Are Monoclonal Antibodies A Reasonable Alternative to COVID Vaccines?

Rumor has it that there’s a new treatment for COVID-19 on the scene. Not hydroxychloroquine or ivermectin — one of which was never anything but fantasy which wound up killing someone; the other of which was actually scientifically plausible but turns out to be totally ineffective. The new thing appears to be monoclonal antibodies, a drug manufactured by Eli Lilly. Regeneron creates what are called “monoclonal antibodies,” which are in essence lab-grown immune system supplements, a booster to the body’s existing immune system cloned from existing immune cells.

Regeneron is not an alternative to a vaccine. There are a lot of reasons for that.

First and most importantly, it costs about $2,000 a dose. Compare that with between $20 to $35 per dose to the four principal vaccines (three of which are in use in the USA; to my knowledge, Astra-Zeneca’s vaccine is not in wide use here). There’s also a whole lot less of the drugs which create monoclonal antibodies available; it costs as much as it does because it’s expensive and difficult to produce. This will probably be a treatment available only to the affluent or at least the very well-insured.

Secondly, the medicines are given at different times. You take a vaccine before you get sick. You take monoclonal antibodies after you’ve already got sick. If you’re taking monoclonal antibodies for COVID, you already have COVID.

Thirdly, a monoclonal antibody treatment does nothing to reduce one’s effectiveness as an incubator, host, and vector for the virus, at least until the disease loses the fight. A vaccinated host defeats the disease quicker and carries a lower viral load, and therefore is less contagious.

Fourthly, some vaccines require two doses, some only one; there is talk of perhaps the Pfizer version of the vaccine requiring a booster for certain kinds of patients. Monoclonal antibodies require five or more treatments.

Finally, because the monoclonal antibodies do not carry any mRNA, they do not “teach” your immune system to adapt to COVID. If anything, because they fight the virus supplementary to the body’s own immune system, they leave the recovered patient significantly more vulnerable to re-infection than if the patient had either been vaccinated or if the patient had successfully fought the virus with effectively no treatment at all or just palliative treatment for symptoms. There’s no reason a person couldn’t get both monoclonal antibodies if they get sick anyway and then later get vaccinated.

But monoclonal antibodies have many of similarities to vaccine treatments. Both vaccinated patients and patients treated with monoclonal antibodies can reasonably expect to be hospitalized less, if at all; recover faster, and die or be intubated less. Both kinds of treatment are experimental. (Except for the Pfizer vaccine, which as of press date has been moved out of “experimental” status with an emergency release by the FDA and now enjoys full approval.) Neither are 100% effective at preventing, curing, or mitigating COVID. (No medicine, whether preventative, curative, or palliative, is ever 100% effective for 100% of people who take it.) If you get vaccinated and have a breakthrough case of COVID anyway, or if you get COVID and are fortunate enough to be able to afford to take a course of monoclonal antibodies, you are going to be contagious and therefore quarantined for a time. Both are grown in a lab and were created using very advanced medical science that’s difficult for laypeople to fully understand, and neither could have been created through “natural” means. Both target only the spike protein on the COVID virus. Some people seem to think that targeting only the spike protein (the little protuberances from the sphere-shaped body of the virus) this is somehow a fault of the mRNA vaccines and the antibodies that result from taking them. This is not rational, but if you hold on to this belief despite that, monoclonal antibodies work the exact same way. Both carry a risk that the virus will mutate in response to encountering widespread immunities. As do all treatments of all pathogen-borne diseases.

But the big deal here is that you take monoclonal antibodies after you get sick and not as a way of avoiding getting sick. They’re literally a hundred times more expensive than vaccination in advance, and much more scarce.

All of which is to say, it’s pretty clear that monoclonal antibodies are a treatment for a disease you already have; vaccines are a way not to get the disease in the first place. They are not the same thing and neither employers nor employees should think that they are. It’s not going to be good enough for someone seeking to avoid vaccinations to say to their employer “I’ll take weekly or bi-weekly tests and if I get it, I’ll pay for the monoclonal antibody treatment myself.” The infected person will still be very contagious and the employer has a legitimate concern about avoiding transmission to others.

Vaccination mandates are presumptively legal. Terminations for those who refuse to get vaccinations are presumptively righteous, absent some failure of the employer to reasonably respond to a request for an accommodation. Maybe there are other theories out there that I haven’t come across yet. But right now, that’s how I read the law.

Without getting into specifics, I’m hearing many rumors of religious exemptions “not being accepted,” which I take to mean employers announcing that they have no accommodation available to the non-vaccinated. Please be aware that the employer choosing to agree with a claim that an employee having a sincere religious objection to vaccination is not the end of the process. There needs to be a reasonable workaround as an alternative to vaccination as well; if the workaround turns out to be unreasonable, the employer probably is going to win a claim for wrongful termination.

Monoclonal antibodies aren’t going to be that reasonable workaround. That’s announcing “My plan if I get sick to take a drug that helps me recover.”

They’re a good thing — if someone does get COVID, and they have access to this treatment, they’ll recover faster. That’s good. But the point of vaccination is to not get sick, and not infect others, in the first place.

Masks, PPE, distancing, and working at home were always intended to be temporary measures to get us through until we could find a systemic solution to COVID. That solution is vaccination. For some employers, a lot of remote work is probably a viable path forward. For a lot of others, though, a return to the centralized workplace is both needed and unavoidable. Which means people need to not be health risks to one another, and employers are legitimately right to protect against that. That’s a legitimate and appropriate thing for employers to be worried about; it’s a fair area in which employers can and should make policies promoting health and safety.

The easiest and best way for an employee to avoid the harsh effects of an employer’s vaccine mandate is to get vaccinated.