A drug designed to prevent deterioration in the condition of coronavirus patients will soon be used in Israel, perhaps as early as Thursday. The main beneficiaries, however, will be unvaccinated patients.
The government spent 30 million shekels ($9.4 million) to buy a supply of REGN-COV2, which is made by Regeneron Pharmaceuticals. Officials hope the drug, aside from saving lives and preventing suffering, will also help reduce the number of patients in serious condition, thereby keeping the country's hospitals from collapsing and allowing the economy to remain open.
But the drug, which is administered intravenously, is effective only if given in the first few days after infection, before the case has become serious.
REGN-COV2, which was used successfully to treat former U.S. President Donald Trump, was approved for emergency use by the U.S. Food and Drug Administration following impressive results in initial clinical trials. The main study, which hasn’t yet been published in a peer-reviewed journal, involved 4,000 patients at risk of developing serious cases of COVID-19. They were divided randomly into two groups, with half receiving the drug and half a placebo.
After 28 days, those who received the drug were 70 percent less likely to be hospitalized or to have died than those who received the placebo. In addition, their symptoms ended on average four days earlier.
Initially, Israel purchased just 2,500 doses, which will be made available to the country's four health maintenance organizations at a rate of around 400 per week. The drug is expensive, costing roughly 5,000 shekels ($1,600) per dose for the initial batch of 2,500 and jumping to 10,000 shekels per dose thereafter. Both the limited supply and the price necessitate prioritizing which patients receive it.
In a letter to the HMOs on Wednesday, Health Ministry director-general Nachman Ash said the drug should be given only to patients at the greatest risk of severe illness. He included a model for assigning points to patients, a ranking that was developed for the ministry by the research institute of the Clalit health maintenance organization.
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But Ash also noted that the HMOs can choose to develop their own models instead, as long as they provide “transparency in calculating the risk level” to both doctors and patients. He also instructed the HMOs to create an exceptions committee that will consider cases in which giving the drug may be warranted even though a patient doesn’t qualify according to the model.
Under Clalit’s model, the drug would generally be given to people over 60, with patients over 70 getting an extra two points. Patients who have been hospitalized in recent years, who are obese or have certain diseases, including cancer, chronic liver disease and obstructive pulmonary disease, also get an extra point.
The biggest point bonanza, however, is for being unvaccinated. Unvaccinated patients will receive a whopping five points – five times as many as a vaccinated patient of the same age who has cancer or has undergone an organ transplant. The “unvaccinated” category includes patients who have received only one dose. It does not include those who have received two doses but not yet the third dose, meaning a booster shot.
According to the model, a patient with seven points has an 18 to 20 percent chance of developing serious illness or dying. For someone with eight points, the risk is 22 to 25 percent.
What this model means is that unvaccinated patients will get priority in receiving an expensive, potentially life-saving drug. The medical reason for this is clear – unvaccinated patients are at much greater risk of serious illness.
Nevertheless, the decision to essentially reward people who fail to get vaccinated makes many HMO staffers uncomfortable.
“Everyone is upset by the fact that most of the people who will get the drug will be unvaccinated,” one senior HMO official said. “But if the goal is to prevent an explosion [of serious cases] at the hospitals, that’s the target population.
“It does create moral discomfort, because people who heeded the instructions and got vaccinated are being pushed to the back of the line,” he added. “And what kind of message does that send to the unvaccinated? That there’s a wonder drug here and it’s not terrible to be unvaccinated, because in the end, they’ll have a good chance of getting this drug.”
Another senior health official agreed. “We’re in a pandemic, and everything has a price,” he said. “And there should also be a price for people who didn’t heed the system’s requests and instructions. They can’t come at the expense of people who did listen.
“Because this is a scarce resource and there isn’t enough for everyone, if you give it to someone who didn’t comply with the social and medical demands to get vaccinated, you’re punishing people who did everything they should have,” he continued. “That's a disincentive to get vaccinated.”
But Prof. Ran Balicer, who heads the Clalit Research Institute, said these issues must “remain outside the health system. The moment you enter the health system, the concept is that everyone is equal, independent of the decisions they made a moment before entering the system.
“When a person comes to you needing treatment, it doesn’t matter what he did a moment before,” he said. “It’s just like when a group of wounded people arrive that includes a drunk driver and the family he injured, the order of priorities is based on the severity of the injuries, not the identity of the wounded.”
The model reflects the risk that unvaccinated people are putting themselves in, he noted, pointing out that it also prioritizes smokers with obstructive pulmonary disease and heavy drinkers with liver disease. “Heart and artery diseases are also related to lifestyle decisions,” he added.
The initial 30 million shekels to buy the drug is coming from money previously set aside for the coronavirus. But if the pandemic continues for more than a few more months and a regular supply of the drug is needed, it will have to be funded out of the general budget for treatments covered by the national health insurance program.