Is Paxlovid, the Covid pill, reaching those who need it most?


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As the country largely abandons mask mandates, physical distancing and other covid-19 prevention strategies, elected officials and health departments are now championing antiviral pills. But the federal government does not say how many people have received these potentially life-saving drugs or whether they are distributed fairly.

Pfizer’s Paxlovid pill, along with Merck’s molnupiravir, aim to prevent vulnerable patients with mild or moderate covid from getting sicker or dying. More than 300 Americans still die from covid every day.

National supply figures, which the Biden administration has shared sporadically, aren’t the only data local health officials need to ensure their residents can access treatments. Recent federal changes designed to allow large drugstore chains like CVS and Walgreens to effectively manage their supplies have had an unintended consequence: Now many public health workers can’t see how many doses have been shipped to their communities or used. . And they can’t tell if the most vulnerable residents fill their prescriptions as often as their wealthier neighbors.

KHN has repeatedly asked health and human services officials to share more detailed covid therapy data and explain how it calculates utilization rates, but they haven’t even shared the total number of people who received Paxlovid.

So far, the most detailed accounting has come from the drugmakers themselves. Pfizer CEO Albert Bourla reported on a recent earnings call that about 79,000 people received Paxlovid in the week ending April 22, up from 8,000 a week two months earlier. .

Unlike vaccinations or covid cases, HHS does not track the race, ethnicity, age, or neighborhood of people who receive treatments. Immunization figures, initially released by a handful of states, allowed KHN to reveal stark racial disparities just weeks into the rollout. Federal data showed that black, Native and Hispanic Americans died at higher rates than non-Hispanic white Americans.

The Los Angeles County Department of Public Health has worked to ensure that its 10 million residents, especially the most vulnerable, have access to treatment. When the supply of Paxlovid was limited in the winter, officials ensured that pharmacies in hard-hit communities were well stocked, according to Dr. Seira Kurian, a regional health officer for the department. In April, the county launched its own telehealth service to assess residents for treatment free of charge, a model that avoids many of the hurdles that make it difficult to access treatment at for-profit, pharmacy-based clinics. for uninsured, rural or disabled patients.

But without federal data, they don’t know how many county residents received the pills.

Real-time data would show whether a neighborhood is fulfilling prescriptions as expected during an outbreak, or which communities public health workers should target for education campaigns. Without access to federal systems, Los Angeles County, which serves more residents than the health departments of 40 entire states, must use the limited public inventory data released by HHS.

This dataset contains only a slice of information and in some cases displays information that is several months old. And because the data excludes certain types of providers, such as nursing homes and Veterans Health Administration facilities, county officials can’t say whether patients took the pills there.

Because so little data is available, Kurian’s team created its own survey, asking providers to report the zip codes of patients who received the covid therapies. Thanks to the survey, it is now easier to determine which pharmacies and clinics need more supplies.

But not everyone completes it, she said: “A lot of times we still have to make guesses.”

In Atlanta, staff at the Good Samaritan Health Center would use detailed information to refer low-income patients to pharmacies with Paxlovid. Although the drug was not readily available during omicron’s first push, the next one will be “a new frontier,” said Breanna Lathrop, the center’s chief operating officer.

Ideally, she says, her staff would be able to see “everything you need to know in one place” – including which pharmacies have the pills in stock, when they’re open and whether they offer home delivery. Student volunteers at the center built a similar database for covid testing earlier in the pandemic.

Paxlovid and molnupiravir became available in the United States in late December. They have quickly become the standard treatment for non-hospitalized patients, replacing almost all monoclonal antibody infusions, which are less effective against current strains of covid.

Although the government does not record Paxlovid use by race and ethnicity, researchers tracked these trends for first-generation infusions.

Amy Feehan, co-author of a CDC-funded study and clinical researcher at Ochsner Health in Louisiana, found that black and Hispanic patients with covid were significantly less likely than white and non-Hispanic patients to receive these early treatments. ambulatory. Other researchers have found that language difficulties, lack of transportation, and not knowing about treatments all contribute to the disparities. Feehan’s study, using data from 41 medical systems, found no significant discrepancies for hospitalized patients, who did not have to seek medication themselves.

Patients at Good Samaritan Health Center in Atlanta often don’t know that if they get tested early, they can receive treatment, Lathrop said. Some assume they don’t qualify or can’t afford it. Others wonder if the pills work or are safe. There are “just a lot of questions in people’s minds,” Lathrop said, about whether “it benefits them.”

When Dr. Jeffrey Klausner was an assistant officer in the San Francisco Department of Public Health, “our first priority was transparency and data sharing,” he said. “Building trust and engaging with the community is important.” Now a professor at the University of Southern California, he said federal and state officials should share what data they have and also collect detailed information about patients receiving treatment — race, ethnicity, age, severity of sickness – so that they may correct any iniquity.

Public health officials and researchers who spoke with KHN said HHS officials may not believe the data is accurate or have adequate staff to analyze it. The head of the HHS therapeutics distribution effort, Dr. Derek Eisnor, suggested as much during an April 27 meeting with state and local health officials. A local official asked the federal agency to share local numbers so they can increase reach in low-use communities. Eisnor responded that because HHS doesn’t require providers to report how much they use, the report “is pretty poor at best,” adding that he doesn’t think it’s his agency’s role to share this information. .

Eisnor also said state health departments should now be able to see local orders and usage from drugstore chains like CVS, and that the agency hopes to post weekly national data online soon. But counties like Los Angeles — which have unsuccessfully applied for access to federal systems — still don’t have access to the data they need to focus outreach efforts or spot emerging disparities.

Spokesman Tim Granholm said HHS is looking at ways to share additional data with the public.

Recordings of the weekly meetings, in which HHS officials share updates on distribution plans and answer questions from public health workers, pharmacists and clinicians, were posted online through March. HHS’ media office has since repeatedly refused to grant KHN access, saying “the recordings are not open to the press.” That’s because HHS wants to encourage open conversation during meetings, according to Granholm. He did not specify which legal authority authorizes the ministry to ban the media from public meetings. KHN obtained the public records through Freedom of Information Act requests.

A senior White House official said the Biden administration is trying to collect accurate data on the number of people receiving Paxlovid and other treatments, but said it does not define success by the number of people who were doing it. Its goal, the official said, is to ensure that the public knows that treatments are available and that doctors and other providers understand which patients are eligible for them.

We still need to know where the pills go, Feehan said. “We need this data as soon as humanly possible.”

Until then, Los Angeles County’s Kurian and his peers will continue to “guess” where residents need more help. “If someone can just give us a report with that information,” she said, “of course that makes it easier.”


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