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A Call to Address Health Inequities Now, Before Next Pandemic

A Call to Address Health Inequities Now, Before Next Pandemic

With the number of new cases of COVID-19 continuing to decline, now may be an excellent opportunity to concentrate on ensuring that everyone has equitable access to vaccinations and other medications in advance of the next public health disaster.

The coronavirus pandemic, which is currently in its third year, has seen significant challenges arise in terms of equitable access to diagnosis, treatment, and immunization.

Despite the fact that inequality in the United States healthcare system is nothing new, the epidemic has exacerbated issues that can and should be addressed immediately, according to experts who spoke at a media briefing hosted by the Infectious Diseases Society of America on Thursday.

For public health officials, the “big picture” message is that they should listen to people in underserved communities, address specific challenges such as lack of access and distrust, and work with local officials and faith leaders to raise awareness about the importance of things such as vaccines and boosters.

Health care practitioners, such as Allison L. Agwu, MD, an associate professor of pediatric and adult infectious diseases at Johns Hopkins University School of Medicine in Baltimore, may also play a role in the effort.

“If you see anything, say something,” she urged people to do. She went on to say that it is vital to use your voice for advocacy.

If you ask Agwu how individual providers might assist, he responds that it is necessary to acknowledge that everyone has prejudices. In every meeting, be aware that you may bring certain innate prejudices with you that you are not aware of. “I’ve got them, and we all have them.”

According to Agwu, consulting data and research on health inequality is a smart way for addressing the problem. When everyone uses the same numbers, it may assist to reduce the likelihood of prejudice. In addition, being deliberate in resolving injustices is beneficial.

However, she points out that even the greatest intentions of individual clinicians can only go so far until the biases in the entire healthcare system are corrected.

Emily Spivak, MD, concurred with this assessment.

“Unfortunately, our healthcare institutions and medical practices are both contributing to this systemic issue. Sadly, they are all ingrained in these institutions,” she added of the racist inequalities.

According to Spivak, “it is wonderful that an individual practitioner can accomplish all of this.” However, he adds, “We really need the culture of health systems and medical practices… to change so that they are proactive and deliberate [and create] strategies to eliminate these imbalances.”

Equity and Monoclonal Antibodies

Located closer to the opposite coast, Spivak, an associate professor of infectious diseases at the University of Utah in Salt Lake City, examined ways to minimize disparities in the state when monoclonal antibodies for treating COVID-19 became available.

At the briefing, she explained that she and her colleagues already had “clinical experience” to know that things were not equal and that they were seeing far more patients infected with the virus, hospitalized, and suffering from really bad outcomes who were members of nonwhite racial or ethnic groups.

“We attempted to get ahead of the situation by stating that we needed to consider how we might provide equitable access to these treatments.”

A little amount of early research assisted Spivak and colleagues in the identification of risk variables for more severe COVID-19 cases.

“And the normal things came up that you would expect: age, male gender — which was higher-risk at the time but is no longer the case — diabetes and obesity,” she said.

One element, however, that came out as a very substantial risk factor was those who classified themselves as belonging to a racial or ethnic group that was not white.

As a result, Spivak and colleagues developed a state risk score that took into account the greater risk associated with persons from nonwhite groups. To increase awareness about the availability and advantages of monoclonal antibody treatment, the researchers reached out to individuals who identified as nonwhite in a database and shared their stories.

People were contacted by the nurses in order to reinforce the message.

Spivak and colleagues conducted a follow-up study using data from more than 180,000 Utah residents and discovered that “these factors continue to hold.”

Risk Adjustment or More Inequity?

“Unfortunately, at the end of January this year, our Department of Health issued a press release in which they announced that the nonwhite race ethnic points or dangers will be eliminated from our state risk calculator,” Spivak said.

“However, they are attempting to get narcotics for individuals in these places via other operational methods, as well as increasing access points in a variety of ways,” she said.

“Instead of using race and ethnicity as a factor in determining treatment eligibility, the Department of Health and Human Services will work with communities of color to improve access to treatments by placing medications in locations that are easily accessible to these populations and working to connect members of these communities with available treatments,” according to the department’s statement.

Data on Disparities

The Centers for Disease Control and Prevention (CDC) gathers statistics on COVID-19 instances, hospitalizations, and fatalities, however not all states break down the data by race and ethnicity.

Despite this caution, the data suggests that Native Americans and Alaska Natives are 112 times more likely than white Americans to be diagnosed with COVID-19 as compared to white Americans. The chances of hospitalization and mortality are also greater in this population.

According to Agwu, this is also true for African Americans and Latinos as a group when compared to white populations.

Furthermore, Black people account for around 10% of those who have gotten at least one dose of a COVID-19 vaccination, despite the fact that they account for just 12 to 13% of the total population of the United States.

Looking Forward

The response to disparities that occurred during the COVID-19 epidemic was reactionary, according to Agwu. On the other hand, public health professionals may now be more proactive and handle serious risks in advance.

“I wholeheartedly agree. We already have the information “Spivak’s assistance. “We won’t have to squander time the next time. We’re familiar with these disparities or systemic [problems]; they’ve been there for a long time.”

When it comes to the next public health catastrophe, she warned that if no progress is made in addressing imbalances, “it will play out the same way again, almost like a playbook.”

Agwu agreed, stating that immediate action is required “so that we don’t have to start over from the beginning every time.”

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