HealthyWomen Joins Nationwide Well being Organizations in Letter to HHS Secretary Alex Azar About Entry to COVID-19 Therapy
November 11, 2020
The Honorable Alex Azar
U.S. Department of Health
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Azar:
The COVID-19 pandemic has exposed deep and systemic inequalities in our healthcare system. Members of minorities and underserved communities not only suffer more often from the serious health consequences of SARS-CoV-2 infections, but also disproportionately from economic difficulties in connection with the pandemic. Our organizations are committed to advancing policy solutions to address these differences head-on in the hope of not only mitigating the effects of the current pandemic, but also promoting a fairer and more equitable health system going forward.
We agree that we call for an informed, thoughtful, equity-based resource allocation and distribution during the current pandemic. This environment has raised difficult questions about how scarce resources are allocated. Whether determining where to ship physical products (vaccines, drugs, reagents, PPE, etc.) or COVID-19 funds, policymakers at all levels need to consider equality and health inequalities when prioritizing where these resources will be sent.
Early evidence on distributions from the Provider Relief Fund (set by the CARES Act) suggests that the proportion of privately insured patients predicts a financial health system better than the proportion of patients from minority communities. Conversely, researchers in Michigan developed a framework that initially assigns scarce remdesivir doses based on criteria that specifically recognize the areas of disproportionate disease burden: first doses should go to communities with the highest mortality rate and the highest rolling number of fans. This prioritization, along with in-depth confidence-building efforts, can help address the underlying trust issues in historically underserved or abused communities.
These and other examples from the past seven months have shown that the methods underlying the allocation strategies are by no means neutral with regard to health equality – they are powerful drivers that have the potential to correct or correct health differences in the allocation of scarce resources to tighten. Given the varying effects of COVID-19 on minorities and underserved communities
we strongly believe that allocating resources without recognizing these realities can exacerbate barriers to access to COVID-19 treatments.
We anticipate that the importance of allocation strategies that prioritize equity will only increase if novel therapies to treat COVID-19 are hopefully approved in the coming months. The United States government is likely to play a key role in distributing the initial supply of these therapies across the country.
While your office prepares to sell these products, we offer the following recommendations:
- In the context of the COVID 19 pandemic, explicitly set the promotion of health equality as the goal of the allocation decisions of ASPR.
In consultation with relevant stakeholders and experts, establish evidence-based criteria that will guide the product into areas where there is a disproportionate burden of disease or other resource constraints (if applicable).
Communicate these decisions and criteria openly with the public.
Develop and communicate the process by which these criteria could be changed as the burden of disease shifts to other populations or communities.
We note that the National Academies of Medicine have set guiding principles for their reflection in their report on the Framework for the Fair Allocation of COVID-19 Vaccines. These guiding principles also align with our recommendations, and we believe they could be helpful in developing similar strategies for the distribution of COVID-19 therapeutics.
We believe such efforts are necessary to ensure that ASPR allocation decisions do not ignore the realities of health inequalities in this country or inadvertently widen them by choosing inappropriate metrics.
Our organizations are ready to work with you in this effort and welcome further discussions on how your allocation strategies can better promote health equity.
Alliance for Age Research
American Cancer Society, Cancer Action Network
Association of Black Cardiologists
Biotechnology innovation organization
The health of black women is essential
Gerontological Society of America
Hill Scientific and Public Affairs, LLC
Institute for Advanced Clinical Studies
Latinos for Equity in Healthcare
Lupus Foundation of America
National Black Church Initiative
National Caucus and Center for Black Aging
National Health Council
National Hispanic Council on Aging
National Forum for Minority Quality
National AIDS Council for Minorities
Coalition for Preparedness and Treatment
The Commonwealth Fund
The National Grange
Trust for America’s Health
US Black Chambers, Inc.
cc: Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response, HHS Cicely Waters, Director, Foreign Affairs Bureau, ASPR, HHS
Laurie Zephyrin et. al., “COVID-19 more common, more deadly in US counties with higher black populations,” To the Point (blog), Commonwealth Fund, April 23, 2020
Yaphet Getachew et. al., “Beyond the Case Size: The Wide-Reaching Disparities of COVID-19 in the United States,” Commonwealth Fund, September 10, 2020
Shanoor Seervai, “Why Are More Black Americans Die Of COVID-19?”, June 26, 2020, in The Dose, Produced by Joshua Tallman and Shanoor Seervai, Podcast, MP3 Audio, 10:29 PM. https://doi.org/10.26099/9phb-x473
Parker Crutchfield et al. al., “Ethical Allocation of Remdesivir,” The American Journal of Bioethics, July 27, 2020
National Academies of Science, Engineering and Medicine. 2020. Framework for an equitable distribution of the COVID-19 vaccine. Washington, DC: The National Academies Press. https://doi.org/10.17226/25917.