Prisons skimp on Covid treatments like Paxlovid, even as Biden plans to flood pharmacies with it

WASHINGTON — Pfizer’s antiviral drug Paxlovid seems tailor-made for combatting Covid-19 in prisons: It doesn’t require an intravenous infusion like other treatments. There are signs it could significantly reduce people’s ability to spread the virus. And it significantly cuts people’s chances of getting seriously ill or dying from Covid-19.

But the drug isn’t being made available to the vast majority of federal prisoners, according to STAT’s review of available data.

Since Paxlovid was authorized by the Food and Drug Administration in December, the federal Bureau of Prisons has received just 160 doses of the drug for the entire federal prison system, which houses more than 150,000 people. That represents less than 0.03% of the 688,000 doses of the drug that the federal government has already shipped to states, territories and other government agencies, like the Department of Defense.

American Samoa — a U.S. territory with roughly 50,000 people that has experienced 290 Covid-19 cases since the start of the pandemic and has had zero deaths — received 20 more doses of Paxlovid than the entire federal prison system, which has reported more than 55,000 Covid-19 cases since the start of the pandemic.

A spokesperson for the Department of Health and Human Services, which manages distribution of these treatments, told STAT that HHS does not unilaterally decide how many drugs the BOP or any federal agency receives. Instead, the BOP is supposed to request these drugs.

“HHS has not received a request from the BOP for additional product at this time,” the spokesperson wrote in a statement.

A spokesperson for the Department of Justice, which includes the BOP, told STAT in a statement that BOP requests treatments from the health department “as needed to ensure BOP patients have access to these medications.” “At no time since December 2020 has [BOP’s central pharmacy] been without COVID therapeutics inventory,” the spokesperson added.

As the Omicron variant was ravaging prisons, the BOP was not requesting a sizable uptick in Paxlovid pills, STAT’s review of the data reveals. Four federal prisons saw triple digit spikes in new Covid-19 cases the week of January 24, and seven prisons saw the same the week before, according to data compiled by researchers at the University of Iowa. But the BOP didn’t request any new Paxlovid doses that week, according to federal data.

“Wide access to this would have prevented death and prevented suffering among a marginalized population that really would have benefited,” said Lauren Brinkley-Rubenstein, co-founder of the Covid Prison Project at the University of North Carolina-Chapel Hill.

The tiny allocation also comes as President Biden plans to flood U.S. pharmacies with the potent drug. Biden announced during his State of the Union address last week that he will soon allow patients around the country to pick up the drug at a pharmacy immediately after testing positive for Covid-19.

Corene Kendrick, the deputy director of the National Prison Project at the ACLU, said that if the drug is being widely used in the community, the law indicates it needs to be available in prisons as well.

“There’s no justification for withholding this, especially given how efficacious it is,” Kendrick said, adding that the current allocation of Paxlovid to federal prisons is “disturbingly low.”

Covid-19 rates in federal prisons have, for the most part, leveled off in recent weeks, as the Omicron wave flattens nationwide. But experts say that’s still no reason for the BOP not to stockpile this drug in preparation for additional surges.

“We are not in the middle of a crisis … but you might imagine that we will see another variant and when that variant comes, it will disproportionately impact prison populations,” said Brinkley-Rubeinstein. “So, distribution of treatment — of therapeutic tools — now, before we see our next wave, is really important to keeping people in prisons safe … It’s imperative that we do what we can now, even though the numbers are low.”

STAT spoke to several experts on Covid-19 therapeutics and prison health care for this story. They all agreed that prisons, by and large, should be using Paxlovid in their facilities.

Eric Topol, the director and founder of Scripps Research Translational Institute, called prisons an “ideal place to have these potent pills.” He also called the Bureau of Prisons’ current allocation of the drug “grossly insufficient.”

Paxlovid has been proven to dramatically lower people’s risk of dying or having serious complications from Covid-19. Pfizer’s clinical trial for the drug found that it reduced the risk of hospitalization and death from Covid-19 for high-risk patients by 89%.

That’s sorely needed in prisons: One study published in the Journal of the American Medical Association in July 2020 found that people in prison were roughly three times more likely to die of Covid-19 than the general population after adjusting for the fact that the prison population skews younger.

There’s also signs that the pills could help slow the spread of Covid, which has rapidly swept through federal prisons because of overcrowding and the difficulty of social distancing.

Pfizer’s Phase 3 trial found that Paxlovid reduced the viral load of infected patients by approximately 10-fold compared to placebo. Outside observers have noted that such a reduction in viral load would likely make people less contagious.

Paxlovid is also easy to administer, making it an ideal drug for prisons, which often have limited medical services onsite. The drug is a three-pill cocktail taken twice a day for five days. The potential side effects, including altered or impaired sense of taste and spikes in blood pressure, are relatively easy to manage.

“This is a simple easy thing that could be rolled out,” said Jody Rich, a correctional health care expert at Brown University, who argued that the drug should be available in stockpiles and disseminated when outbreaks occur.

The only limiting factor to its widespread use in prisons is that the drug is not recommended for people with certain conditions, like severe liver impairment, and that interactions with other medications must be closely managed, multiple prison health experts explained to STAT.

The BOP’s own guidelines suggest that Paxlovid could be used for a wide swath of people in its custody. The guidelines state that the drug should be administered to anyone who tests positive for Covid-19 within the last five days, has mild to moderate systems, and is at high risk for severe illness.

Paxlovid isn’t the only Covid-19 treatment that isn’t widely available in BOP facilities — though the other drugs aren’t as clearly suited for treating Covid-19 in prisons.

The BOP has received only 48 doses of another oral antiviral drug, Merck’s molnupiravir, since that drug was authorized by the FDA in late December, according to STAT’s review of the data.

The government has sent out roughly 2 million doses of that drug to states and territories, though many of those doses are sitting on shelves because the drug is only 30% effective at reducing the risk of Covid-19 hospitalization.

Prisons also don’t appear to be getting widespread access to injectable monoclonal antibody treatments, STAT’s review of federal data reveals.

Throughout the Omicron wave, the federal government flooded states with the GlaxoSmithKline’s sotrovimab because it was proven to be one of the few antibody treatments effective in reducing the risk of hospitalization and death from the Omicron variant.

The government has sent out more than 600,000 doses of the drug since Omicron was first detected in the United States. The BOP received just over 300.