A call to address health inequalities now, before the next pandemic

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March 4, 2022 — As new cases of COVID-19 continue to decline, now may be the time to ensure everyone has equal access to vaccines and other medicines before the next public health emergency .

The coronavirus pandemic, now in its third year, has seen major issues develop around equal access to diagnosis, care and vaccination.

Inequalities in America’s healthcare system may not be new, but the pandemic has magnified problems that could and should be solved now, experts said at a Thursday press conference sponsored by the Infectious Diseases Society. of America.

The overarching message is for public health officials to listen to people in disadvantaged communities, address the unique challenges of access and trust, and engage local officials and faith leaders to help promote the importance of things like vaccines and boosters.

Healthcare providers can also do their part to help, said Allison L. Agwu, MD, 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.

Asked how individual providers could help, Agwu said it’s important to recognize that everyone has biases. “Recognize that you may present inherent biases in every encounter that you don’t recognize. I have them, we all have them.”

Looking at data and evidence on health inequalities is a good strategy, Agwu said. When everyone uses the same numbers, it can help reduce bias. Intentionality that tackles inequalities also helps.

But the best intentions of individual providers will go no further than if the biases of the overall health care system are corrected, she said.

Emily Spivak, MD, agreed.

“Our healthcare systems and our medical practices are unfortunately part of this systemic problem. These inequalities in racism – they are unfortunately all built into these systems,” she said.

“For an individual provider, that’s great,” Spivak said, “but we really need the culture of health systems and medical practices… to change to be proactive and thoughtful. [and devise] interventions to reduce these inequalities.

Equity and monoclonal antibodies

Closer to the other coast, Spivak, an associate professor of infectious diseases at the University of Utah in Salt Lake City, pondered how to reduce inequity in Utah when monoclonal antibodies became available for the treatment of COVID-19.

“We already had the clinical experience to know that things weren’t equal and we were seeing a lot more infected, hospitalized patients with very poor outcomes who were predominantly of non-white race or ethnicity,” a- she said during the briefing.

“We tried to put ourselves forward and say that we need to think about how we can fairly provide access to these drugs.”

Some early research helped Spivak and his colleagues identify risk factors for more severe COVID-19.

“And the usual things that you would expect fell away: age, male sex – it was a higher risk then, it’s not anymore – diabetes and obesity,” a- she declared.

“But something that really stood out as a really big risk factor was people who self-identified as being of non-white race or ethnicity.”

Spivak and colleagues therefore proposed a state risk score that incorporated the higher risk for people from non-white groups. They contacted patients identified as non-white in a database to educate them about the availability and benefits of monoclonal antibody therapy.

The nurses also called people to reinforce the message.

More recently, Spivak and his colleagues repeated the search on data from more than 180,000 Utah residents and “found that these predictors still hold.”

Risk adjustment or more inequity?

“Unfortunately, at the end of January this year, our Ministry of Health issued a Press statement that removed points or non-white race ethnic risk from our state risk calculator,” Spivak said.

“But they’re working through other operational means to try to get people to use drugs in those communities and increase the hotspots 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 medicines in places easily accessible by these populations and working to connect members of these communities to available treatments.”

Data on disparities

the The CDC collects data on COVID-19 cases, hospitalizations and deaths, but not all states disaggregate information by race and ethnicity.

Despite this caveat, the data reveals that, compared to white Americans, Native Americans and Alaska Natives are 1.5 times more likely to be diagnosed with COVID-19. Hospitalization and mortality rates are also higher in this group.

“This is also seen for African American and Latino populations, compared to white 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.

Looking forward to

For Agwu, tackling the inequalities that emerged during the COVID-19 pandemic felt reactive. But now public health officials can be more proactive and deal with major issues ahead of time.

“I totally agree. We already have the data,” adds Spivak. “We don’t need to delay next time. We know these inequities or systemic [issues] — they’ve been here for decades.”

If progress is not made to address inequalities, she predicted, with the next public health emergency, “it will play out the same way again, almost like a playbook.”

Agwu agrees, saying action must be taken now “so that we don’t start from scratch every time”.