By Deidre McPhillips, CNN
(CNN) – Paxlovid, an antiviral treatment for Covid-19, has been hailed as a game-changer in the pandemic thanks to its strong performance in reducing the risk of serious illness. Early supply challenges have been overcome in the United States, and the drug may be more important than ever as case numbers rise and more contagious variants spread amid stalled vaccination rates.
“Right now, with people not using preventative measures and with vaccinations not going up as fast as we would like and not enough people being boosted, the capacity treating 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, epidemiologist and infectious disease specialist at the University of Utah.
But the federal government hasn’t shared any details about who is being prescribed Paxlovid, leaving some experts worried that as Covid-19 continues to spread, those even more at risk may not have equal access to this next line. defense.
“We know that this pandemic has exposed all the disparities in our healthcare system – all the inequalities – and there is every reason to think that access to this medicine will be like the other problems associated with this pandemic,” said said Pavia, who is also a member of the National Institutes of Health’s Covid-19 Treatment Guidelines Committee.
“I think it’s very important that we know how Paxlovid is being used and whether it’s reaching all the groups that need it equally.”
Barriers could exacerbate inequalities
Gathering health care demographic data is still useful in the larger goal of making the system fairer, experts say.
“I think we will most likely find disparities if we look under the hood, like we found with the vaccine,” said Steve Grapentine, a pediatric infectious disease pharmacist at the University of California, San Francisco and member of the NIH panel.
“The only way to make improvements and really monitor the progress of all the interventions we do would be to measure it,” he said.
And there are a few inherent barriers to Paxlovid that make this information particularly important in this case, experts say.
Paxlovid works best when used within a few days of symptom onset, but it requires a prescription and is more difficult for some people to reach a health care provider in a timely manner. Also, Paxlovid may have negative interactions with other medications and more complex prescribing guidelines that may be difficult for doctors to understand and may affect how they prescribe it.
“It is very likely that there will be disparities in the use of Paxlovid depending on where people live, their income and their race. But we have to, I think, have visibility,” Pavia said.
The US Department of Health and Human Services recently updated a Covid-19 therapeutics website to tally the number of courses ordered and the number administered.
As of Thursday, around 831,000 courses of Paxlovid had been administered – out of the nearly 2.5 million that had been ordered since the treatment was cleared for emergency use in mid-December.
A closer look shows that some states (including Nevada, Washington, and New York) administered a much larger share of their supply than others (including South Dakota, Mississippi, and Alabama).
But there are no broad demographics on who Paxlovid is prescribed beyond state-level totals — at least none have been shared publicly.
In a fact sheet released Thursday, the White House said the administration had “called on all sites dispensing oral antivirals to collect robust demographic data on people receiving prescriptions for COVID-19 treatments.”
“We are working with our pharmaceutical partners and healthcare providers to better understand who is receiving these treatments,” an HHS spokesperson told CNN. “This demographic data will improve our ability to identify – in real time – any access gaps and work to close those gaps quickly.
Major drugstore retailers played a vital role in sharing information about vaccine adoption early in last year’s rollout, and CNN reached out to CVS and Walgreens to see if there were similar efforts in course to follow the adoption 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 collecting information. information based on a “recent request from the federal government”. .”
Blacks, Hispanics and Native Americans have been at least twice as likely to be hospitalized with Covid-19 as whites throughout the pandemic, but it’s unclear if people in these groups are actually in able to get treatment that can reduce that risk by 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 US Centers for Disease Control and Prevention. But there is no evidence that this treatment is applied to these communities.
The goal is to be able to correlate disease activity with “a corresponding increase in prescriptions, if we do what we need to do to keep people from ending up in hospital,” Pavia said. “But you actually have to know where the drug was distributed relative to when the disease was there to be able to look at that.”
Prescription tracking is different from vaccine tracking
States are required to report to the federal government how much product they have in stock and how much is distributed, but any demographic details the government has are only anecdotal at this time, according to a senior health official from the Biden administration.
The official said the government was working with states to ensure the treatment reached the intended populations. But CNN contacted health departments in all 50 states to see if they had more demographic details on who Paxlovid is prescribed; more than half responded, but none of them had this information either.
Some state health departments referenced local efforts to get Paxlovid to providers in underserved areas, and some suggested contacting providers directly for more detailed information about who gets the drug.
The California Department of Public Health specifically noted that while there is “a wealth of demographic and geographic information about people receiving Covid-19 vaccines in the state”, the same is not true. for the treatments.
Indeed, states had set up vaccination databases long before the pandemic that allowed centralized reporting of vaccinations against Covid-19. But there is no similar registry for prescription drugs, leaving private databases, scattered among providers, as the only option for collecting information about who receives Paxlovid.
The Minnesota Department of Health said it was working with the state’s Electronic Health Records Consortium to begin collecting some of this information, but any findings would be “months away from becoming a reality.”
With the expansion of supply and the launch of the testing initiative to deal with the Biden administration, the feds have touted the fact that about 9 out of 10 people in the United States live within 5 miles of a site that actively distributes antivirals such as Paxlovid to treat Covid-19. Another HHS website maps thousands of places where Covid-19 treatments are available.
But knowing where the drugs are distributed can only give a rough idea of who they are going to, experts say.
“It doesn’t tell you it was distributed, it doesn’t tell you how it got to patients and which patients it got to,” Pavia said. Anonymized personal data can show “not just where the drugs are on the shelves or where the drug entered the bloodstream when it was needed.”
Some work has been done to track antibiotic abuse and opioid prescriptions in this way, but experts say there is still plenty of opportunity.
“We need more robust infrastructure and data systems in electronic health records” that allow for “more systematic assessment of these types of issues,” 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 reach our end goal, which is to eliminate disparities in health. care.”
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