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Sasha Mallett, Sue Taylor, and Kimberly Cooley all have immune deficiencies that make them particularly vulnerable to viruses. Covid-19and they all sought to achieve the same thing: a new treatment that could prevent the disease in people who were unable to produce antibodies after receiving a coronavirus vaccine, or who had no vaccine at all.

Ms. Cooley, a liver transplant recipient in Duck Hill, Miss., received the antibody drug Evusheld without any problems from the transplant team at the University of Mississippi Medical Center. However, Ms. Taylor from Cincinnati was not treated by the two hospitals near her home. And Dr., a doctor in Portland, Ore. Mallett had to drive five hours to the hospital to give him a dose.

While much of the country remains unmasked amid falling caseloads and fresh hopes that the pandemic has faded, the Biden administration has insisted it will continue to protect the more than seven million Americans with weakened immune systems who remain vulnerable to Covid. Developed by Evusheld AstraZeneca With financial support from the federal government, it is essential to its strategy.

But there is so much confusion about the drug among healthcare providers that roughly 80 percent of available doses lie unused in warehouses, on pharmacy and hospital shelves — Ms Taylor, 67, and Dr. Even patients like Mallett go to great lengths to get them, often without success.

Because they had a poor response to the coronavirus vaccine and were unable to fight Covid-19, many immunocompromised people continued to isolate themselves at home and feeling left behind as the country reopens. Administered in two consecutive injections, Evusheld appears to provide long-term protection – perhaps half a year – providing considerable appeal for this group.

But for now, the drug is in short supply. It is distributed by the federal government only as it is authorized for emergency use. According to a senior federal health official, the Biden administration has purchased 1.7 million doses, enough to completely cure 850,000 people, and have about 650,000 doses available for distribution to states as of last week. But only about 370,000 doses were ordered by states, and less than a quarter of them were used.

“There’s a lot of people who drive for hours and get scrapped to get Evusheld,” said Ms. Cooley, 40, “it’s on shelves in Mississippi.”

Interviews with doctors, patients, and government officials show a wide variety of reasons for not using the drug. Some patients and doctors are unaware of Evusheld’s existence. Some don’t know where to get it. Government guidelines on who should be given priority for medicine are inadequate. In some hospitals and medical centers, supplies are reserved for patients at highest risk, such as new transplant recipients and cancer patients, while in other parts of the country doses are distributed on a lottery or first-come basis. – service basis.

Hesitation is also a problem. Some doctors and other providers do not know how to use Evusheld and therefore hesitate to prescribe it. The fact that this is an antibody therapy can be confusing, as most such treatments are used after someone gets Covid, rather than preventative care.

In addition to the confusion revised Food and Drug Administration guidelines For Evusheld, published last month, he called for doubling the recommended initial dose after data showed the drug may be less effective against certain variants.

D., chief of the allergy and immunology division at Nationwide Children’s Hospital in Columbus, Ohio. “This is overwhelming and completely new,” said Mitchell H. Grayson. “Providers are definitely trying to keep up, it’s just – I don’t know how good everyone else is at this.”

about 3 percent of Americans characterized as immunocompromised by healthcare professionals because they have a disease or are receiving treatment that weakens their body’s immune response. It includes organ transplant recipients and people with conditions such as cancer, lupus, and rheumatoid arthritis.

Evusheld’s arrival in December immediately started an uproar. In Facebook groups and online messages, patients and their loved ones began to exchange information about how to receive it. Government datasets on Evusheld’s usability were so complex and confusing that Rob Relyea, a software developer in the Seattle area, developed his own. mapping tool This keeps track of how much of the drug is available and which providers have it.

“People need to know where to line up,” he said.

Mr. Relyea, 51, had a vested interest: His wife, Rebecca, is in remission from cancer. They tried 10 hospitals but were unsuccessful, but then luckily found the drug because Ms. Relyea’s name was chosen in a lottery for Evusheld at a hospital near their home in early February.

However, they have yet to hear about scheduling a second dose that Ms Relyea needs based on the new recommendations.

Oregon’s Dr. Mallett was one of many who were desperate to take the drug. He has common variable immunodeficiency, a condition that prevents the immune system from producing enough antibodies. His son started attending kindergarten in person last fall, and when the Omicron variant increased, his teacher and classmates began testing positive for Covid.

To find Evusheld, Dr. Mallett scoured an online database of government posts and cold-bloodedly searched hospitals, pharmacies, and healthcare organizations that had taken the drug for weeks.

When Ore eventually found a hospital in La Grande that wanted to give him a dose, he worked with his doctor to sign up there as a patient. Then she dropped everything and went to the hospital in the rain, got the needle and came right back – an 11-hour trip in total.

Dr. Mallett is highly educated, medically knowledgeable, wealthy, and easily able to take time off from her job—privileges that help her get a dose but others don’t.

“I definitely have a lot of ethical concerns about how I take this drug,” he said. “Did I take advantage of our broken system?”

Dr. Many of the healthcare professionals she called while trying to find a dose had not even heard of Evusheld—even though their workplaces had the drug in stock, Mallett said.

Some experts argue that Evusheld should go first to people who can’t get vaccinated due to severe allergies and those who produce the least antibodies in response to coronavirus vaccines. But antibodies are only one component of the immune system, and the Centers for Disease Control and Prevention still advise against using tests that determine antibody levels to assess someone’s immunity.

D., a transplant surgeon at NYU Langone Health working on coronavirus vaccines in transplant patients. “The biggest problem is that there is absolutely no guidance or prioritization or any presentation anywhere and there is confusion,” said Dorry Segev. . “You can’t really do anything without official guidelines.”

The Biden administration is trying to clear up the confusion. Top federal health officials are working to raise awareness among state paramedics, providers and patients. Last week they made a call to discuss the revised dosing guideline with advocates of disability; they also urged patient groups to partner with management in their outreach and education efforts.

Assistant health secretary for the Department of Health and Human Services, Dr. “I feel really strongly that this drug has great potential to help people who are immunocompromised who don’t always respond to vaccines,” said Rachel Levine. to call. However, Dr. Levine said he doesn’t anticipate that the CDC’s guidance on antibody testing will change.

Unvaccinated patients are obvious candidates for Evusheld. However, Dr. Among those vaccinated, calculations have become much more fuzzy and may include assessment of other underlying conditions or risk factors, Segev and other experts say.

For patients who manage to take Evusheld, experts say it’s still unclear exactly how much protection the drug provides. The drug’s effectiveness in protecting immunocompromised patients is difficult to quantify because many of the study participants avoided risky behavior and it would be unethical to ask them not to do so. Researchers may not know the exact effectiveness of the drug for months.

Evusheld was found to provide comparable protection to vaccines in a clinical trial, but the number of immunocompromised participants was never disclosed. Adding to the uncertainty, AstraZeneca studied the drug before Omicron came along. Research over the past few months has shown that Evusheld’s protects against variantbut it is not clear how much.

The lack of precise information disappointed Ms. Cooley, a liver transplant recipient in Mississippi. She’s still taking the same precautions she took before she got Evusheld, like making groceries deliveries, staying home, and only seeing a few trusted family members in masks. This is because she values ​​her elderly mother and has seen a number of other elderly people die from Covid-19, including her grandmother, in her community, where many choose not to be vaccinated.

Those who couldn’t find a dose of Evusheld turned to online communities rather than healthcare organizations. Dr., 54, a physician in Bethesda, Md., who has a genetic condition that affects the immune system. They seek help from other immunocompromised people, such as Vivian G. Cheung.

Dr. Cheung took a dose in January after calling various health agencies for two weeks and has been helping others navigate the process ever since. He receives up to 10 requests for help each day, but he estimates that only a quarter of those who do manage to get Evusheld.

Ms. Taylor of Cincinnati has widespread variable immunodeficiency. Currently, however, one nearby hospital limits Evusheld’s supply to transplant patients, while another is not yet accepting patients from outside its system. He cannot look elsewhere; She said she was uncomfortable driving long distances due to underlying health conditions.

Ms. Taylor said she didn’t want to take a dose from someone who might need it more, but would feel less “panicized” if she could take Evusheld. He may start seeing his children inside again and return to his life before Covid.

For now, isolation, masking and hoping a dose will be found soon.

Rebecca Robbins contributing reporting.