Hospitals and physicians around the country are sharply criticizing the federal government for the uneven and opaque way it is distributing its supply of the Covid-19 drug remdesivir....Should we assume that this is like many other aspects of the Trump administration's pandemic response -- Jared Kushner is in charge and the decisions are being made by young Masters of the Universe from investment banks and consulting firms? Does someone on Kushner's team have an old college chum who's now at Mass General, while no one with any connections to the princeling's princelings works at North Shore Medical Center?
About two dozen hospitals are believed to have been chosen to receive the drug so far, but clinicians told STAT it is unclear why some medical centers were chosen to receive coveted doses while others weren’t — and who is making those decisions in the first place....
“In my opinion, and I think in the opinion of many of my colleagues, there is a complete lack of transparency about how this decision is being made and who is making it,” said Daniel Kaul, an infectious disease physician at the University of Michigan. His hospital’s pharmacy department informed him that their center wouldn’t be getting any doses of remdesivir after being in contact with the drug’s private distributor, AmerisourceBergen, earlier on Wednesday....
Even medical centers chosen to receive the drug were in the dark. “I legitimately do not have any insight into how hospitals were selected,” said Paul Biddinger, director of Massachusetts General Hospital’s Center for Disaster Medicine and one of the leaders of the hospital’s pandemic response.
On Tuesday evening, he said, the hospital’s pharmacy got confirmation that it would receive enough remdesivir for about 170 patients. He had heard that three other medical centers in the state also got allocations. Most other Massachusetts hospitals — including some that were among the hardest hit by Covid-19 — would receive none....
Mass. General, with 381 patients as of Wednesday, seemed a clear choice for remdesivir. But two others that are receiving doses are much farther down the list: Melrose-Wakefield Hospital had 52 patients, while North Shore Medical Center in Salem had 102, according to a state database of Covid-19 cases. Meanwhile, Beth Israel Deaconess Medical Center in Boston, with 248 cases, and Boston Medical Center, with 238, aren’t slated to get the drug....
Earlier instances of unapproved drugs being authorized for emergency use have been very different, said Michael Ison, an infectious disease physician at Northwestern Medicine. During the H1N1 flu outbreak in 2009, he explained, the Centers for Disease Control and Prevention created a website as soon as the FDA authorized emergency use for peramivir, so that hospitals could apply for the medicine.
Not so for remdesivir. “Currently there is no way anywhere I’ve seen to figure out how this is being distributed or how they’re making decisions about this,” Ison said.
Whatever the explanation, we know the decisions aren't being made carefully and conscientiously, because both Trump and his de facto chief of staff Kushner believe, even during a deadly pandemic, that care and conscientiousness are for losers.
So I'll repeat what I've said before: If you think you'll be able to get a dose of the eventual COVID-19 vaccine shortly after it's made available, remember that distribution of the vaccine will be exactly like this if it arrives in the next presidential term and Trump has been reelected. There'll be no transparency about the distribution. There'll be no discernible logic. It's possible that the vaccine will be distributed in a way that's riddled with corruption and profiteering, but it's also possible that arrogant, unqualified people will just make decisions based on connections and personal whims.
Toss in Trump's politics of resentment and you should assume you'll have trouble getting vaccinated for the duration of Trump's presidency, even if his term extends to January 2025 and we have a vaccine next year. "Anyone who wants the vaccine can get the vaccine," Trump will say. It won't be true for a long time.
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