High Demand for Drug to Prevent Covid in the Vulnerable, Yet Doses Go Unused

A new treatment that can prevent the disease in people who can't produce antibodies after receiving a coronaviruses vaccine is what all of them have tried to get.

The University of Mississippi Medical Center's transplant team gave Ms. Cooley the drug called Evusheld, which is used to fight infections after a transplant. Ms. Taylor was denied treatment by two hospitals near her home. The doctor in Portland had to drive five hours to the hospital to get a dose.

The Biden administration has insisted that it will continue to protect the seven million Americans with weakened immune systems who remain vulnerable to Covid, despite the fact that much of the nation has gone underground. The federal government supported the development of Evusheld, which is essential to the strategy.

Even as patients like Ms. Taylor, 67, and Dr. Mallett, 38, go to great lengths, 80% of the available doses are sitting unused in warehouses and on pharmacy and hospital shelves.

Many people with compromised immune systems have been left behind as the country reopens because they have a weakened response to the coronaviruses vaccine. It appears that Evusheld may offer long- lasting protection for this group, possibly for half a year.

The drug is in short supply. The federal government is distributing it because it is only authorized for emergency use. A senior federal health official said the Biden administration had purchased 1.7 million doses and had nearly 650,000 ready for distribution to the states. Less than a quarter of the 370,000 doses ordered by the states have been used.

There are so many people who are scrapping and driving for hours to get Evusheld.

Interviews with doctors, patients and government officials suggest different reasons for the unused drug. Some people don't know Evusheld exists. Some people don't know where to get it. Government guidelines on who should be prioritized for the drug are not very clear. In some hospitals and medical centers, supplies are reserved for patients at the highest risk, such as recent transplant recipients and cancer patients, while in other areas of the country they are given out through a lottery or on a first-come, first-served basis.

Hesitance is an issue. Some doctors don't know how to use Evusheld and are reluctant to prescribe it. The fact that it is an antibody treatment can be confusing, because most such treatments are used after someone gets Covid rather than for preventive care.

Adding to the confusion are revised Food and Drug Administration guidelines for Evusheld, which called for doubling the initial recommended dose after data showed the drug may be less effective against certain variants.

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It is overwhelming and it is all new, said Dr. Mitchell H. Grayson, chief of the allergy and immunology division at Nationwide Children's Hospital.

Roughly 3 percent of Americans are characterized by health professionals as immunocompromised because they have a disease that weakens their body's immune response or are receiving a treatment that does so. They include transplant recipients and people with diseases.

The arrival of Evusheld in December set off a scramble. Patients and their loved ones began sharing information about how to get it. Rob Relyea, a software developer in the Seattle area, created a mapping tool that tracks how much of the drug is available and which providers have it.

He said people should know where to get in line.

Mr. Relyea's wife, Rebecca, is in the process of recovery from cancer. He said that they tried 10 hospitals but got the drug through luck, as Ms. Relyea's name was picked in a lottery at a hospital near their home in February.

They haven't heard anything about scheduling a second dose for Ms. Relyea.

The doctor in Oregon was desperate to get the drug. She has a condition that prevents her immune system from making enough antibodies. When the Omicron variant surged, his teacher and classmates began testing positive for Covid.

To find Evusheld, Dr. Mallett scoured an online government database of shipments and spent weeks cold-calling hospitals, pharmacies and health organizations that received the drug.

She worked with her doctor to enroll as a patient at the hospital in La Grande, Ore. After dropping everything and driving to the hospital in the rain, she received the shots and immediately turned back.

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Many others don't have the same privileges that Dr. Mallett has, but she is able to take time away from her job.

I have ethical doubts about how I got this medication.

Many health workers didn't know about Evusheld, even if their workplace had the drug in stock.

Some experts think that people who can't get vaccine because of allergies should be the first to get Evusheld. The Centers for Disease Control and Prevention still recommends against using tests to assess someone's immunity because it's only one component of the immune system.

The biggest problem is that there is no guidance or prioritization, and it has been a mess.

The confusion is being addressed by the Biden administration. State health officials, providers and patients have been working with top federal health officials to raise awareness. The administration convened a call with advocates for the disabled to discuss the revised guidance and urged patient groups to work with them.

The assistant secretary for health in the Department of Health and Human Services believes that this medication has great potential to help the immune suppressed who don't respond to vaccinations. Dr. Levine did not think that the C.D.C.'s guidance would change.

Patients who can't bevaccinated are obvious candidates for Evusheld. The calculations can involve assessments of other underlying conditions or risk factors, as well as being far murkier among the vaccine recipients.

Experts say it's not clear how much protection the medication gives. It is difficult to gauge the impact of the drug in protecting patients because many were avoiding risky behaviors and it would have been unethical to ask them not to. The exact effectiveness of the drug may not be known for a long time.

The number of participants who were immunocompromised was never disclosed, despite the fact that Evusheld was found to offer protection comparable to vaccines in a clinical trial. Adding to the uncertainty, the drug was studied by the company. It is not clear what degree Evusheld protects against the variant.

Ms. Cooley was frustrated by the lack of information. She is still taking the same precautions as before, such as getting groceries delivered, staying at home and seeing only a few trusted family members with masks on. She cares for her elderly mother and has seen a number of other elderly people die from Covid-19 in her community, where many people have chosen not to get vaccine.

Some people who can't find a dose of Evusheld have turned to online communities. They are looking for help from other immunocompromised people, such as Dr. Cheung, who has a genetic condition that affects her immune system.

Dr. Cheung got a dose in January after calling various medical institutions for two weeks, and she has been helping others navigate the process since then. She gets up to 10 requests for help a day, but only a quarter of them get Evusheld.

Ms. Taylor is a woman in Cincinnati. One hospital near her is limiting its supply of Evusheld to transplant patients, while another is not yet accepting patients from outside its system. She said she was uncomfortable driving long distances because of her underlying health conditions.

If she could get Evusheld, Ms. Taylor said she would feel less panicked. She might be able to get back to the life she had before Covid.

She is in a holding pattern of isolating, masking and waiting for a dose to become available.

Rebecca Robbins was involved in reporting.