COVID-19 Treatment Shortage
Joey Sweeney, PharmD, BCPS
COVID-19 cases have been on the rise in the United States. As a result of this surge, increased demand for COVID-19 treatments has strained supply.
The American Society of Health-System Pharmacists (ASHP) reports shortages of the glucocorticoid dexamethasone sodium phosphate, a critical steroid used in severe COVID-19 infections, due to increased demand. The paralytics rocuronium and vecuron-ium, commonly used for mechanically ventilated COVID-19 patients, are also in short supply. But perhaps the most alarming drug on the shortage list is the interleukin-6 receptor antagonist tocilizumab. Rheumatoid arthritis patients, certain pediatric arthritis patients, and sclerosis-associated interstitial lung disease patients are all competing with COVID-19 patients for their supply of tocilizumab.
“The supply of tocilizumab (Actemra) has been a result of the surge of the Delta variant, particularly in states with lower vaccination rates,” said Michael Ganio, PharmD, BCPS, FASHP, senior director of pharmacy practice and quality at ASHP. “If we continue to see surges in hospitalized COVID-19 patients, it’s likely the demand for tocilizumab will continue to increase and will put more strain on the supply,” said Ganio.
In addition to preventing severe COVID-19 infection, monoclonal anti-bodies formulated for COVID-19 have been employed in reducing infections via post-exposure prophylaxis. “The COVID-19 monoclonal antibodies are already playing a significant role in reducing hospitalizations. Unfortunately, as cases have surged, HHS has had to re-implement a state/territory allocation program to ensure equitable access to these therapies,” said Ganio.
On a positive note, the supply of remdesivir has been able to keep up with increased demand for the treatment of COVID-19.
Pharmacy steps up to the plate again
HHS amended the COVID-19 PREP Act declaration to expand access to monoclonal antibody therapies by allowing pharmacists to order subcutaneous post-exposure prophylaxis and treatment doses of casirivimab/imdevimab combinations, and pharmacists, pharmacy technicians, and student pharmacists to administer them, explained Ganio.
“The PREP Act declaration amendment also allows pharmacists to order future therapies that are administered subcutaneously, intramuscularly, or
orally,” he said. “When an oral [therapy for COVID-19] is available, pharmacists will be able to diagnose COVID-19 via existing testing programs, recognize whether the patient meets EUA criteria for COVID-19 therapeutic, then prescribe the appropriate treatment.”
Vaccine stockpile represents ethical quagmire
Highly effective and safe COVID-19 vaccinations have been available for almost a year. Despite ample supply of vaccines in the United States, over 60 million eligible Americans have refused vaccination.
The United States, which has secured enough COVID-19 vaccines for its entire population, has recently experienced a preventable COVID-19 surge. Emergency departments and intensive care units across the country are filling up with mostly unvaccinated Americans who present with COVID-19. American children, who are unable to get vaccinated at press time, have not had the benefit of herd immunity. In some regions of the South, where adult vaccination is particularly low, childrens’ hospitals have been overflowing with COVID-19 cases.
As a result of vaccination refusal among American adults, the country has found itself with a large vaccine stockpile. This unused supply represents an ethical quagmire. Every expired vaccine dose in America represents a vaccine dose unavailable for another person elsewhere in the world. Some poor countries have still not secured enough vaccines for their most at-risk populations. Tedros Adhanom Ghebreyesus, PhD, WHO Director-General, had this to say earlier this year regarding vaccine supply disparities between rich and poor countries: “I need to be blunt: the world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”