As the nation largely abandons mask mandates, physical distancing, and other COVID-19 prevention strategies, elected officials and health departments alike are now championing antiviral pills. But the federal government isn’t saying how many people have received these potentially lifesaving drugs or whether they’re being distributed equitably.
Pfizer’s Paxlovid pill, along with Merck’s molnupiravir, are aimed at preventing vulnerable patients with mild or moderate COVID from becoming sicker or dying. More than 300 Americans still die from COVID every day.
National supply counts, which the Biden administration has shared sporadically, aren’t the only data local health officials need to ensure their residents can access the treatments. Recent federal changes designed to let large pharmacy chains like CVS and Walgreens efficiently manage their supplies have had an unintended consequence: Now many public health workers are unable to see how many doses have been shipped to their communities or used. And they can’t tell whether the most vulnerable residents are filling prescriptions as often as their wealthier neighbors.
KHN has repeatedly asked Health and Human Services officials to share more detailed COVID therapeutic data and to explain how it calculates utilization rates, but they have not shared even the total number of people who have gotten Paxlovid.
So far, the most detailed accounting has come from the drugmakers themselves. Pfizer CEO Albert Bourla reported on a recent earnings call that an estimated 79,000 people received Paxlovid during the week that ended April 22, up from 8,000 a week two months earlier.
Unlike COVID vaccinations or cases, HHS doesn’t track the race, ethnicity, age, or neighborhood of people getting treatments. Vaccination numbers, initially published by a handful of states, allowed KHN to reveal stark racial disparities just weeks into the rollout. Federal data showed that Black, Native, and Hispanic Americans have died at higher rates than non-Hispanic white Americans.
Los Angeles County’s Department of Public Health has worked to ensure its 10 million residents, especially the most vulnerable, have access to treatment. When Paxlovid supply was limited in the winter, officials there made sure 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 treatment free of charge, a model that avoids many of the hurdles that make treatment at for-profit pharmacy-based clinics difficult for uninsured, rural, or disabled patients to use.
But without federal data, they don’t know how many county residents have gotten the pills.
Real-time data would show whether a neighborhood is filling prescriptions as expected during a surge, or which communities public health workers should target for educational campaigns. Without access to the federal systems, Los Angeles County, which serves more residents than the health departments of 40 entire states, has to use the limited public inventory data that HHS publishes.
That dataset contains only a slice 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 tell if patients there have taken the pills.
Because so little data is available, Kurian’s team created its own survey, asking providers to report the ZIP codes of patients who have received the COVID therapies. With the survey, it’s now easier to figure out which pharmacies and clinics need more supplies.
But not everyone completes it, she said: “Oftentimes, we have to still do some guesstimating.”
In Atlanta, staff at Good Samaritan Health Center would use detailed information to direct low-income patients to pharmacies with Paxlovid. Though the drug wasn’t readily available during the first omicron surge, the next one will be “a new frontier,” said Breanna Lathrop, the center’s chief operating officer.
Ideally, she said, her staff would be able to see “everything you need to know in one spot” — 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 U.S. in late December. They have quickly become the go-to treatments for non-hospitalized patients, replacing nearly all the monoclonal antibody infusions, which are less effective against current COVID strains.
Though the government doesn’t record 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 research scientist 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 initial outpatient treatments. Other researchers found that language difficulties, lack of transportation, and not knowing the treatments existed all contributed to the disparities. Feehan’s study, using data from 41 medical systems, found no large discrepancies for hospitalized patients, who didn’t have to seek out the drugs themselves.
Patients at Atlanta’s Good Samaritan Health Center often don’t know that if they get tested quickly they can receive 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, about whether “it benefits them.”