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As the nation largely forgoes mask mandates, physical distancing and other covid-19 prevention strategies, both elected officials and health departments are now advocating antiviral pills. But the federal government doesn’t say how many people have received these potentially life-saving drugs or whether they are being distributed fairly.
Pfizer’s Paxlovid pill, along with Merck’s molnupiravir, are intended to prevent vulnerable patients with mild or moderate covid from becoming ill or dying. More than 300 Americans still die from Covid every day.
National stock counts, which the Biden administration has shared sporadically, aren’t the only data local health officials need to ensure their residents have access to the treatments. Recent federal changes designed to allow major pharmacy chains like CVS and Walgreens to efficiently manage their inventories have had an unintended consequence: Now many health professionals can’t see how many doses have been sent to their communities or used. And they don’t know whether the most vulnerable residents fill prescriptions as often as their wealthier neighbors.
KHN has repeatedly asked health and human services officials to share more detailed covid therapeutic data and explain how it calculates usage rates, but they haven’t even shared the total number of people who received Paxlovid.
To date, the most detailed accounting has come from the drug manufacturers themselves. Albert Bourla, CEO of Pfizer, reported on a recent earnings call that an estimated 79,000 people received Paxlovid in the week ending April 22, up from 8,000 a week two months earlier.
Unlike covid vaccinations or cases, HHS does not track the race, ethnicity, age or neighborhood of people receiving treatments. Vaccination numbers, initially published by a handful of states, enabled KHN to reveal major racial disparities within weeks of the rollout. Federal data showed that black, native and Hispanic Americans died more often than non-Hispanic white Americans.
The Los Angeles County Department of Health has made an effort to ensure that its 10 million residents, especially the most vulnerable, have access to treatment. When Paxlovid’s supply was limited over the winter, officials there ensured that pharmacies in hard-hit communities were well-stocked, according to Dr. Seira Kurian, a regional health officer in the department. In April, the county launched its own telehealth service to assess residents for free treatment, a model that avoids many of the hurdles that make treatment in for-profit clinics difficult 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 filling in regulations during a wave as expected, or which communities public health workers should target for educational 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 that HHS publishes.
That dataset only contains a piece of information and in some cases shows months old information. 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 there took the pills.
With so little data available, Kurian’s team created its own survey and asked health care providers to report the zip codes of patients who received the covid therapies. With the survey, it’s now easier to find out which pharmacies and clinics need more supplies.
But not everyone completes it, she said, “often we have to do some guesswork.”
In Atlanta, staff at the Good Samaritan Health Center would use detailed information to refer low-income patients to pharmacies with Paxlovid. While the drug wasn’t readily available during the first ommicron wave, the next one will be “a new frontier,” said Breanna Lathrop, the center’s chief operating officer.
Ideally, she said, her employees 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 built the center a similar database for covid testing earlier in the pandemic.
Paxlovid and molnupiravir became available in the US at the end of December. They have quickly become the go-to treatments for non-hospitalized patients, replacing almost all monoclonal antibody infusions, which are less effective against current covid strains.
While the government doesn’t register Paxlovid use by race and ethnicity, researchers tracked those trends for the first-generation infusions.
Amy Feehan, co-author of a CDC-funded study and a 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 those first outpatient treatments. . Other researchers found that language difficulties, lack of transportation, and not knowing the treatments existed all contributed to the differences. Feehan’s study, which used data from 41 medical systems, found no major differences for hospitalized patients, who did not have to search for the drugs themselves.
Patients at the Good Samaritan Health Center in Atlanta often don’t know that if they get tested quickly, they can get 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, as to whether “it benefits them.”
When Dr. Jeffrey Klausner was a deputy officer with the San Francisco Department of Public Health, “our first priority was transparency and data sharing,” he said. “It’s important to build trust and connect with the community.” Now a professor at the University of Southern California, he said federal and state officials should share the data they have and also collect detailed information about patients being treated — race, ethnicity, age, disease severity — so they can identify any inequalities. can correct.
Public health officials and researchers who spoke to KHN said HHS officials may not think the data is accurate or they don’t have enough staff to analyze it. The head of HHS’s therapeutic distribution division, Dr. Derek Eisnor, suggested this during an April 27 meeting with state and local health officials. A local official asked the federal agency to share local numbers so they could increase reach in low-use communities. Eisnor replied that because HHS doesn’t require providers to say how much they use, the reporting is “mediocre at best,” adding that he didn’t think his agency’s role was to share that information.
Eisnor also said state health departments should now be able to see local orders and the use of pharmacy chains like CVS, and the agency hopes to release weekly national data online soon. But counties like Los Angeles — which have unsuccessfully applied for access to the federal systems — still don’t have access to the data they need to focus on outreach efforts or spot emerging inequalities.
Spokesperson Tim Granholm said HHS is exploring 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 health professionals, pharmacists and clinicians, were posted online through March. The HHS media agency has since repeatedly refused to grant KHN access, saying “the recordings are not accessible to the press”. According to Granholm, HHS wants to encourage an open conversation during the meetings. He did not say which legal authority allows the department to bar media from public meetings. KHN obtained the public records through WP requests.
A senior White House official said the Biden administration is trying to collect accurate data on how many people receive Paxlovid and other treatments, but said success is not defined by how many people do. The focus, the official said, is to make sure the public knows that treatments are available and that doctors and other providers understand which patients are eligible.
We still need to know where the pills are going, Feehan said. “We need that data as soon as possible.”
Until then, Kurian and her Los Angeles County colleagues will continue to “guess” where residents need more help. “If someone can just give us a report with that information,” she said, “of course it makes it easier.”