How Equitable is Access to COVID-19 Treatments?


With uptake of COVID-19 vaccines and boosters leveling off and the U.S. presently within the midst of one other Omicron wave, guaranteeing equitable and speedy distribution of COVID-19 therapies will likely be vital for mitigating the uneven impacts of the pandemic. COVID-19 has disproportionately affected sure underserved and high-risk populations, together with people of color and people who are socioeconomically disadvantaged. As a result of many of those teams stay at increased risk of publicity, provided that they’re much less prone to work in jobs that may be achieved remotely and as a consequence of different structural components, entry to therapies (along with vaccines) is especially vital. The Biden Administration has recognized growing entry to COVID-19 therapies as a precedence, however there was wide variation in access throughout states and native jurisdictions.

Thus far, data on who has acquired COVID-19 therapies stays very restricted, hindering the flexibility to evaluate whether or not entry to them has been equitable. To offer higher perception into entry to COVID-19 therapies, we analyzed data from the HHS Workplace of the Help Secretary for Preparedness and Response on public places which have acquired shipments of federally-procured oral antiviral COVID-19 therapies. We examined availability therapies by county and sure county traits, together with metro vs. non-metro standing, poverty charge, and majority Black, Hispanic, or American Indian or Alaska Native (AIAN), the teams who’ve skilled the biggest disparities in COVID-19 health outcomes. The evaluation is restricted to oral antiviral COVID-19 therapies that may be administered at dwelling.

In sum, the findings present that:

  • COVID-19 oral antiviral therapies can be found by services throughout the nation and practically all folks reside in a county with availability no matter whether or not they reside in a metro or non-metro space, their earnings, or their race/ethnicity.
  • Nevertheless, the small variety of counties with the best poverty charges and people which are majority Black, Hispanic, and AIAN are much less prone to have a facility with COVID-19 therapies accessible and have fewer services accessible in comparison with their counterpart counties. Findings are extra combined for remedy programs. Non-metro and majority Hispanic and AIAN counties even have fewer programs accessible than their counterpart counties, whereas excessive poverty and majority Black counties having barely bigger numbers of programs accessible.

In sum, whereas practically all folks reside in a county with a facility with COVID-19 therapies accessible, disparities in entry persist among the many doubtlessly highest threat and highest want counties. Non-metro counties and majority Hispanic and AIAN counties, which have fewer services and programs accessible have extra restricted entry to therapies general. Excessive poverty and majority Black counties, which have fewer services however extra programs accessible relative to their inhabitants dimension, could not have disparities by way of variety of therapies accessible, however should still have extra restricted entry, as people might must journey a farther distance to acquire them. Provided that there have been no latest shortages in remedy programs, proximity to a facility could also be a extra related measure of entry presently.

Whereas this evaluation offers some perception into the supply of services and coverings, getting them additionally is dependent upon having information about therapies, entry to medical recommendation, and the time and sources to acquire them. Nevertheless, so far, no federal knowledge is accessible on who’s receiving therapies. Going ahead, continued steps to make sure fairness in entry to COVID-19 therapies will likely be vital, as will growing knowledge availability to know who has acquired COVID-19 therapies.

Background

The Meals and Drug Administration (FDA) has issued emergency use authorization for 2 dwelling oral antiviral COVID-19 treatments. These therapies – Paxlovid and Lagevrio – can be found for individuals who take a look at optimistic for COVID-19 and are at excessive threat of growing severe sickness. They have to be taken throughout the first 5 days after COVID-19 signs seem and every require a prescription from a well being care supplier. Each have been proven to considerably scale back hospitalization and dying from COVID-19. The federal authorities has bought provides of each therapies for distribution to websites all through the nation and to be offered free of charge to those that are eligible.

The Biden Administration launched a nationwide Test to Treat initiative in March 2022 to increase entry to oral antiviral COVID-19 therapies. The Take a look at-to-Deal with initiative builds on prior distribution of oral antivirals, which started in December 2021, to states, Tribes, territories, and group well being facilities, which in flip distribute these therapies to well being care suppliers, pharmacies, and different places. The objective of this program is to allow folks to get examined and, if they’re optimistic and coverings are applicable for them, obtain a prescription from a well being care supplier and have their prescription stuffed all at one location. These Take a look at-to-Deal with websites can be found at places nationwide, together with clinics, federally-funded well being facilities, long-term care services, and community-based websites. In May 2022, the Administration expanded the initiative to incorporate new federally-supported Take a look at-to-Deal with places that concentrate on reaching hard-hit and high-risk communities and serving to to make sure equitable entry to COVID-19 therapies. The Administration signifies that 40% of pharmacy websites with oral antivirals accessible are situated in communities with the best ranges of social vulnerability.

Key Findings

Practically all folks (98%) reside in a county with at the least one facility that has COVID-19 oral antiviral therapies accessible. As of June 7, there have been 2.6 million programs of oral antiviral therapies accessible in 37,100 services throughout the U.S. Practically 8 in 10 (79%) of counties have a facility with COVID-19 oral antiviral therapies accessible, whereas one in 5 (21% or 665) counties don’t. Even with these gaps in some counties, practically all folks within the U.S. (98%) reside in a county with a facility accessible no matter whether or not they reside in metro or non-metro space, their earnings, or their race/ethnicity.

The common variety of services and remedy programs accessible varies throughout counties. On common, there are 10.2 services and 668 remedy programs accessible per 100,000 folks per county. Nevertheless, the variety of services per 100,000 ranges drastically, from 0 to 154 throughout counties. Equally, the variety of programs per 100,000 ranges from 0 to 22,644 throughout counties.

On common, entry to COVID-19 oral antivirals is essentially comparable between metro and non-metro counties, though non-metro counties usually tend to not have a facility with therapies accessible. Nationwide, there are 1,167 metro counties and 1,976 non-metro counties. The bulk (86%) of the inhabitants lives in metro counties, whereas 14% lives in non-metro counties. Non-metro counties are extra possible than metro counties to not have a facility with oral antiviral therapies accessible (28% vs. 9%), and other people residing in a non-metro county are much less prone to have a facility with remedy accessible (92% vs. 100%). Nevertheless, the typical variety of services per 100,000 folks was related for metro (10.7) and non-metro (9.9) counties, reflecting the decrease inhabitants density in non-metro counties. Metro counties did have extra programs accessible in comparison with non-metro counties (737 vs. 629 per 100,000 folks).

Though practically all folks (98%) with incomes beneath poverty reside in a county that has a facility with COVID-19 therapies accessible, high-poverty counties have fewer services accessible than areas with decrease charges of poverty. Whereas most counties have low or average poverty charges (outlined as lower than 10% and between 10% and 30%, respectively), a small quantity (87) counties have a excessive poverty charge of 30% or extra. 4 in ten (40%) excessive poverty counties didn’t have a facility with oral antiviral COVID-19 therapies accessible in comparison with 26% of low poverty counties and 19% of average poverty counties. Furthermore, excessive poverty counties had fewer services in comparison with low and average poverty counties (7.7 vs. 10.4 and 10.2 per 100,000 folks, respectively). Nevertheless, excessive poverty counties have barely extra remedy programs accessible in comparison with low and average poverty counties (692 vs. 601 and 686 per 100,000 folks, respectively).

Majority Black, Hispanic, and American Indian Alaska Native (AIAN) inhabitants counties have extra restricted entry to services with oral antiviral COVID-19 therapies than non-majority Black, Hispanic, and AIAN counties. (There have been no majority Asian counties, so related evaluation was not carried out for this group.)

  • Total, there are 96 counties the place Black folks make up 50% or extra of the inhabitants. These counties are dwelling to just about 10% of the entire Black inhabitants. Whereas practically all Black folks (99%) reside in a county that has a facility with COVID-19 therapies accessible, these majority Black counties have extra restricted entry in comparison with non-majority Black counties. Roughly one in three (31%) majority Black counties didn’t have a facility with oral antiviral COVID-19 therapies accessible in comparison with 21% of counties the place Black folks make up lower than half of the inhabitants. Furthermore, there have been 8.6 services per 100,000 folks in majority Black counties in comparison with 10.3 services per 100,000 folks in non-majority Black counties. Nevertheless, majority Black counties had a considerably bigger variety of programs accessible on common in comparison with non-majority Black counties (705 vs. 667 per 100,000 folks).
  • Hispanic folks account for at the least 50% of the inhabitants in 102 counties which are dwelling to just about 20% of the entire Hispanic inhabitants. Practically all Hispanic folks (99%) reside in a county with a facility with COVID-19 therapies accessible, however majority Hispanic counties have fewer services accessible than non-majority Hispanic counties. One-third (33%) of majority Hispanic inhabitants counties didn’t have a facility with COVID-19 therapies accessible in comparison with about one in 5 (21%) of non-majority Hispanic counties. On common, there have been 7.3 services per 100,000 folks in majority Hispanic counties in comparison with 10.3 services per 100,000 folks in non-majority Hispanic counties. Majority Hispanic counties additionally had fewer programs accessible than non-majority Hispanic counties (503 vs. 674 per 100,000 folks).
  • In 28 counties, AIAN folks make up 50% or extra of the inhabitants, and these areas are dwelling to 11% of the entire AIAN inhabitants. Total, simply over 9 in ten (91%) of AIAN folks reside in a county with a facility accessible. Nevertheless, three-quarters (75%) of AIAN majority inhabitants counties didn’t have a facility with COVID-19 therapies accessible in comparison with roughly one-quarter (21%) of non-majority AIAN counties. Furthermore, majority AIAN counties had a decrease common variety of services accessible than non-majority AIAN counties (4.2 vs. 10.3 per 100,000 folks) and a decrease common variety of programs accessible (185 vs. 673 per 100,000 folks).

Implications

The COVID-19 pandemic has disproportionately affected the well being and monetary safety of individuals of coloration as a consequence of underlying disparities that place folks of coloration at elevated threat for publicity and sickness, and guaranteeing fairness in entry to COVID-19 therapies (in addition to vaccines) is vital for mitigating disparities and stopping in opposition to additional widening of disparities going ahead.

This evaluation reveals that whereas therapies can be found at services throughout the nation and practically all folks reside in a county with such a facility, no matter their earnings, race/ethnicity, or whether or not they reside in a metro or non-metro space, some disparities in entry persist among the many doubtlessly highest threat and highest want counties. Non-metro counties and majority Hispanic and AIAN counties, which have fewer services and programs accessible have extra restricted entry to therapies general. Excessive poverty and majority Black counties, which have fewer services however extra programs accessible relative to their inhabitants dimension, could not have disparities by way of variety of therapies accessible, however should still have extra restricted entry, as people might must journey a farther distance to acquire them. Provided that there have been no latest shortages in remedy programs, proximity to a facility could also be a extra related measure of entry presently.

Whereas the counties dealing with disparities account for a small share of counties general, they symbolize areas which have the best shares of residents who’ve borne the heaviest burdens of the pandemic. These excessive burden counties symbolize a narrower set of counties than those who measure excessive on the general social vulnerability index, an index developed by the federal authorities to establish communities that can probably want assist in response to hazardous occasions, which the Administration is utilizing to information equitable distribution. Our findings recommend that distribution primarily based on the social vulnerability index alone could go away some areas with excessive concentrations of residents at elevated threat dealing with gaps in entry, and as such, extra fairness lenses could also be useful for selling entry.

Importantly, whereas this evaluation offers some perception into the supply of COVID-19 oral antiviral therapies, getting them additionally is dependent upon having information about therapies, entry to medical recommendation, and the time and sources to acquire them. As such, even when there’s broad geographic availability of therapies, there should still be disparities in who is ready to receive them. Going ahead, continued steps to make sure fairness in entry to COVID-19 therapies will likely be vital, as will growing knowledge accessible to know who has acquired them.

Strategies

For this knowledge word, KFF researchers analyzed knowledge on the county degree and drawing from a number of sources:

Our important end result of curiosity, services with oral antiviral COVID-19 therapies accessible, was collected from the U.S. Division of Well being & Human Companies (HHS) COVID-19 Public Therapeutic Locator Data as of June 7, 2022 The HHS knowledge contains places which have acquired an order of Evusheld, Paxlovid, Renal Paxlovid, Lagevrio (molnupiravir), or bebtelovimab within the final two months and/or have reported availability of those therapeutics throughout the final two weeks. The evaluation is restricted to places within the 50 states and D.C. (excludes territories) that reported stock up to now two weeks and have a present provide of oral antivirals (Paxlovid, Renal Paxlovid, or Lagevrio). Places that didn’t report stock throughout the prior two weeks and whose standing was unknown weren’t included within the evaluation. These places could have therapies accessible however are usually not counted as an lively location on this evaluation.

Metro and non-metro classifications are primarily based on the U.S. Department of Agriculture’s 2013 Rural-Urban Continuum Codes. Counties with codes 1 by 3 are categorised as “metro” and 4 by 9 are categorised as “non-metro.” The agricultural-urban continuum codes distinguish metropolitan counties by the inhabitants dimension of their metro space and nonmetropolitan counties by diploma of urbanization and adjacency to a metro space. Information to categorize counties by racial composition of residents is predicated on the Census Bureau’s 2019 American Community Survey (ACS) 5-Year Estimates by county. Particularly, we calculate the share of the county inhabitants that’s majority (50% or extra) Hispanic, non-Hispanic American Indian Alaska Native, and non-Hispanic Black. Non-Hispanic Asian folks weren’t included on this evaluation, as no county had a majority non-Hispanic Asian inhabitants in accordance with 2019 ACS knowledge. Information to categorize counties by poverty degree can be primarily based on the Census Bureau’s 2019 American Community Survey 5-Year Estimates by county. We used the 30% threshold to outline “excessive poverty” since research has shown that the detrimental results of neighborhood poverty are most outstanding when a neighborhood has between 20% and 40% poverty and 30% is often utilized in present literature measuring excessive poverty neighborhoods.

Appendix

Key Traits Variety of Counties % of Counties with no Facility with Oral Antiviral COVID-19 Remedies Accessible Common Variety of Amenities with Oral Antiviral COVID-19 Remedies Accessible per 100,000 by County Common Variety of Oral Antiviral COVID-19 Therapy Programs Accessible per 100,000 by County
Geography
Metro 1,167 9% 10.7 737
Non-Metro 1,976 28% 9.9 629
Revenue
Low Poverty (<10% beneath poverty) 654 26% 10.4 601
Reasonable Poverty (10-30% beneath poverty) 2,401 19% 10.2 686
Excessive Poverty (30%+beneath poverty) 87 40% 7.7 692
Racial Composition
Non-Majority Black (<50%) 3,046 21% 10.3 667
Majority Black (50%+) 96 31% 8.6 705
Non-Majority Hispanic (<50%) 3,040 21% 10.3 674
Majority Hispanic (50%+) 102 33% 7.3 503
Non-Majority AIAN (<50%) 3,114 21% 10.3 673
Majority AIAN (50%+) 28 75% 4.2 185
NOTES: Values (excluding the variety of counties column) have been rounded to the closest entire quantity. For Geography, counties with USDA Rural-City Continuum Codes between 1 and three are categorised as “metro” and counties with codes 4 by 9 are categorised as “non-metro”. Solely the 50 states and D.C. had been included on this evaluation (territories had been excluded). Additional, solely therapeutics suppliers which have reported on their stock standing up to now two weeks as having a present accessible provide of oral antivirals (Paxlovid, Renal Paxlovid, or Lagevrio) had been included.
SOURCE: Census Bureau’s 2019 American Neighborhood Survey Estimates (used for each Poverty and Racial Composition analyses); U.S. Department of Agriculture (USDA) 2013 Rural-Urban Continuum Codes; U.S. Department of Health and Human Services (HHS) COVID-19 Public Therapeutic Locator Data, as of June 7, 2022.

 

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