In the event of supply constraints, unvaccinated patients with COVID-19 are among populations that should be prioritized to receive monoclonal antibodies, according to an updated statement on NIH COVID-19 Treatment Guidelines released Thursday.

If triage is required due to supply constraints, the NIH COVID-19 Guidance Panel has recommended prioritizing monoclonal antibody therapy “for unvaccinated or incompletely vaccinated individuals,” as well as vaccinated individuals. who are not expected to develop an adequate immune response, such as those with immunocompromised conditions, those taking immunosuppressive drugs, or those aged 65 and over.

The panel also recommended using monoclonal antibodies as a treatment for COVID-19, and not as pre-exposure prophylaxis after exposure to SARS-CoV-2, when the product supply is insufficient.

In the statement, the panel said the aim was “to provide advice on which individuals could benefit the most from anti-SARS-CoV-2 mAb. [monoclonal antibody] therapy.”

H. Clifford Lane, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), who is co-chair of the NIH COVID-19 treatment guidelines panel, said MedPage today that “different groups and ethics come into play in different contexts”.

“Our guiding ethical principle is that you should use [treatment] to give the most benefits to the greatest number. From our perspective, that doesn’t take into account what that person may have done in other parts of their life, ”he said, referring to his vaccination status.

Lane also stressed that these were only indications in the event of a shortage of monoclonal antibodies, but the recommendation is that all high-risk patients with COVID-19 should receive this treatment if it is available.

September 13, HHS announced updated guidelines for the distribution of monoclonal antibodies, noting a transition to a control system coordinated by states and territories.

“The HHS will determine the weekly amount of mAb products each state and territory receives based on COVID-19 workload and mAb usage,” the statement said.

However, Peter Hotez, MD, PhD, of Baylor College of Medicine in Houston, said MedPage today that some elected officials are setting up MAb infusion centers instead of vaccination mandates, “which is totally against science”.

Asked about the NIH guidelines, Hotez added, “I’m afraid this sends the wrong message of false equivalence that you can choose to get vaccinated or wait until you get sick and receive a monoclonal antibody.”

As previously reported, Tennessee has already chosen to do so in September. A report of NBC News said the state recommended limiting monoclonal antibody therapy to unvaccinated or vaccinated but immunocompromised people, according to NIH guidelines.

Indeed, Lane said there was no way the organization could control “a political agenda”.

When asked if he thought the guidelines might have a chilling effect on vaccination rates, he added that he hoped not, but the NIH wanted to “stay out of it.”

“It’s an individual decision, individual choices, and we’re not really commenting on that,” Lane said. “It’s a lot easier to get one or two injections than an infusion.”

“Nothing we do should diminish the importance of vaccination,” he added.

  • Molly Walker is associate editor and covers infectious diseases for MedPage Today. She is the recipient of the J2 Achievement Award 2020 for her COVID-19 coverage. To follow