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State Government Penalizes Vaccinated by Rationing Regeneron

Judy Stone, MD

Disclosures

September 23, 2021

Today's shocking COVID news comes from journalist Brett Kelman. He reports, "The Tennessee state government now recommends vaccinated residents be denied access to monoclonal antibody treatment to preserve supplies for those who are unwilling to get vaccinated and remain most vulnerable by their own choice.

https://twitter.com/BrettKelman/status/1440134938196692999

In other words, if you took the responsible step of vaccination to slow the pandemic and protect yourself and others, but you get a breakthrough infection, your vaccination may now actually disqualify you from getting one of the most effective treatments for the virus. If you did nothing, you can still get the care."

Kelman reported on this more in the Tennessean.

The rationale for this is that the mortality rate from COVID for those who are vaccinated is low.

Also, a recent NIH Guideline on the use of monoclonal antibodies when "there are logistical constraints" (a euphemism for rationing) is prioritizing unvaccinated people over those who have been vaccinated. The one exception is if the vaccinated person is immunocompromised.

REGEN-COV is available through the FDA under an emergency use authorization (EUA). The EUA also states that it is for those who are "not fully vaccinated or who are not expected to mount an adequate immune response." However, the EUA notes that "Post-exposure prophylaxis with REGEN-COV (casirivimab and imdevimab) is not a substitute for vaccination against COVID-19." REGEN-COV is not fully approved by the FDA.

In reality, we now have a life-saving drug, bought with our tax dollars at $2100 a pop, being used primarily in the South as a substitute for a $20 vaccine. Seven states account for 70% of the country's use of Regeneron. The Feds have taken over the distribution, saying they are trying to allocate it "more equitably." Those states are, predictably, crying that they are being "discriminated against."

I'm ambivalent. I know the risk of death in those who are fully vaccinated is low — 0.5% in one recent study from the UK. The CDC recently reported that of more than 178 million people in the US who have been vaccinated, there have been 15,790 breakthrough infections leading to hospitalization or death, and 3040 deaths.

I am sympathetic to the plight of poor people who cannot afford to take time off from work or caring for their families to get the vaccine, as they may feel poorly for 2-3 days. Others may not have had ready access to the vaccine because of work obligations or transportation issues, or lack of papers.

But I am outraged by those "free-dumb" folks who decry basic public health recommendations like masking. Others are conspiracy-mongering, believing the government is going to "chip" them with the vaccine, or refuse to take it because it is too new. These folks want to corner the Regeneron supply and are suddenly willing to take an unapproved medicine. I guess they believe if it is good enough for Abbott and Trump, they'll take it.

But it feels like those of us who have followed all the rules, stayed home for months, wore masks when out, and immediately took the COVID vaccines to try to help our communities as well as ourselves, are now getting shafted. We are being denied access to hospital beds for surgery, heart attacks, or cancer care, as hospitals are overrun with COVID patients. In Idaho now, when crisis standards of care have been declared, there is a "Universal DNR Order: Adult patients hospitalized during a public health emergency...should receive NO attempts at resuscitation ... in the event of cardiac arrest."

All of the forms of rationing take into account a person's age. None of them consider the vaccination status.

I don't claim to know a better way out of this, but I simply can't understand this debacle and how vaccines — which have been widely accepted as an entrance requirement for school — have now been so politicized. Same with the need to wear masks.

We've got to find a way not to be held hostage by cult-like beliefs.

Do you have thoughts as to what might be effective in combating the disinformation leading to these beliefs?

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About Dr Judy Stone
Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family's Story of Hope and Triumph over Evil and Conducting Clinical Research: A Practical Guide.

She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.

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