“Right now, with people not taking preventive measures and vaccinations not increasing as fast as we would like and not enough people being ramped up, the ability to help people at high risk of ending up in hospital or dying is really ours 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 it who is prescribed Paxlovid, worrying some experts that those still at higher risk may not have equal access to this next line of defense if Covid-19 continues to spread.
“We know that this pandemic has exposed all the inequalities in our healthcare system – all the injustices – and there is every reason to believe that access to this drug will be the same as other issues in this pandemic,” Pavia said. who is also a member of the National Institutes of Health’s Covid-19 Treatment Guidelines Panel.
“I think it’s very important that we know how Paxlovid is being used and if it’s reaching all groups that need it equally.”
Barriers could exacerbate injustices
Gathering demographic data in healthcare is always useful to make the system fairer, experts say.
“I think we’re going to most likely find differences when we look under the hood, like we found with the vaccine,” said Steve Grapentine, pediatric infectious disease pharmacist at the University of California, San Francisco and a member of the NIH panel.
“The only way to make improvements and actually monitor the progress of our interventions is to measure it,” he said.
And there are a few obstacles inherent in Paxlovid that make this information especially important in this case, experts say.
Paxlovid works best when used within a few days of symptoms starting, but it requires a prescription and some people find it more difficult to reach a doctor in a timely manner. Additionally, Paxlovid can have negative interactions with other drugs and more complex prescribing guidelines that may present challenges for physicians to become familiar with and may affect the way they prescribe it.
“It is very likely that there will be differences in Paxlovid use based on where people live, their income level and race. But I think we need to have transparency,” Pavia said.
As of Thursday, about 831,000 cycles of Paxlovid had been administered – of the nearly 2.5 million ordered since the treatment was approved for emergency use in mid-December.
A closer look reveals that some states (including Nevada, Washington, and New York) managed a much larger proportion of their supply than others (including South Dakota, Mississippi, and Alabama).
But there’s no comprehensive demographic data on who is prescribed Paxlovid beyond the state-level totals — at least none that has been shared publicly.
“We are working with our pharmacy partners and healthcare providers to better understand who is receiving these treatments,” an HHS spokesman told CNN. “This demographic data will improve our ability to identify access gaps in real time and work to close those gaps promptly.”
Major pharmacy retailers were an integral part of sharing information about vaccine uptake when rollouts began last year, and CNN reached out to both CVS and Walgreens to see if similar efforts were being made to track uptake of Paxlovid . CVS said it has “a duty to provide federal officials with the demographic data they request” but would not provide further details, and Walgreens said they are in the “early stages” of collecting information based on a “Current request from the Federal Government” are based .”
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 extended 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 prevent people from ending up in the hospital,” Pavia said. “But you have to actually know where the drug was dispensed relative to when the disease was out there to be able to see that.”
Prescription tracking is different from vaccine tracking
States are required to report to the federal government how much product they stock and how much is being spent, according to a senior health official in the Biden administration, but any demographic details the government has are only anecdotal at this time.
The official said the government has been working with states to ensure treatment reaches the intended population. But CNN reached out to health officials in all 50 states to see if they had more demographic details about who is prescribed Paxlovid; more than half responded, but none of them had this information.
Some state health officials cited local efforts to get Paxlovid to providers in underserved areas, and some suggested contacting providers directly for more detailed information about who is receiving the drug.
The California Department of Health specifically noted that while there is “a wealth of demographic and geographic information about who is receiving Covid-19 vaccines in the state,” the same does not apply to treatments.
In fact, long before the pandemic, states had established immunization databases that enabled centralized reporting of Covid-19 vaccinations. But there’s no similar registry for prescription drugs, so private databases scattered across providers are the only way to gather information about who’s receiving Paxlovid.
The Minnesota Department of Health said it is working with the state’s Electronic Health Record Consortium to begin collecting some of this information, but that all of the results are “months away from becoming a reality.”
But knowing where the drugs are being distributed can only give a rough idea of who they’re going to, experts say.
“That doesn’t tell you it was dispensed, doesn’t tell you how it got to the patients and which patients it got to,” Pavia said. Anonymized personal data can “not only show where the medicines are on the shelves or where the medicine entered the bloodstream when needed”.
Some work has been done to track antibiotic abuse and opioid prescription in this way, but experts say there are still many possibilities.
“We need more robust infrastructure and data systems in all electronic health records” that allow for “a more routine assessment of these types of issues,” Grapentine said.
“I don’t know if we know all the right interventions to address inequalities, but at least if we have the data, we can see progress on those interventions and get where our ultimate goal should be, which is to address health inequalities.” Care.”