By Chris Satullo
Imagine that a contagious disease were rampaging across our land. Imagine further that it had sickened more than 42 million Americans – and killed nearly 700,000, maybe more.
Now imagine, of you will, two different medical approaches to stemming the carnage from this virus.
Treatment 1 costs about $20 per person and involves a needle jab that takes about 10 seconds for harried medical personnel to administer. It’s been given to 182 million Americans in the space of less than a year. That experience has confirmed the rosy predictions made last year for its potential effectiveness: Treatment 1 prevents the disease 60-70 percent of time. Even when people still get snared by the virus, it keeps symptoms from getting serious enough to require hospitalization at least 90 percent of the time.
Supplies of Treatment 1 are ample. Then-President Trump received this treatment as soon as it was available.
Still, Treatment 1 suffers from skepticism in some quarters because it is produced by “Big Pharma” in collaboration with the federal government and was originally offered under an “emergency use” authorization. “Rushed into use” is the skeptics’ operative, but inaccurate, phrase.
Treatment 1 is also, admittedly, so new that no authoritative data exist on exactly how long its good effects last, or whether it will have any long-term side effects beyond its minimal immediate ones.
Now, consider Treatment 2.
It costs about $2,100 per dose, 100 times the cost of Treatment 1, and takes up to two hours per dose to administer, requiring specialized equipment and skilled hands. What’s more, it is only administered once a person is already infected, or has been exposed to someone who is. It is not meant for widespread prevention. And it is in much shorter supply than Treatment 1.
Yes, Treatment 2 is proving adept at saving lives that might otherwise have been lost to this disease. It’s a marvelous medical advance. It probably saved then-President Trump’s life when he received this treatment last fall before it was generally available to the public.
That said, Treatment 2 is, just as much as Treatment 1, a collaboration of Big Pharma and the federal government, being administered under an emergency use authorization with no firm data on how long its good effects last, or what any long-term side effects might be.
So I ask: Given these facts, on which of these two treatments would a smart Wall Street investor or even a savvy football fan plunk down their bets?
Treatment 1, of course.
Hyping Treatment 2 over Treatment 1 would be nearly as ridiculous as a hedge fund deciding to go in big on Theranos today, or a bettor taking little Alcorn State even up against NCAA champion Alabama.
Just makes no sense.
By now, you’ve figured out that Treatment 1 is the COVID-19 vaccine, in its various Pfizer, Moderna and J&J incarnations. Treatment 2 involves monoclonal antibodies, like the drug Regeneron that Trump’s medical team gave him when he caught COVID. Trump then praised the drug to the skies after his release.
Monoclonal antibodies have risen rapidly in use over the last month as the Delta variant of the virus sticks its talons deeper into America.
It is in particular demand across the sunny South. Up until now, 70 percent of the doses given have been infused in seven Sun Belt states: Florida, Mississippi, Tennessee, Alabama, Georgia, Louisiana and Texas, which represent 36 percent of the nation’s population.
Not coincidentally, all those states, excepting Florida, are in the bottom 10 nationally for vaccine rates. All are bastions of MAGA-esque mask defiance. Florida Gov. Ron DeSantis, who has all but declared jihad against masks, is pushing monoclonal antibodies for his constituents as if he has stock in Regeneron.
Bottom line: Residents of those states, their heads clogged with bad info, are illogically counting on Treatment 2 ahead of Treatment 1, predictably getting sick and expecting the rest of us to pick up the tab for their stupid decision.
You see, the federal government, as is proper, pays for every dose of monoclonal antibodies going into coronavirus patients. Through Medicare, Medicaid and subsidized Obamacare, it is paying a vast share of the costs for administering the infusions.
Not only that, some of these “elective” COVID patients are clogging ICUs, taking away beds, resources and staff time that should be going to other patients who are seriously ill.
Seeing shortages looming, the Biden administration just approved spending $3 billion more to buy and distribute more doses of monoclonals across America. But, for the first time, expressing exasperation through bureaucracy, Biden has ordered that the feds stop supplying doses to states on demand. Instead, his directions are to try to spread doses equitably around the land.
No more letting Bubba bogart the drugs.
Tennessee, with its inimitable genius, promptly responded by saying it was going to give unvaccinated patients priority over most vaccinated ones (with some exceptions for the severely immunosuppressed.) Yes, you can make a medical ethics case for prioritizing people with the weakest defenses against the invader, but it still rankles to see MAGA idiocy catered to in this way.
Let me suggest taking the latest Biden logic a step further.
As tempting as it might seem to relegate to the back of the Regeneron line any people who caught the virus through stiff-necked MAGA-ness, that’s obnoxious ethically. We don’t deny chemo to smokers who get cancer or surgery to liver patients who drank a little too much. Start doling out care based on our moral judgments and where does it stop?
That would also be just as wrong, in terms of authentic, “we’re in this together” patriotism, as when The Donald, back in early pandemic times, tried to groove medical equipment like ventilators to states that voted red. You can’t overcome the amoral by aping them.
No, access to monoclonal antibodies should continue to be handed out first to whomever is the most medically needy, as hospitals can best determine that. But who should pay?
Here is where one glimpses a chance for accountability to be delivered to irresponsible governors like DeSantis, who have made this epidemic longer-lasting and more lethal through their insane policies against masking and their public ambivalence about vaccines.
I see no problem, ethically, with the Biden administration continuing to send doses of Regeneron to the Stupid Seven states, then following the doses up with a bill to the states for the costs. That’s not about partisan payback; it’s about cultivating wise policy and not letting public officials pawn off accountability.
Again, no person should go without available life-saving care due to partisan spats. But let’s make governors of states with breathtakingly stupid policies on masking or vaccines pay out of their own treasuries for every one of those doses of monoclonal antibodies that their residents get, along with the costs of administering them.
Is this constitutionally kosher? I’m decidedly not a law professor. It would seem to me, though, that it would indeed be constitutional, under Article I, Section 8, Clause 1 of the U.S. Constitution and the ruling precedent of South Dakota v. Dole. Such a federal action would seem to be well-targeted to the Dole standard: that the action be aimed at “protecting the general welfare” and “germane to a federal interest.”
If those governors didn’t pay their Regeneron bills, on time and in full, the feds might, say, consider suspending the flow of all federal highway funds to their states.
That ought to get Maskless Ron’s attention.
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Chris Satullo, a civic engagement consultant, is a former editorial page editor/columnist at The Philadelphia Inquirer, and a former vice president/news at WHYY public media in Philadelphia