Is Paxlovid, the Covid pill, reach­ing those who most need it? The gov­ern­ment won’t say

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 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.”

When Jef­frey Klaus­ner was a deputy of­fi­cer at the San Fran­cis­co De­part­ment of Pub­lic Health, “our first pri­or­i­ty was trans­paren­cy and da­ta shar­ing,” he said. “It's im­por­tant to build trust, and to en­gage with the com­mu­ni­ty.” Now a pro­fes­sor at the Uni­ver­si­ty of South­ern Cal­i­for­nia, he said fed­er­al and state of­fi­cials should share the da­ta they have and al­so col­lect de­tailed in­for­ma­tion about pa­tients re­ceiv­ing treat­ment — race, eth­nic­i­ty, age, ill­ness sever­i­ty — so that they can cor­rect for any in­equities.

Pub­lic health of­fi­cials and re­searchers who spoke with KHN said that HHS of­fi­cials may not think the da­ta is ac­cu­rate or have ad­e­quate staff to an­a­lyze it. The head of HHS’ ther­a­peu­tics dis­tri­b­u­tion ef­fort, Dr. Derek Eis­nor, sug­gest­ed as much dur­ing an April 27 meet­ing with state and lo­cal health of­fi­cials. One lo­cal of­fi­cial asked the fed­er­al agency to share lo­cal num­bers so they could in­crease out­reach in com­mu­ni­ties with low us­age. Eis­nor re­spond­ed that be­cause HHS doesn’t re­quire providers to say how much they use, the re­port­ing “is kind of mediocre at best,” adding that he didn’t think it was his agency’s role to share that in­for­ma­tion.

Eis­nor al­so said that state health de­part­ments should now be able to see lo­cal or­ders and us­age from phar­ma­cy chains like CVS, and that the agency hopes to soon re­lease week­ly na­tion­al da­ta on­line. But coun­ties like Los An­ge­les — which has re­quest­ed ac­cess to the fed­er­al sys­tems with no suc­cess — still don’t have ac­cess to the da­ta they need to fo­cus out­reach ef­forts or spot emerg­ing dis­par­i­ties.

Spokesper­son Tim Granholm said that HHS is look­ing in­to ways to share ad­di­tion­al da­ta with the pub­lic.

Record­ings of the week­ly meet­ings, in which HHS of­fi­cials share up­dates about dis­tri­b­u­tion plans and an­swer ques­tions from pub­lic health work­ers, phar­ma­cists, and clin­i­cians, were post­ed on­line un­til March. HHS’ me­dia of­fice has since re­peat­ed­ly de­clined to grant KHN ac­cess, say­ing “the record­ings are not open to press.” That’s be­cause HHS wants to en­cour­age open con­ver­sa­tion dur­ing the meet­ings, ac­cord­ing to Granholm. He did not say what le­gal au­thor­i­ty al­lows the de­part­ment to bar me­dia from the pub­lic meet­ings. KHN ob­tained the pub­lic records through Free­dom of In­for­ma­tion Act re­quests.

A se­nior White House of­fi­cial said that the Biden ad­min­is­tra­tion is at­tempt­ing to col­lect ac­cu­rate da­ta on how many peo­ple re­ceive Paxlovid and oth­er treat­ments but said it doesn’t de­fine suc­cess by how many peo­ple do so. Its fo­cus, the of­fi­cial said, is on mak­ing sure the pub­lic knows treat­ments are avail­able and that doc­tors and oth­er providers un­der­stand which pa­tients are el­i­gi­ble for them.

We still need to know where the pills are go­ing, Fee­han said. “We need that da­ta as soon as hu­man­ly pos­si­ble.”

Un­til then, Los An­ge­les Coun­ty’s Kuri­an and her peers will keep “guessti­mat­ing” where res­i­dents need more help. “If some­one can just give us a re­port that has that in­for­ma­tion,” she said, “of course, that makes it eas­i­er.”


By Han­nah Recht

First pub­lished at KHN (Kaiser Health News) — a non­prof­it news ser­vice cov­er­ing health is­sues. It is an ed­i­to­ri­al­ly in­de­pen­dent pro­gram of KFF (Kaiser Fam­i­ly Foun­da­tion), which is not af­fil­i­at­ed with Kaiser Per­ma­nente.

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