
FDA’s Emergency Use Process Under Scrutiny
Some observers fear that political interference in the process may erode confidence in the scientific basis for FDA regulatory decisions.
Under pressure to expand public access to new medicines, diagnostic tests, and other medical products needed to detect and treat patients struck by COVID-19, FDA has issued more than 100 Emergency Use Authorizations (EUAs) since early February, compared to fewer than 75 during the 10 previous years. While this activity reflects the imperative for fast action by federal agencies and manufacturers to address the pandemic crisis, it also generates questions about the vetting of these requests and how well FDA can follow up with sufficient tracking of the safety and efficacy of these products. And some observers fear that political interference in the process may erode confidence in the scientific basis for FDA regulatory decisions.
FDA
Only two EUAs this year are for therapeutics. FDA issued an EUA May 1, 2020 to Gilead Sciences to permit limited use of the investigational drug remdesivir to treat very ill COVID-19 patients. Here the emergency authorization was approved after a clinical trial provided evidence of some effectiveness in highly critical situations. As expected, the EUA limits the drug’s use to hospitalized patients with severe COVID-19 disease, while clinical testing continues.
More controversial is FDA’s approval of an EUA to permit the use of certain widely available malaria drugs to treat COVID patients, despite concerns from medical authorities about no data supporting effectiveness against the coronavirus and the risk of serious adverse effects on individuals with certain heart conditions. Even so, FDA issued an EUA for chloroquine and hydroxychloroquine on March 28, 2020 to permit use of drugs in the Strategic National Stockpile (SNS) but only for distribution to health professionals treating hospitalized patients with confirmed COVID-19.
Despite such limitations, FDA continued to draw criticism for acceding to political pressure from the White House to enable broad use of these drugs. But in an interview posted on STAT on April 24, 2020, Center for Drug Evaluation and Research (CDER) Director Janet Woodcock explained that permitting access to some three million pills donated by Bayer and others augmented short supplies that undermined approved treatment for lupus and rheumatoid arthritis, and that FDA tested the donated drug, which came from uninspected manufacturing facilities in India, extensively for quality. Woodcock maintained that the EUA does not undermine FDA review standards and that the
Woodcock is supported by subsequent revelations about the political infighting leading up to this EUA. The lengthy
filed May 5, 2020 by Rick Bright, director of Health and Human Services’ (HHS’) Biomedical Advanced Research and Development Authority (BARDA), details efforts by Bright and others to prevent widespread use of hydroxychloroquine as a supposed preventive and cure for COVID-19. Bright recounts how HHS officials initially pressured BARDA to establish a nationwide Expanded Access Investigational New Drug (IND) protocol for chloroquine, which would make the drug available outside the hospital setting and without close physician supervision, but that Woodcock provided support for an EUA from FDA with restricted uses.
In response to these developments, Sens. Elizabeth Warren (D-Mass) and Patty Murray (D-Wash)
Meanwhile, FDA faces challenges in continuing to evaluate hundreds of EUA requests. The agency website on EUAs notes that some 385 diagnostic test developers plan to submit EUA requests for tests to detect the coronavirus. And, now with the emergence of evidence that Gilead’s remdesivir may offer greater benefits to very ill patients, demand for chloroquine has diminished, leaving hospitals and clinics with millions of unneeded pills.
Newsletter
Stay at the forefront of biopharmaceutical innovation—subscribe to BioPharm International for expert insights on drug development, manufacturing, compliance, and more.