Evusheld: The debate over its rollout in the UK

Evusheld contains two anti-bodies against Covid - but the Department of Health says there is "insufficient data" when it comes to protection against the Omicron variant - Science Editor Deborah Cohen reports

Shannon longs for a normal life. 

Covid vaccines are not effective for her, as she’s on a variety of immunosuppressant drugs because of her illness.

She’s been shielding for over two and half years, and has lived away from her daughter and husband for long periods of time for fear of catching Covid.

After trying online learning, Shannon decided she wanted her daughter to go to school. 

“All of her friends were in school and I don't want my daughter's mental health to suffer because of my condition, which doesn't seem appropriate,” Shannon says.

“So around her 15th birthday, we made the decision that I would move to a flat.”

Shannon has been shielding for over two and half years as Covid vaccines are not effective for her. Credit: ITV News

Shannon had pinned her hopes on Evusheld (also known as tixagevimab and cilgavimab) to protect her from the virus. 

It’s a new drug that uses a modified version of naturally occurring antibodies that bind to the virus that causes Covid to stop it entering and infecting cells - antibodies her body can’t make. 

Evusheld is available in dozens of other countries - but for now, it won’t be available here. 

The government says there is “insufficient data” when it comes to the protection against the omicron variants, following what they say has been a “robust review of the available data".

“My family and I are really losing patience and also losing hope. And it's not nice being hopeless,” Shannon says. 

Patient groups are critical about the lack of transparency that led to the decision. 

'My family and I are really losing patience'

“There's nothing in writing that we can read about the decision making. It's just not transparent,” Shannon says. 

ITV News has asked government agencies whether the data behind this decision will be published. 

The UK Health Security Agency (UKHSA) were reported to be looking at how effective Evusheld is against certain omicron variants. 

None of the agencies involved have responded to our requests regarding the publication of further data. 

While patient groups are upset and frustrated about the decision not to roll out Evusheld across the NHS, the medical world is split. 

Over 120 clinicians from different specialties have signed a letter calling for Evusheld to be used as soon as possible.

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Others have a slightly different take.  

Prof Carlo Palmieri, a medical oncologist, says any benefits of the drug need to be balanced against any harms - and Evusheld is not risk free, he says. 

“Clearly it’s disappointing when a preventive treatment fails to meet the mark when it’s reviewed.

"I think that clearly is a disappointment and many patients obviously wanted the treatment and it would have made a difference,” he says. 

“These decisions are made by experts, meeting and going through the data. I trust my colleagues who’ve made those decisions. They have the evidence in front of them,” he adds. 

Dr Andrew Hill, a pharmacologist from Liverpool University, has been looking at treatments for Covid throughout the pandemic and remains to be convinced about Evusheld. 

Dr Andrew Hill is sceptical about the new treatment

“This drug was tested over a year ago on old Covid strains and now we have omicron, which has a different shape. These antibodies lock on to a particular shape of virus," he says.

He’s sceptical about “real world” data from other countries that show it’s effective against the omicron variant.

These are the kind of studies that showed ivermectin and hydroxychloroquine - two discredited drugs for Covid - worked, he says. 

He says if AstraZeneca believed in this drug, they should run trials against the newer variants. 

Dr Hill also says there’s the issue of cost. The NHS has a limited budget and what it spends on Evusheld can’t be spent on other things.  

The cost of drugs isn’t usually transparent in the UK so it’s unclear how much AstraZeneca, the drug company that markets it, is asking for here. 

“If we have to use really high doses on a really high cost treatment, is it worth spending hundreds of millions of pounds on treating people with this drug when we don't even know if it's effective?” Hill asks. 

The government says it’s asked the NHS drug watchdog, NICE, to see if it's cost-effective and provides value for money. This is what typically happens to drugs for other conditions before they’re rolled out across the NHS. The results of this review will be available in April next year. 

But patient groups point to the fact that this hasn’t happened with drugs for Covid. They feel like they’re being left behind. 

“We don't understand why they're doing a different process for Evusheld than they use for all the other Covid treatments,” Shannon says.

“I don't think they should go back to a normal process because Covid isn't over…we need agile processes. Like the rest of the world has, we cannot go through lengthy, NICE processes and stay ahead of this virus.”

The government says it continues to explore the market for preventative treatment options.  But with Covid still around, for Shannon and many others like her, life remains on hold.