Although there is ample supply of monoclonal antibodies, antivirals, and other Covid-19 treatments, most of these drugs remain unused due to limited access, as well as a lack of awareness among patients and providers, Pien Huang writes for NPR's "Shots."

Why nearly 80% of this 'lifesaving' Covid-19 antibody treatment is going unused (and what to do about it)

Millions of Covid-19 drugs sit unused on shelves

Currently, the federal government distributes five Covid-19 outpatient treatments, four of which can prevent severe illness if taken within a short time after symptom onset and one that can prevent coronavirus infection in immunocompromised individuals. However, data from HHS indicates that millions of these treatments are sitting unused on shelves.

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"There's an assumption that there's not enough of [these drugs] around but it does seem when you look at the numbers that there is a lot around—it's just not being used," said Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security. "They clearly are not getting to people at high enough rates to have their maximum impact."

In particular, states and health care providers have reported that less than half of the supply of treatments they have ordered since October 2021 has been used, despite health experts' initial expectations that the drugs would "fly off the shelves," Huang writes.

Of the available treatments, bebtelovimab, a monoclonal antibody authorized by FDA last month, and molnupiravir, Merck's antiviral pill, have the lowest utilization rates at 2% and 14% of their ordered supplies, respectively. Evusheld, a preventative monoclonal antibody treatment for immunocompromised individuals, has also seen low usage—only 25% of the currently ordered doses have been used so far.

In addition, other highly recommended treatments such as sotrovimab, which is 80% effective against hospitalization in high-risk people, and Pfizer's Paxlovid, which is 90% effective against hospitalization, are going unused. Currently, less than half of the treatments' distributed supplies have been used.

Restricted eligibility, lack of awareness impact use of the drugs

According to Huang, these treatments are currently prioritized for people at high-risk of Covid-19, which means people at lower risk who want to access the treatments are often turned away by sites and providers.

"I had a situation last week where a young person who ... got COVID called their physician for Paxlovid and was denied," said Phyllis Tien, an infectious disease physician at the University of California, San Francisco, who serves on NIH's Covid-19 treatment guidelines panel. Although the patient had a risk factor for Covid-19, their doctor did not think they qualified for the treatment based on their age and vaccination status.

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"There are some people who want it and are being turned away, and then there are others who perfectly fit the criteria and don't want it," Tien said.

Another factor that has limited utilization of these treatments is a lack of awareness among both patients and providers. Some of these treatments, such as Paxlovid and molnupiravir, can also be complicated to prescribe. 

In addition, patients may have difficulty accessing the treatments in time since many of them must be administered in a short window of time after symptom onset. Patients must be diagnosed with Covid-19, prescribed a treatment, and then find pharmacies with antiviral pills in stock or infusion clinics with appointments, all within a few days.

"It's multifactorial why these drugs are underutilized," Adalja said. "It's likely all of those things are playing some role in the discrepancies between what's been order [and] what's actually been administered."

To improve access to Covid-19 treatments, the Biden administration earlier this month launched the "Test to Treat" initiative. Under this initiative, people who test positive for Covid-19 at pharmacies will be able to receive antiviral pills free of charge. However, a lack of congressional funding may soon limit the administration's ability to support this initiative. According to senior administration officials, the country may run out of monoclonal antibody treatments by May and Evusheld by the summer.

"It's a bad situation when these drugs are going unused, when we have people hospitalized and dying from COVID," Adalja said. "It's the way this pandemic has gone. A lot of the medical countermeasures haven't been able to be used optimally." (Huang, "Shots," NPR, 3/18)