In May, Vanderbilt University Medical Center (VUMC) received 40 vials of remdesivir, the most promising experimental treatment for Covid-19 so far. But when hospital officials realized VUMC was the only hospital in Tennessee to get the drug, they worked to distribute it statewide—and ultimately helped shape the state's Covid-19 response, Eric Boodman reports for STAT News' "On the Front Lines."

What new data reveals about two much-hyped experimental Covid-19 treatments

Winning 'a strange pharmaceutical lottery'

VUMC on May 6 unexpectedly received 40 vials of remdesivir, Gilead Sciences' promising experimental treatment for Covid-19, from the federal government, Boodman reports. "The hospital's leaders hadn't realized, right then, that they'd just won a strange pharmaceutical lottery, determined not by chance, but by some murky federal calculus," Boodman reports. "When the cases of the drug appeared, on May 6, they imagined other medical centers were also getting these surprise shipments."

As such, clinicians at VUMC began administering the experimental treatment to Covid-19 inpatients who they believed would most benefit from the drug. Knowing they'd need to ration the small amount of the drug they had, doctors at the hospital implemented a certain set of criteria to help them determine which Covid-19 patients should receive it. As part of that process, a small group of doctors at the hospital were responsible for deciding which of the qualifying Covid-19 patients at VUMC would get the experimental treatment.

But days later, VUMC began receiving requests for remdesivir from pharmacists and hospitals elsewhere in the state, and hospital leaders then realized that VUMC was the only hospital in Tennessee to receive the drug, Boodman reports. At this point, Boodman reports, VUMC's physicians and leaders realized that they not only had to make decisions about who among their own patients should receive the drug—but also which patients throughout the state should receive the drug.

Patty Wright, a leader of the hospital's emergency response, said VUMC decided they couldn't hoard their supply of the highly sought-after drug, and instead needed to come up with a system to distribute the treatment.

How VUMC helped distribute remdesivir throughout Tennessee

VUMC first began by evaluating individual requests. For instance, Cary Chrisman, a pharmacist at Methodist Medical Center, had contacted the hospital about possibly getting remdesivir to treat a Covid-19 patient on a ventilator. Mark Sullivan, executive director of adult pharmacy operations for VUMC, set up a plan to give the drug to Chrisman, who drove 165 miles to pick up six doses of remdesivir and then another 165 miles back to Methodist Medical Center. 

After honoring Chrisman's request, VUMC developed an application form for providers throughout the state to request doses of remdesivir from the hospital, and the process ultimately received unanimous approval from the Tennessee Hospital Association's board. Sullivan initially was in charge of tracking VUMC's requests for remdesivir, but the hospital later developed an online intake system for the applications.

In order to make the application and approval process as fair and unbiased as possible, VUMC's application form doesn't ask for patients' full names. Instead, determinations on which patients receive remdesivir are based almost entirely on patients' lab results, Boodman writes.

VUMC also regularly updates its patient eligibility requirements to match the most recent research findings regarding the remdesivir's safety and effectiveness for Covid-19 patients, Boodman reports.

Boodman writes that Tennessee has since received at least 2,280 additional vials of remdesivir, which the state's Department of Health sent to VUMC to be distributed through the new system (Boodman, "On the Front Lines," STAT News, 6/9).