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Opportunities for Advancing Health Justice in the COVID-19 Era

Summary

The COVID-19 pandemic has disproportionately impacted communities of color since the first cases were identified in the United States.

Despite making up less than 20% of the overall US population, African Americans, Latinos, and Indigenous peoples account for nearly half of the COVID-19 cases, hospitalizations, and COVID-related deaths across the country. With states actively pursuing plans for vaccine distribution following the emergency use authorization issued for the Pfizer-BioNTech COVID-19 vaccine on December 11 and a Food & Drug Administration review for the Moderna vaccine on December 17, concerns regarding development and distribution have been expressed by experts in Black and Brown communities.

Achieving herd immunity through natural immunity will likely result in millions of otherwise preventable deaths. As a result, the US is highly dependent on the success of a COVID-19 vaccine to support herd immunity within the population. Experts indicate that 70% of a given population must be immune to COVID-19. Only 14% of Black Americans “mostly or completely trust” a COVID-19 vaccine will be safe, according to data from COVID Collaborative. Vaccine hesitancy is critical, as even a small percentage the population refusing to take the vaccine puts the nation out of range to achieve herd immunity.

Challenges with vaccination among communities of color are not limited to the novelty of the COVID-19 vaccine. For example, during the 2018–2019 flu season, 39% of Black adults and 37% of Hispanic adults received the influenza vaccination, compared to 49% of White adults. Similarly, in recent years, 56% of African-Americans 65 or older and 49% of Hispanic or Latino adults 65 or older received the pneumococcal vaccine, compared to 71% of their White counterparts. This poses a significant public health threat to these communities of color because they suffer worse outcomes from these infections. Further, this highlights the potential impact on COVID-19 vaccine uptake from these communities, significantly lowering the chance of herd immunity.

Attempts to alleviate mistrust and hesitancy from these communities during the pandemic have included historically Black college and university presidents joining COVID-19 vaccine trials and the Federal Office of Minority Health collaboration with Morehouse School of Medicine on a $40 mission plan to help inform racial and ethnic minorities about COVID-19. While these efforts to increase engagement have raised awareness for historically marginalized communities, additional strategies are needed to build trust to combat the current pandemic and to tackle persistent health disparities in the years to come. As life sciences companies make strides toward improving health equity, 3 key opportunities have emerged from the COVID-19 pandemic to guide future efforts toward promoting inclusion.

  • Expand Trial Eligibility Criteria to Include More People of Color: Intentional efforts to diversify COVID-19 clinical trials to better reflect the population of individuals affected by COVID-19 were publicized widely. However, a lack of diversity is a persistent issue for clinical trials across multiple condition areas. Broadening eligibility criteria to promote more diverse enrollment practices is critical for the development of the COVID-19 vaccine and for many other conditions with a disproportionate impact on communities of color. Common comorbidities that are disproportionately reflected in communities of color (e.g., diabetes and hypertension) are often factors for clinical trial exclusion, causing trials to be overly restrictive, thus limiting enrollment and participation. Unless a safety risk is associated with those conditions and participation, such criteria should be reconsidered as they exclude many people of color and lower the likelihood of investigators understanding the efficacy of vaccines and experimental drugs.
  • Collaborate with Community Organizations and Providers to Improve Outreach and Vaccine Education: Communities of color particularly benefit from receiving care and communication from healthcare providers who identify with their racial/ethnic identity or exhibit strong cultural competency. During the COVID-19 pandemic, physicians of color have been at the forefront of efforts to refine public health messaging to directly address concerns from their communities. Community-based organizations and local health departments have the targeted expertise and historical context to identify the most effective tactics for mobilizing local communities to action. In partnership with these organizations, life sciences companies can create workgroups to translate scientific data and develop recommendations for state and federal agencies. Pharmaceutical companies have recently partnered with organizations such as the National Urban League to initiate outreach campaigns. According to 2018 data from the Association of American Medical Colleges, only 5% of physicians in practice nationwide identify as Black or African-American. Similarly, 6% of physicians identify as Hispanic. Given these limited numbers nationwide, life sciences companies should invest in training opportunities to expand cultural competence among the physician community. Additional efforts to engage stakeholder groups, such as faith-based communities and local non-profit organizations, with established credibility among communities of color will be necessary to build trust in healthcare among minority communities.
  • Prioritize a Focus on Social Determinants to Promote Health Equity: Inequities in social determinants of health disproportionately place racial and ethnic minority groups at increased risk of contracting and dying from COVID-19. Social factors contributing to this increased risk include education, food insecurity, housing, and access to transportation. Not only are these factors associated with a higher number of COVID-19 cases, hospitalizations, and deaths, but they also contribute to higher rates of other medical conditions that increase the severity of COVID-19 infections. Life sciences companies—along with community-based organizations—all play an essential role in promoting fair access to health. These organizations can partner to advance opportunities to improve minority access to vaccinations amid the distribution of the COVID-19 vaccine and improve health equity in communities.

An evidence-driven approach to improving the quality of care for communities of color has long been championed by experts and community advocates. Life sciences companies and other stakeholders must support future initiatives in a targeted and sustainable way to address the root causes of existing healthcare disparities in the US.

Avalere is well positioned to support life sciences companies in their pursuit of health equity. Contact us to learn more about engaging key stakeholders across the healthcare spectrum and improving care delivery for all patients.

Contributor

Leana Wen, MD, an Avalere Senior Advisor and Contractor, is an emergency physician and visiting professor of health policy and management at the George Washington University’s Milken School of Public Health, where she is also a distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. Dr. Wen is an expert in public health preparedness and previously served as Baltimore’s health commissioner.

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