Unvaccinated people in Tennessee now have priority access to one of the few COVID-19 drugs shown to reduce hospitalization and death: monoclonal antibody treatment.
The state's government recommended this week that most vaccinated residents should be last in line for the treatment, which comes in the form of infusions or injections, the Tennessean reported 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 authorized the first monoclonal antibody treatment for COVID-19 in November.
But the drugs are in short supply in Tennessee and across the US as the Delta variant continues to spread in states with low vaccination rates. In Tennessee, where just 44% of the population is fully vaccinated, COVID-19 cases still hover above 5,000 per day.
As of September 13, the federal government has been determining how many monoclonal antibody treatments each state will get based on that state's COVID-19 case count and how much supply it uses up each week. The government announced last week that hospitals can no longer order monoclonal antibodies directly from a wholesale supplier, AmerisourceBergen, due to shortages.
So Tennessee is asking healthcare workers to prioritize the most vulnerable - namely, unvaccinated, partially vaccinated, elderly, and immunocompromised people.
"It's definitely an ethical dilemma," Rodney Rohde, chair of the Texas State University clinical laboratory science program, told Insider. "I pray and I hope that no healthcare professional would ever be put in that situation."
Rohde said Tennessee's recommendation could potentially spur other states to issue similar guidelines.
In a letter to Congress last week, seven Republican representatives from Tennessee called on the federal government to "do everything in its power" to increase the availability of monoclonal antibodies.
But disease experts stress that vaccines are the better approach. The shots lower the risk of hospitalization by 71% to 93%, depending on which one you receive, according to a recent report from the Centers for Disease Control and Prevention. Recent studies also show that vaccines protect against severe disease for at least six months to a year.
Whereas vaccines instruct the body to produce a harmless viral protein, 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 drugs must be administered within 10 days (though ideally three to four) after symptoms start.
"Monoclonals are basically giving you direct antibodies that are only passively protective - in other words, they work right then on that infection at that time, but you are not protected long-term," Rohde said. "Vaccination is still critical in individuals because in theory, you would have to get monoclonals every time you had a bad experience with a viral infection."
The US has authorized three monoclonal antibody treatments for emergency use. In a study of non-hospitalized COVID-19 patients, 3% of those who got Eli Lilly's drug went to the hospital, compared to 10% of those who got a placebo. Regeneron's cocktail yielded similar results. That suggests monoclonal antibodies could reduce the risk of hospitalization by up to 70%.
"A lot of the arguments people use for not getting the vaccine technically would also apply to these monoclonal antibodies," Vivek Cherian, an internal-medicine physician in Chicago, told Insider. "It's a very, very new thing. It got developed very rapidly. It used modern science to get there. But people who aren't willing to get vaccinated are willing to get this treatment."
Since unvaccinated people are far more vulnerable to severe disease 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.