workers who worked there and finally got a dose,” she says.

Getting a dose – in the middle of the omicron surge – didn’t change her daily life. She still doesn’t go to the grocery store. It gave him some peace of mind, as well as a bit of guilt: “I know the system, I know people who can pull the strings for me – that’s just wrong, isn’t it? Everything about it is fake,” Cheung said.

Cheung now defend online Evusheld doses for others. It helps her feel that she has earned hers.



Evusheld, COVID drug for the immunocompromised, is out of stock: Hits

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