March 4, 2022 — With the number of new cases of COVID-19 continuing to fall, now could be the time to ensure everyone has equal access to vaccines and other medicines ahead of the next public health emergency.
The coronavirus pandemic, now in its third year, has led to major issues surrounding equal access to diagnosis, care and vaccination.
Inequality in the U.S. health care system may be nothing new, but the pandemic magnifies issues that can and must be addressed now, experts said at a media briefing Thursday sponsored by the Infectious Diseases Society of America.
The message of the “big picture” is that public health officials are listening to people in underserved communities, addressing unique access and trust challenges, and engaging local officials and faith leaders to help promote the importance of things like vaccines and boosters.
Health care providers can also do their part to help, said Allison L. Agwu, MD, an associate professor of pediatric and adult infectious diseases at Johns Hopkins University School of Medicine in Baltimore.
“If you see something, say something,” she said. Using your voice for advocacy is important, she added.
When asked how individual providers can help, Agwu said it’s important to recognize that everyone has biases. “Recognize that in every encounter you can present some inherent biases that you don’t recognize. I have them, we all have them.”
Consulting the data and evidence on health inequalities is a good strategy, Agwu said. When everyone uses the same numbers, it can help reduce prejudice. Intentionality to tackle inequality also helps.
But the best intentions of individual health care providers will only go so far unless the biases in the overall health system are addressed, she said.
Emily Spivak, MD, agreed.
“Unfortunately, our health systems and medical practices are part of this systemic problem. These inequalities in racism — they’re all embedded in these systems, unfortunately,” she said.
“For an individual healthcare provider to do all of this is great,” Spivak said, “but we really need the culture of health systems and medical practices … to change to be proactive and considerate.” [and devise] interventions to reduce these inequalities.”
Equity and monoclonal antibodies
Closer to shore, Spivak, an associate professor of infectious diseases at the University of Utah in Salt Lake City, considered how to reduce disparities in Utah when monoclonal antibodies first became available to treat COVID-19.
“We already had the clinical experience to know that things were not even up to date and we were seeing a lot more patients who were infected, were hospitalized and had really bad outcomes who were essentially from non-white racial or ethnic groups” , she said during the briefing.
“We’ve tried to get ahead of it and say we need to think about how we can equitably provide access to these drugs.”
Some early studies helped Spivak and colleagues identify risk factors for more severe COVID-19.
“And the usual things fell out that you’d expect: age, male gender — that was a higher risk then, it’s not anymore — diabetes and obesity,” she said.
“But something that really stood out as a very important risk factor was people identifying themselves as non-white racial or ethnic groups.”
So Spivak and colleagues came up with a state risk score that included the higher risk for people from non-white groups. They reached out to patients identified as non-white in a database to raise awareness about the availability and benefits of monoclonal antibody therapy.
Nurses also called people to reinforce the message.
More recently, Spivak and colleagues repeated the study on data for more than 180,000 Utah residents and “found that these predictors still hold true.”
Risk adjustment or more inequality?
“Unfortunately, our health ministry released a press statement in late January this year removing the ethnic points or risks of non-white races from our state risk calculator,” Spivak said.
“But they’re working with other operational means to try to get people drugs into these communities and increase access points in different ways,” she said.
The department’s statement reads in part: “Instead of using race and ethnicity as a factor in determining treatment eligibility, UDOH will work with communities of color to improve access to treatment by placing drugs in locations that are easily accessible.” for these populations and by working to connect members of these communities to available treatments.”
Data on differences
The CDC collects data on COVID-19 cases, hospitalizations and deaths, but not all states break down the information by race and ethnicity.
Despite that caveat, the data shows that, compared to white Americans, Native Americans and Alaskans are 1½ times more likely to be diagnosed with COVID-19. Hospital admissions and death rates are also higher in this group.
“That’s also seen for African American and Latino populations, compared to Caucasian populations,” Agwu said.
And about 10% of Americans who have received at least one dose of a COVID-19 vaccine are black, even though they make up 12% to 13% of the US population.
Look forward to something
For Agwu, addressing inequalities that emerged during the COVID-19 pandemic felt reactive. But now public health officials can be more proactive and address key issues ahead of time.
“I completely agree. We already have the data,” Spivak helps. “We don’t have to stand still next time. We know these inequalities or systemic [issues] — they’ve been here for decades.”
If no progress is made to address the inequalities, she predicted, with the next public health emergency, “it will be the same again, almost like a playbook.”
Agwu agreed, saying action is needed now “so we don’t start over every time.”
This post A call to tackle health inequalities now, before the next pandemic
was original published at “https://www.webmd.com/lung/news/20220304/fix-health-inequities-before-next-pandemic?src=RSS_PUBLIC”