First, there are simply not enough doses in the world yet. Regeneron currently has enough doses for 50,000 patients. Eli Lilly, who makes a different COVID-19 monoclonal antibody therapy that is also in clinical trials, says she will have 100,000 doses in October. To put this in context, the United States has 50,000 new cases of COVID-19 everyday.
The manufacturing of monoclonal antibodies cannot simply scale up on a large scale to treat everyone, says Howard Levine, who heads a group of pharmaceutical manufacturing consultants at BioProcess Technology Group. The antibodies are made in large stainless steel tanks using genetically engineered hamster ovary cells. Like all living things, they can only grow so fast. Tanks are also sophisticated pieces of equipment that can take months to install, Levine says. Regeneron and Eli Lilly have already increased their production capacity, and they expect to have 300,000 and 1 million doses respectively by the end of the year. The two companies also recently filed for emergency use authorization – a looser and faster process than formal approval from the Food and Drug Administration – which Trump says will come soon.
Monoclonal antibodies should be reserved for patients most at risk of possibly developing severe COVID-19. “To be able to process thousands of [of patients] is probably doable, ”says Wayne Marasco, who studies monoclonal antibodies at Harvard. “Tens of thousands of people are pushing it, in the short term.” Doctors will need to predict who could benefit the most. People who are older, have underlying illnesses, or already have severe symptoms such as low oxygen – like the president himself – would be more likely to get monoclonal antibodies.
But doctors will have to make the decision early in the illness, before these patients become seriously ill. Monoclonal antibodies are likely to work best when the virus is still trying to take hold in the body. In general, you want to “stop a microbe from replicating – in this case the virus – as soon as possible,” Cohen says. But stopping the virus depends on the ability of patients to get tested for COVID-19 early, receive their results quickly, and get to a hospital that stocks experimental treatment before they even really need a treatment. hospitalization. At this time, monoclonal antibodies must be administered intravenously, so they cannot be offered in pharmacies or in most medical offices.
These obstacles are not a problem for the president, who has the best medical care the country has to offer. But as my colleague Olga Khazan writes, COVID-19 treatment is significantly less comprehensive and accessible for the average person. Ordinary Americans have repeatedly experienced delays in testing during this pandemic. And when the United States earlier this year began allocating initially scarce doses of the antiviral drug remdesivir, which Trump also took, many hospitals arrived empty-handed.