Polarisation clouds the role for Regeneron’s Covid treatment
Executives must believe in their products. The classic cautionary tale is jewellery boss Gerald Ratner, who boasted he was selling “total crap” and wrecked his career.
But it is also possible to disrespect potential customers the opposite way. At a healthcare conference this week, Regeneron co-founder George Yancopoulos asserted that the death from Covid-19 of former US secretary of state Colin Powell “could probably [have] been prevented” by the use of monoclonal antibodies.
Speculating on whether Regeneron’s signature treatment may have saved Powell, an 84-year-old man who also suffered from blood cancer, was all the more amazing as Yancopoulos is also the pharma company’s chief scientist. But Regeneron is a company surrounded by odd boosterism and weird political polarisation.
When President Donald Trump was ill with Covid-19 last year he received early access to Regeneron’s antibody therapy, which was yet to be made available to the general public, and claimed it was a “miracle” and a “cure”. Distributing the medicines to hospitals around the country was “much more important” than the vaccine, Trump said.
Following in the footsteps of their defeated leader, Republican politicians have continued to promote the use of monoclonal antibodies, laboratory-made versions of the body’s natural defences that are also produced by Eli Lilly and GlaxoSmithKline, while rejecting vaccine mandates.
Allen West, a Republican candidate in the governor’s race in Texas, fell ill with coronavirus this month. Rather than rue his decision not to get the vaccine, the politician pronounced he was “even more dedicated to fighting against vaccine mandates. Instead of enriching the pockets of Big Pharma and corrupt bureaucrats and politicians, we should be advocating the monoclonal antibody infusion therapy.”
Regeneron, though, is hardly a mom-and-pop business. It has a market value of $60bn. Its treatment was sold to the US government at $2,100 a dose, more than 100 times the price of vaccines from BioNTech/Pfizer and Moderna.
Doing little to mend the partisan divide, Yancopoulos told the HLTH conference this week that the current Biden administration and the media had failed to communicate the life-saving potential of monoclonal antibodies, thereby costing “tens of thousands, if not hundreds of thousands of lives”.
Regeneron has done its best to fill this perceived gap, with television ads first launched in February — “Tested positive for Covid-19? Call your doctor now about monoclonal antibodies” — notwithstanding the fact that the treatment is suitable for only some patients.
“Regeneron has a very specific use. That really needs to be made clear,” said Dr Leana Wen, an emergency physician and professor of health policy and management at George Washington University. “It’s a problem when there are politicians who tout it as a cure.”
The noise around Regeneron has put it in the same bucket as ivermectin, hydroxychloroquine, remdesivir and zinc — all seized upon by anti-vaxxers as the right response to coronavirus.
There is one crucial difference. The efficacy of those drugs against Covid-19 is low, non-existent or unproved, whereas Regeneron’s treatment works. A UK study in June found it cut deaths by 20 per cent among patients who were hospitalised with coronavirus and whose immune systems had not produced a robust antibody response.
Used on patients that were high-risk but treated early after infection, it cut the chances of hospitalisation and death by 70 per cent, according to a US study in May.
Patients who are immunosuppressed and cannot produce their own antibodies are the biggest potential beneficiaries. “These people are . . . prisoners of the pandemic,” Yancopoulos told the same conference. “They’re afraid to go out because they’re at such high risk and vaccines are really pretty useless approaches for many of them.”
Outside the US, where the medicine is distributed by Roche, there is neither the same polarisation nor as much awareness. But the ultimate problem is not demand but supply. The two pharma companies have said they plan to make only 2m doses in total a year. The nature of the monoclonal antibodies means production cannot be scaled up rapidly.
Over time it may not be needed. Vaccines will be sufficient to help most people. Emerging antiviral pills from Merck and others are much simpler to administer. Still, the monoclonal antibodies from companies including Regeneron are likely to have a role for some patients.
It would be better if this were not clouded in over-exuberant boosterism or an excessively sceptical reaction. Perhaps Yancopoulos feels this too. At the end of his conference remarks this week, he was asked for his biggest disappointment during the pandemic. He replied: “I thought it would bring us together.”