The lack of specialized covid-19 treatments for people with weak immune systems has left millions of Americans with limited options if they get sick as the pandemic heads into an uncertain winter. Once heralded as game-changers for covid patients considered at risk for getting seriously ill — one was used to treat then-President Donald Trump in 2020 — monoclonal antibodies are now largely ineffective against current covid variants.

Easier-to-administer antiviral drugs, such as Paxlovid, have largely taken their place but aren’t safe for all immune-compromised people because they interact with many other drugs. But the federal government funding that drove drug development in the early days of the pandemic has dried up, and lawmakers have rebuffed the Biden administration’s pleas for more. Without that, there’s little incentive for drugmakers to work on new antibody treatments that could be more effective.

And without a government program like Operation Warp Speed to develop second-generation vaccines and treatments, at-risk patients could be in danger of developing severe cases of covid and flooding hospitals when the U.S. health care system is already strained, thanks to an influx of patients with an array of respiratory illnesses, including flu and RSV. “Just because we have exited the emergency phase of the pandemic does not mean that covid is over or that it no longer poses a danger,” said Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner.

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