By Lev Facher
Gov. Ron DeSantis of Florida has refused to say whether he’s received a booster shot. He’s suggested, misleadingly, that Covid-19 vaccines cause infertility. He hired a surgeon general who has questioned the data surrounding vaccines and called those who refuse to be immunized “brave.”
But when it comes to experimental Covid therapeutics, DeSantis and his government are all-in — even when outside researchers, the Food and Drug Administration, and the medicines’ own manufacturers say they don’t work.
The controversy has accelerated this week following the FDA’s decision to restrict monoclonal antibody treatments made by Regeneron and Eli Lilly, citing data that show they’re ineffective against the Omicron variant. DeSantis has cast the decision as “fundamentally wrong” and pledged to “fight back” — a perplexing claim to health experts, given the scientific consensus about the therapeutics’ lack of effectiveness, and the numerous other treatments available to Floridians sick with Covid.
“There are meaningful things that can be done here, even for folks who only believe in treatments,” said Vin Gupta, a pulmonologist and faculty member at the University of Washington’s Institute for Health Metrics and Evaluation. DeSantis aides could mitigate the damage wrought by their vaccine skepticism, Gupta argued, if they at least gave accurate information about potential treatments.
Related: Patchwork system for rationing a Covid drug sends immunocompromised patients on a ‘Hunger Games hunt’
The Florida controversy underscores a bizarre phenomenon: That while largely baseless vaccine hesitancy has hindered the U.S. pandemic response, Americans are tripping over themselves to take therapeutics that are experimental, expensive, and ineffective — precisely the characteristics that anti-vaccine advocates falsely ascribe to Covid immunizations, which are proven, free, and effective.
“It is confusing that people are willing to take what is really an experimental monoclonal antibody, but they aren’t willing to take a vaccine that millions of people have gotten, and has been shown to be safe and effective,” said Sonja Rasmussen, a physician, former CDC official, and professor of pediatrics and epidemiology at the University of Florida.
It’s not a new phenomenon, either. Throughout the pandemic, right-wing advocates have argued that doctors should prescribe hydroxychloroquine, an antimalarial drug, and ivermectin, an anti-parasitic drug, to treat Covid-19. No data suggest either is an effective treatment.
The latest brush-up over antibody treatments that don’t work against Omicron is all the more puzzling to health experts given the number of effective treatments already available.
One antibody treatment manufactured by Vir Biotechnologies and GlaxoSmithKline remains effective at treating Omicron. Another antibody drug by AstraZeneca has been shown to be effective at preventing Covid-19, including its most recent variants. And in late December, the FDA authorized two new antivirals from Pfizer and Merck — Pfizer’s, in particular, appears to be effective against Omicron.
Gupta ascribed the phenomenon to a fundamental flaw in Americans’ view of health care: That most people see doctors’ role as treating illnesses, not preventing them.
“Some people are much more ready and willing to quit smoking, or to get the vaccine, when they’re in my ICU, but they’re not willing to do those things before,” he said. “They think about treatment. They think about seeing docs only when they need to. And that absolutely is informing why people are so willing to accept a monoclonal therapy.”
Indeed, the DeSantis administration has made access to monoclonal therapies a centerpiece of its Covid response, operating dozens of treatment sites across the state and moving just weeks ago to secure additional doses of Regeneron’s therapy amid the Omicron surge.
Florida’s per-capita death rate ranks 18th among the 50 states. Just 23.6% of the state’s population has received a booster vaccine dose, ranking 47th among all states and edging out only West Virginia, Kansas, and Alaska.
Still, DeSantis has cast the FDA’s move as endangering the lives of Floridians. In a press conference this week, he claimed the Biden administration’s decision was based on a “single, non-peer-reviewed, non-clinical study, that was actually done by a consultant for a rival company to the other two monoclonal antibody treatments.” A spokesperson for the Department of Health and Human Services pushed back immediately, citing numerous research papers indicating the treatments were ineffective at treating Omicron.
DeSantis suggested the paper was also tainted by a conflict of interest, noting that its author is a consultant for Vir Biotechnologies. Vir and GlaxoSmithKline are the manufacturers of sotrovimab, a monoclonal antibody treatment that the FDA has endorsed as an Omicron treatment.He did not acknowledge that the two manufacturers have publicly applauded the FDA’s decision. Eli Lilly, the maker of one antibody combination, said its use in Omicron patients was “not medically appropriate.” Regeneron, the manufacturer of the other, said its cocktail “does not work against the Omicron variant in lab tests.”
DeSantis has argued, nonetheless, that given the scarcity of treatments, any move to restrict access to Covid treatments puts lives at risk. But in an interview with STAT, Janet Woodcock, the acting FDA commissioner, said caution is warranted when using experimental medicines, and that staffing shortages had hindered the state’s ability to administer the drugs anyway.
“There’s no free lunch with drugs,” she said. “They all have harm as well as benefit. And giving people something that doesn’t work. … Sometimes you can have anaphylaxis, you have to start an IV, it isn’t a simple procedure.”
Beyond their ineffectiveness against Omicron, Eli Lilly and Regeneron’s therapies are vastly more expensive to taxpayers. Eli Lilly’s treatment cost the federal government roughly $1,250 per dose; Regeneron’s cost $2,100.
The vaccines, by contrast, are far cheaper: The federal government has paid Moderna just over $15 per dose, on average, and paid Pfizer just under $20.
The cost disparity, too, highlights yet another inconsistency: Distrust of drug companies and their profit motives has driven substantial vaccine hesitancy, but people are far less skeptical when it comes to exorbitantly expensive, unproven treatments.
“If the reason you’re giving for not wanting the vaccine is that ‘Big Pharma’ made it and is profiting from it, certainly you can say the same thing — probably even more so — for monoclonals,” Rasmussen said. “People aren’t being consistent. They’re going with their politics more than with their thinking.”
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