Tennessee says vaccinated people should be last in line for antibody treatments to save them for the unvaccinated

• Tennessee recommends prioritizing unvaccinated residents for monoclonal antibody treatments.
• Vaccinated residents are behind them in line, since they're less vulnerable to severe COVID-19.
• Monoclonal antibodies are in short supply as the Delta variant tears through unvaccinated areas.

Unvaccinated people in Tennessee now have priority access to one of the few COVID-19 drugs shown to reduce hospitalization and death: monoclonal antibody treatment.

The state's government recommended this week that most vaccinated residents should be last in line for the treatment, which comes in the form of infusions or injections, the Tennessean reported Monday.

The drugs are designed to mimic the body's natural immune response by targeting certain coronavirus proteins and preventing them from entering our cells. The Food and Drug Administration authorized the first monoclonal antibody treatment for COVID-19 in November.

But the drugs are in short supply in Tennessee and across the US as the Delta variant continues to spread in states with low vaccination rates. In Tennessee, where just 44% of the population is fully vaccinated, COVID-19 cases still hover above 5,000 per day.

As of September 13, the federal government has been determining how many monoclonal antibody treatments each state will get based on that state's COVID-19 case count and how much supply it uses up each week. The government announced last week that hospitals can no longer order monoclonal antibodies directly from a wholesale supplier, AmerisourceBergen, due to shortages.

So Tennessee is asking healthcare workers to prioritize the most vulnerable - namely, unvaccinated, partially vaccinated, elderly, and immunocompromised people.

"It's definitely an ethical dilemma," Rodney Rohde, chair of the Texas State University clinical laboratory science program, told Insider. "I pray and I hope that no healthcare professional would ever be put in that situation."

Rohde said Tennessee's recommendation could potentially spur other states to issue similar guidelines.

"It's a mess when we get into legislating who to treat," he added.

Vaccines offer better protection than antibody drugs

In a letter to Congress last week, seven Republican representatives from Tennessee called on the federal government to "do everything in its power" to increase the availability of monoclonal antibodies.

But disease experts stress that vaccines are the better approach. The shots lower the risk of hospitalization by 71% to 93%, depending on which one you receive, according to a recent report from the Centers for Disease Control and Prevention. Recent studies also show that vaccines protect against severe disease for at least six months to a year.

Whereas vaccines instruct the body to produce a harmless viral protein, then develop antibodies against it, monoclonal antibodies help prevent people with mild or moderate symptoms from developing severe COVID-19 by stopping the virus from replicating. The drugs must be administered within 10 days (though ideally three to four) after symptoms start.

"Monoclonals are basically giving you direct antibodies that are only passively protective - in other words, they work right then on that infection at that time, but you are not protected long-term," Rohde said. "Vaccination is still critical in individuals because in theory, you would have to get monoclonals every time you had a bad experience with a viral infection."

Put another way, he said, "an ounce of prevention is better than a pound of cure."

Unvaccinated people have a greater medical need for antibody drugs

The US has authorized three monoclonal antibody treatments for emergency use, from GlaxoSmithKline, Regeneron, and Eli Lilly. In a study of non-hospitalized COVID-19 patients, 3% of those who got Eli Lilly's drug went to the hospital, compared to 10% of those who got a placebo. Regeneron's cocktail yielded similar results. That suggests monoclonal antibodies could reduce the risk of hospitalization by up to 70%.

The emergency authorization those three drugs have is the same type as the Moderna and Johnson & Johnson vaccines. Pfizer's shot, meanwhile, has been fully approved for general use among adults ages 16 and up.

"A lot of the arguments people use for not getting the vaccine technically would also apply to these monoclonal antibodies," Vivek Cherian, an internal-medicine physician in Chicago, told Insider. "It's a very, very new thing. It got developed very rapidly. It used modern science to get there. But people who aren't willing to get vaccinated are willing to get this treatment."

People in southern states especially seem to be demanding antibody treatments. Roughly of 70% monoclonal antibody orders in recent weeks came from seven southern states, six of which have among the lowest vaccination rates in the US, MSNBC reported.

Since unvaccinated people are far more vulnerable to severe disease and death than unvaccinated people, it makes sense to give them first access to antibody drugs, Cherian said, even if the policy seems unfair to vaccinated people.

"If you feel like you're doing your part, your duty and obligation to yourself, your family, and society, and then you go to the hospital and they're basically saying 'no' because you did your due diligence, I get why that can leave a sour taste in someone's mouth," he said. "But in general it still seems that the people who are at the highest risk, vaccinated or not, will still qualify."