West was hospitalized for COVID over the weekend and thankfully sounds like he’s doing better today. As for the answer to the question posed in the headline, I’m thinking it’s partly because people like Allen West are treating the vaccine and COVID therapeutics as an either/or proposition even though they won’t cop to that. Tell anti-vaxxers that there’s an effective treatment waiting for them if they get sick and they’ll use it as one more reason not to get the shot.

I agree with him that we should do more to publicize antibody treatments, though, despite the risk that doing so will further dissuade the unvaccinated from getting their shots. Doing so would doubtless increase uptake among those sick with COVID, especially those who don’t have a regular doctor and may not follow pandemic news closely enough to know that monoclonal antibodies are available to help if they fall ill. A member of my own family whom I speak to regularly about COVID news was under the impression yesterday that the antibody treatments are something you give people after they’ve already recovered, which, uh, is not so. If that represents the depth of misunderstanding across the public about the treatments, then yeah, we need to do more to promote them.

If nothing else, it might steer people who are snorting ivermectin or whatever towards a proven alternative.

7/ Why not promote protocols such as Regeneron monoclonal antibody infusion therapy? Why not promote Budesonide nebulizer treatments? Why not promote healthy over the counter therapies such as zinc — which I take — D3, vitamin C, Hydroxychloroquine, and yes, Ivermectin?

— Allen West (@AllenWest) October 11, 2021

I think the feds are about to do more promotion of treatments with the looming arrival of Merck’s new wonder pill, molnupiravir, before the end of the year. Prescribing that drug as a matter of course immediately after a positive test could reduce hospitalizations a ton so people need to know about it. West’s opinion would be easier to digest if he weren’t also promoting folk remedies alongside legit antivirals, though, and if he hadn’t argued yesterday, incoherently, that he prefers antibody treatments to the vaccine because vaccine sales benefit Big Pharma. Who does he think is making the antibody treatments, Santa’s elves?

6/ Instead of jabbing Americans, and not illegal immigrants, with a dangerous shot which injects them with these spike proteins . . . guess what? I now have natural immunity and double the antibodies, and that's science.

— Allen West (@AllenWest) October 10, 2021

COVID vaccines cost something like 25 bucks per dose and are free to the public. Monoclonal antibodies are $2,100 per course. Is this guy kidding with his profit-motive rationale?

I’m also trying to parse the logic of believing the vaccines are “dangerous” while calling for them to be given to illegal immigrants. I guess he means that we should save the alleged “safe” option for COVID, the antibody treatments, for Americans and let the foreigners take their chances with vaccines that had already saved more than a quarter million lives in the U.S. by July according to one estimate. Either way, West is demonstrating the illogic that the feds fear will be reinforced if they aggressively promote monoclonal antibodies: Anti-vaxxers will use it as a pretext to argue that the shots are now unnecessary.

But they are necessary. Scott Gottlieb was asked about West’s comments on CNN today and argued that antibody treatments aren’t an alternative to vaccination, beginning with the fact that they’re not very effective unless they’re taken early:

The best protection that can be afforded is through vaccination. The drugs are good, but they’re not 100 percent and they need to be delivered very early in the course of infection. If you’re outside of the window, if you’re not someone with access to really good medical care and constant testing and can’t get diagnosed early as a lot of people who are fortunate can, but some people don’t have that kind of medical access. If you infuse the antibody drugs late in the course of the illness, you’re not going to derive as meaningful a therapeutic benefit — and in some cases — no benefit at all if it is used too late in the course of the disease.

Another obvious problem with relying on post-infection treatment instead of pre-infection vaccination is that the vaccines reduce transmission. If you want to slow the spread of the virus, immunization will help, therapeutics won’t. Which is important given what Gottlieb said this morning about the supply of molnupiravir being tight in the early going. The more people in a community are vaccinated, the fewer will need a hard-to-find treatment to avoid hospitalization.

Finally, the vaccines are simply more effective than the drug is. Vaccines cut the risk of hospitalization by some 95 percent; in Merck’s trials for molnupiravir, the unvaccinated who got the drug were 50 percent less likely to land in the hospital than those didn’t get it.

The “logic” behind resisting Big Pharma’s cheap and superior vaccine while embracing Big Pharma’s expensive and less effective antibody treatment is opaque to me but I’d guess it’s mainly a product of motivated reasoning. After someone invests emotional energy day after day for months in resisting vaccination, they’ll lunge at any vaguely plausible alternative that’s available as a just-as-good-if-not-better option. That’s why proven treatments like monoclonal antibodies end up being lumped in with folk remedies like zinc and vitamins by the likes of West and Joe Rogan. It doesn’t matter that the antibodies come out of the same pharma factories as the vaccines. It only matters that they’re Not The Vaccines.

One last reason that it makes sense to promote antibodies more is because the hardcore anti-vaxxers who continue to hold out even as onerous mandates take effect are so unpersuadable at this point that offering them treatments isn’t going to give them a new excuse to avoid the shot. They’ll grasp at any excuse at this point to justify their recalcitrance. The latest is booster shots:

The dichotomy illustrates one of the most frustrating problems facing public health officials at this stage of the pandemic: Almost all the eligible adults who remain unvaccinated in the United States are hard-core refusers, and the arrival of boosters is making efforts to coax them as well as those who are still hesitating even more difficult. In the September vaccine monitor survey from the Kaiser Family Foundation, 71 percent of unvaccinated respondents said the need for boosters indicated that the vaccines were not working.

[E]ven as boosters are providing added protection for vulnerable populations, they are raising further doubts among people like Christopher Poe, 47, who works in a manufacturing plant in Lima, Ohio. He hasn’t gotten the shot, despite haranguing and wheedling from worried relatives. He said the need for a booster had deepened his skepticism.

“It seems like such a short time and people are already having to get boosters,” Mr. Poe said. “And the fact that they didn’t realize that earlier in the rollout shows me that there could be other questions that could be out there, like the long-term effects.”

There are plenty of potential long-term effects from a bad bout with COVID too, including premature cognitive decline. Any concern about one’s health after receiving the vaccine should apply tenfold to one’s health after being infected by a novel virus that scientists have studied for less than two years. But as I say, you won’t persuade most holdouts at this point. Might as well try to sell them on getting treated early once they have reason to believe they’re infected. Because they will be eventually.