How Equitable is Entry to COVID-19 Therapies?

With uptake of COVID-19 vaccines and boosters leveling off and the U.S. at present within the midst of one other Omicron wave, making certain equitable and speedy distribution of COVID-19 therapies might be essential for mitigating the uneven impacts of the pandemic. COVID-19 has disproportionately affected sure underserved and high-risk populations, together with folks of coloration and people who are socioeconomically deprived. As a result of many of those teams stay at elevated danger of publicity, on condition that they’re much less prone to work in jobs that may be executed remotely and as a result of different structural components, entry to therapies (along with vaccines) is especially essential. The Biden Administration has recognized rising entry to COVID-19 therapies as a precedence, however there was vast variation in entry throughout states and native jurisdictions.

To this point, information on who has acquired COVID-19 therapies stays very restricted, hindering the power to evaluate whether or not entry to them has been equitable. To offer higher perception into entry to COVID-19 therapies, we analyzed information from the HHS Workplace of the Help Secretary for Preparedness and Response on public areas 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 price, and majority Black, Hispanic, or American Indian or Alaska Native (AIAN), the teams who’ve skilled the biggest disparities in COVID-19 well being outcomes. The evaluation is proscribed 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 means of amenities 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 revenue, or their race/ethnicity.
• Nonetheless, 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 amenities accessible in comparison with their counterpart counties. Findings are extra combined for therapy 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 probably highest danger and highest want counties. Non-metro counties and majority Hispanic and AIAN counties, which have fewer amenities and programs accessible have extra restricted entry to therapies general. Excessive poverty and majority Black counties, which have fewer amenities however extra programs accessible relative to their inhabitants measurement, might not have disparities by way of variety of therapies accessible, however should still have extra restricted entry, as people might need to journey a farther distance to acquire them. Provided that there have been no latest shortages in therapy programs, proximity to a facility could also be a extra related measure of entry at the moment.

Whereas this evaluation gives some perception into the supply of amenities and coverings, getting them additionally will depend on having information about therapies, entry to medical recommendation, and the time and sources to acquire them. Nonetheless, to this point, no federal information is offered on who’s receiving therapies. Going ahead, continued steps to make sure fairness in entry to COVID-19 therapies might be essential, as will rising information 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 therapies. These therapies – Paxlovid and Lagevrio – can be found for individuals who take a look at optimistic for COVID-19 and are at excessive danger of growing critical sickness. They have to be taken inside 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 cut back hospitalization and demise from COVID-19. The federal authorities has bought provides of each therapies for distribution to websites all through the nation and to be supplied without spending a dime to those that are eligible.

The Biden Administration launched a nationwide Check to Deal with initiative in March 2022 to increase entry to oral antiviral COVID-19 therapies. The Check-to-Deal with initiative builds on prior distribution of oral antivirals, which started in December 2021, to states, Tribes, territories, and neighborhood well being facilities, which in flip distribute these therapies to well being care suppliers, pharmacies, and different areas. The purpose of this program is to allow folks to get examined and, if they’re optimistic and coverings are acceptable for them, obtain a prescription from a well being care supplier and have their prescription stuffed all at one location. These Check-to-Deal with websites can be found at areas nationwide, together with clinics, federally-funded well being facilities, long-term care amenities, and community-based websites. In Might 2022, the Administration expanded the initiative to incorporate new federally-supported Check-to-Deal with areas that target 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 very 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 amenities 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 revenue, or their race/ethnicity.

The common variety of amenities and therapy programs accessible varies throughout counties. On common, there are 10.2 amenities and 668 therapy programs accessible per 100,000 folks per county. Nonetheless, the variety of amenities per 100,000 ranges significantly, 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 probably than metro counties to not have a facility with oral antiviral therapies accessible (28% vs. 9%), and other people dwelling in a non-metro county are much less prone to have a facility with therapy accessible (92% vs. 100%). Nonetheless, the common variety of amenities 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 under poverty reside in a county that has a facility with COVID-19 therapies accessible, high-poverty counties have fewer amenities 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 price 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 amenities in comparison with low and average poverty counties (7.7 vs. 10.4 and 10.2 per 100,000 folks, respectively). Nonetheless, excessive poverty counties have barely extra therapy 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 amenities 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.)

• General, 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 whole 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 amenities per 100,000 folks in majority Black counties in comparison with 10.3 amenities per 100,000 folks in non-majority Black counties. Nonetheless, 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 very least 50% of the inhabitants in 102 counties which are dwelling to just about 20% of the whole 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 amenities 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 amenities per 100,000 folks in majority Hispanic counties in comparison with 10.3 amenities 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 whole AIAN inhabitants. General, simply over 9 in ten (91%) of AIAN folks reside in a county with a facility accessible. Nonetheless, 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 amenities 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 result of underlying disparities that place folks of coloration at elevated danger for publicity and sickness, and making certain fairness in entry to COVID-19 therapies (in addition to vaccines) is essential for mitigating disparities and stopping towards additional widening of disparities going ahead.

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

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 people who measure excessive on the general social vulnerability index, an index developed by the federal authorities to establish communities that may almost certainly want help 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 might depart some areas with excessive concentrations of residents at elevated danger dealing with gaps in entry, and as such, extra fairness lenses could also be useful for selling entry.

Importantly, whereas this evaluation gives some perception into the supply of COVID-19 oral antiviral therapies, getting them additionally will depend on 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 get hold of them. Going ahead, continued steps to make sure fairness in entry to COVID-19 therapies might be essential, as will rising information accessible to know who has acquired them.

Strategies

For this information be aware, KFF researchers analyzed information on the county degree and drawing from a number of sources:

Our foremost end result of curiosity, amenities with oral antiviral COVID-19 therapies accessible, was collected from the U.S. Division of Well being & Human Providers (HHS) COVID-19 Public Therapeutic Locator Information as of June 7, 2022 The HHS information contains areas 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 inside the final two weeks. The evaluation is proscribed to areas within the 50 states and D.C. (excludes territories) that reported stock prior to now two weeks and have a present provide of oral antivirals (Paxlovid, Renal Paxlovid, or Lagevrio). Places that didn’t report stock inside the prior two weeks and whose standing was unknown weren’t included within the evaluation. These areas might 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. Division of Agriculture’s 2013 Rural-City Continuum Codes. Counties with codes 1 by means of 3 are categorized as “metro” and 4 by means of 9 are categorized as “non-metro.” The agricultural-urban continuum codes distinguish metropolitan counties by the inhabitants measurement 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 Neighborhood Survey (ACS) 5-Yr 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 based on 2019 ACS information. Information to categorize counties by poverty degree can also be primarily based on the Census Bureau’s 2019 American Neighborhood Survey 5-Yr Estimates by county. We used the 30% threshold to outline “excessive poverty” since analysis has proven that the adverse results of neighborhood poverty are most outstanding when a neighborhood has between 20% and 40% poverty and 30% is usually utilized in present literature measuring excessive poverty neighborhoods.

Appendix