In San Diego, Dr. Ramers said, some large, for-profit hospitals have decided not to administer the antibodies at all because of the logistical hassles, leaving wealthier, well-insured patients to hunt down doses at his publicly funded clinic. Some nurses that he hired for infusions left for short, better-paying assignments in hard-hit intensive care units.

“The natural, capitalist incentives for health care organizations that are for profit don’t really favor doing this,” Dr. Ramers said. “It’s a lot of work.”

Understand Vaccine and Mask Mandates in the U.S.

Of the 2.4 million monoclonal antibody doses shipped nationally, at least 1.1 million have been used. Precisely how many are still sitting on shelves is hard to determine because of reporting gaps. Still, waning federal supplies and soaring demand from less-vaccinated Southern states have caused what several states have described as large shortfalls in deliveries.

North Carolina providers have requested 15,000 weekly doses, the health department there said, more than double what the federal government has allocated. Florida said its latest weekly allotment left clinics there 41,000 doses short of what they wanted.

Hospitals had previously been able to order the drugs themselves. But the Department of Health and Human Services will now decide how many doses each state receives based on case rates and use of the treatment. State governments, in turn, will decide on doses for individual sites.

The new ordering process, which the Biden administration said would ensure “equitable distribution,” has unsettled some backers of the drug. Gov. Ron DeSantis of Florida, a Republican, warned on Thursday that state officials were unprepared for the new responsibility of parceling out doses.

And in heavily vaccinated states, like New York, people coordinating treatments fear that shipments will plummet because of low case rates, leaving hospitals with so few doses that they shutter their programs. Some hospitals recently reported growing numbers of vaccinated patients receiving infusions.

This content was originally published here.