The Trump administration mishandled the initial distribution of the only approved coronavirus medication, delaying treatment to some critically ill patients with covid-19, the disease caused by the virus, according to nine current and former senior administration officials.
The first tranche of 607,000 vials of the antiviral medication, remdesivir, donated to the government by drugmaker Gilead Sciences, was distributed in early May -- in some cases to the wrong hospitals, to hospitals with no intensive care units and therefore no eligible patients, and to facilities without the needed refrigeration to store it, meaning some had to be returned to the government, said the officials familiar with the distribution effort.
Demand for remdesivir soared after the National Institutes of Health announced on April 29 that a clinical trial had shown that hospitalized patients with advanced covid-19 who received the experimental drug recovered faster than similar patients who received placebos. Two days later, the Food and Drug Administration, citing those results, approved the drug to treat severely ill patients.
Doctors said that because the drug is the only approved treatment for covid-19 patients and in extremely short supply, any delay or reduced availability would be potentially catastrophic.
[CORONAVIRUS: Click here for our complete coverage » arkansasonline.com/coronavirus]
"We think the earlier you get it when you're critically ill, the more likely it is to be beneficial, so delays could end up making the difference between whether the drug is effective or not," said Ashish Jha, director of the Harvard Global Health Institute and a practicing physician. "The fact that we'd be so incompetent in our distribution of this that we'd ... inefficiently distribute the one therapy we have is stunning. How can we make that mistake? What are you working on that's more important than this?"
The government's initial distribution in the first week of May was so problematic that White House coronavirus response coordinator Dr. Deborah Birx shared fallout from state health and hospital officials with senior staff members on the task force, according to three senior administration officials.
"I hope the experience with remdesivir has taught decision-makers to be more prepared and more strategic" about handling vaccines, said Steven Joffe, a medical ethicist at the University of Pennsylvania.
80% Distributed
A spokeswoman for the Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response, which oversaw the distribution, did not address whether the drug went to the wrong hospitals or whether any of it had to be sent back as a result. She instead pointed to a web page explaining how preparedness and response office was allocating the drug.
As of last week, about 80% of the donated remdesivir from Gilead had been distributed, according to the preparedness and response office. Gilead plans to donate an additional 333,160 vials of the drug by mid-June, according to the Health and Human Services Department, bringing the total donation to 940,000 vials.
The accounts shared by state and federal officials indicate that the Office of the Assistant Secretary for Preparedness and Response began sending out cases of the donated drug to hospitals in the first days of May.
On a May 5 call, that office first informed state health officials that it was distributing the experimental drug to hospitals across the country, said one state health official who spoke on condition of anonymity because he was not authorized to speak about a private call. The initial batch of medicine was sent to facilities in 13 states, he said.
Many hospitals were not prepared to receive the medication, however, because they were not alerted ahead of time, said several senior administration officials and hospital and state officials. State health officials initially did not know how the government was deciding where to send such a limited supply of the medication.
"That caught everyone by surprise," the state health official said. "The states should have been part of the decision-making. They should not be told after the fact about what's being put in motion."
Some of the medication was sent to Montefiore Medical Center in New York, for instance, but the hospital did not have the refrigerator space to store the drug, according to two senior administration officials and one New York health official. Montefiore did not respond to numerous requests for comment. It is unclear what happened to those vials of the drug.
On that same May 5 call after the first distribution, state officials told Robert Kadlec, Health and Human Services assistant secretary for preparedness and response, that the data the agency was relying on was problematic, said the state official on the call.
The Office of the Assistant Secretary for Preparedness and Response initially used data that showed hospital intensive care unit bed capacity and size, as well as county-level case data, the state official said. But state officials told Kadlec that the data overstated the need in some parts of the country while underestimating it in others, the state official said.
On May 9, Health and Human Services altered the process, announcing that it would send the drug to states, which would then decide which facilities would get the medicine, how much and when -- much as they handle distribution from the Strategic National Stockpile, the state health official said.
Hospital and state officials said the process has since drastically improved.
Problems Denied
Amerisource Bergen, which distributed the drug for Gilead while following the government's directives, denied that there were any problems in sending remdesivir to states and hospitals.
"AmerisourceBergen representatives contacted every facility, including both health systems and state health departments, designated by the government to receive Remdesivir prior to shipping product to ensure they had cold chain capability and were prepared to receive the drug," company spokesman Gabe Weissman said in a statement. "Upon completion of these shipments, AmerisourceBergen confirmed with each recipient that the quantity and temperature of the delivered medication was appropriate."
Daniel Abazia, director of pharmacy for Capital Health, a two-hospital system in southern New Jersey, said the confusion that surrounded the initial rollout of remdesivir dissipated as the state took over the allocation.
He said the health system has gotten two shipments of the drug and now is in a "good position," especially since its number of covid-19 patients is decreasing.
Now, with a more coordinated federal response, states and hospitals are grappling with decisions about how to allocate the scarce medication and which covid-19 patients should get it.
Some hospitals are administering the drug to as many patients as they can who meet the Food and Drug Adminisgtration criteria, without worrying about whether the drug might run out. Critics of that system say it could hurt patients who get sick later. Other hospitals are adding conditions or using modified lotteries.
A Section on 05/29/2020