“Right now, with people not using prevention measures and vaccines not growing as fast as we would like and not enough people being empowered, the ability to treat people at high risk of ending up in hospital or dying is really our best potential tool to reduce the impact of infection, “said Dr. Andrew Pavia, an epidemiologist and infectious disease physician at the University of Utah.
But the federal government has not shared any details about who is being prescribed Paxlovid, which is why some experts are concerned that as Covid-19 continues to spread, those still at higher risk may not. have equal access to this next line of defense.
“We know that this pandemic has highlighted all the disparities in our health care system, all the inequalities, and there are many reasons to think that access to this medicine will be the same as other problems with this pandemic,” Pavia said. who is also a member of the Covid-19 Treatment Guidelines Panel of the National Institutes of Health.
“I think it’s very important that we know how to use Paxlovid and if it reaches all the groups that need it equally.”
Barriers could exacerbate inequalities
According to experts, the collection of demographic data in healthcare is always useful with a broader goal of making the system more equitable.
“I think we’re likely to find disparities if we look under the hood, as we did with the vaccine,” said Steve Grapentine, a pediatric infectious disease pharmacist at the University of California, San Francisco and a member of the NIH panel.
“The only way we’re going to really improve and control the progression of any intervention we do would be by measuring it,” he said.
And there are some barriers inherent in Paxlovid that make this information especially important in this case, experts say.
Paxlovid works best when used within a few days of onset of symptoms, but requires a prescription and is more difficult for some people to reach a healthcare provider in a timely manner. In addition, Paxlovid may have negative interactions with other more complex prescription drugs and prescriptions that may be difficult for doctors to familiarize themselves with and may affect the way they prescribe.
“It’s very likely that there will be disparities in the use of Paxlovid depending on where people live, their income and their race. But I think we need to have visibility,” Pavia said.
The U.S. Department of Health and Human Services recently updated a Covid-19 therapy website to count the number of courses ordered and the number administered.
As of Thursday, some 831,000 Paxlovid courses had been administered, of the nearly 2.5 million that had been requested since treatment for emergency use was authorized in mid-December.
A closer look shows that some states (including Nevada, Washington, and New York) have managed a much larger share of their supply than others (including South Dakota, Mississippi, and Alabama).
But there is no comprehensive demographic data on who prescribes Paxlovid beyond statewide totals, at least none of which have been publicly shared.
In a news release released Thursday, the White House said the administration has “asked all sites that distribute oral antivirals to collect solid demographic data on people receiving prescriptions for COVID-19 therapeutics.”
“We are working with our pharmacy partners and healthcare providers to better understand who is receiving these treatments,” an HHS spokesman told CNN. “These demographics will improve our ability to identify, in real time, any access gaps and work to alleviate them quickly.”
Large pharmacy retailers were instrumental in sharing information on vaccine uptake early last year, and CNN contacted both CVS and Walgreens to see if similar efforts were underway to monitor the absorption of Paxlovid. CVS said it is “committed to providing federal officials with the demographic data they have requested,” but will not share further details, and Walgreens said they are in the “early stages” of gathering information based on a “recent request from the federal government.” . “
Blacks, Hispanics, and Americans are at least twice as likely to be hospitalized with Covid-19 as whites throughout the pandemic, but it’s unclear whether people in these groups can actually get treatment that can reduce that risk. almost almost. 90%.
In recent months, case rates among Asians have been higher than any other racial or ethnic group for the first time in the pandemic, according to data from the U.S. Centers for Disease Control and Prevention. But there is no evidence that this treatment is increasing in these communities.
The goal is to be able to correlate disease activity with “a corresponding increase in prescriptions, if we are doing what we need to do to prevent people from ending up in hospital,” Pavia said. “But you really have to know where the drug was dispensed in relation to when the disease was in order to be able to look at it.”
Prescription tracking is different from vaccine tracking
States must report to the federal government how much product they have in inventory and how much is dispensed, but any demographic detail the government has is only anecdotal at this time, according to a senior Biden health official.
The official said the government has been working with states to make sure treatment reaches the planned populations. But CNN contacted the health departments of the 50 states to see if they had more demographic details about who is prescribed Paxlovid; more than half responded, but none of them had that information either.
Some state health departments referred to local efforts to get Paxlovid to neglected area providers, and some suggested contacting providers directly for more detailed information about who is receiving the medicine.
The California Department of Public Health specifically noted that while there is “a wealth of demographic and geographic information about who is getting Covid-19 vaccines in the state,” the same is not true of treatments.
In fact, states had immunization databases established long before the pandemic that allowed centralized notification of Covid-19 vaccines. But there is no similar record for prescription drugs, leaving private databases, scattered among providers, as the only option to gather information about who is receiving Paxlovid.
The Minnesota Department of Health shared that it is working with the state’s Consortium of Electronic Health Records to begin collecting some of this information, but that any findings would be “months away from becoming a reality.”
With the expansion of the offer and the launch of the test initiative to deal with the Biden administration, the federal government has promoted the fact that approximately 9 out of 10 people in the US live within 5 miles of a place which actively distributes antivirals such as Paxlovid to treat Covid-19. Another HHS website maps thousands of locations where Covid-19 treatments are available. A new analysis by GoodRx, a company that monitors drug prices, found that Paxlovid’s distribution has varied across the country, with some counties not receiving doses and others receiving more than enough to treat all the recently reported Covid-19 cases. Although rural counties have suffered, the distribution based on a county’s racial and ethnic composition, poverty rate, and other sociodemographic factors has been more equitable, according to the analysis.
But knowing where the drugs are distributed can only give a rough idea of who they will go to, experts say.
“That doesn’t tell you what was dispensed, it doesn’t tell you how it got to the patients and what patients it got,” Pavia said. Anonymous personal data can show “not just where the drugs are on the shelves or where the medicine entered the bloodstream when needed.”
Work has been done to monitor the misuse of antibiotics and opioid prescriptions in this way, but experts say there are still many opportunities.
“We need a more robust infrastructure and data systems in electronic health records that allow for a“ more routine assessment of this type of problem, ”Grapentine said.
“I don’t know if we know all the right interventions to eliminate disparities, but at least if we have the data, we can see progress in these interventions and get to where our ultimate goal should be, which is to eliminate disparities in health care.”