As the pandemic continues to shine a bright light on inequalities in health care access in the U.S., policy responses to the pandemic have the potential to pave the way to a more equitable future.
This should not be surprising, given that the problem of vaccinating the country's sprawling and highly diverse population as rapidly as possible is essentially a problem of health care access writ large.
The urgency of the crisis has forced policymakers and regulators to rethink long-established practices and develop innovative solutions. After the pandemic subsides, those innovations can lead to improved health care for minority, rural, low-income, and other underserved communities.
For example, the current focus on vaccinating holdouts has underscored the importance of grassroots education and messaging that is targeted to specific audiences. To tackle low vaccination rates among 12- to 18-year-olds, federal and state public health agencies are systematically enlisting the help of TikTokers, YouTubers and other social-media influencers—both big names and micro-influencers with as few as 5,000 followers.
And at the end of July, the White House allocated $121 million to mobilize community-based health and outreach workers to help counter vaccine misinformation, leveraging organizations such as fire departments and houses of worship.
BUILDING GRASSROOTS CONNECTIONS, FORGING TRUST
To be successful, public health initiatives must have the public's trust. Those initiatives can be seriously impeded by a lack of trust in the medical establishment, as has long been the case among underserved—and particularly minority—communities.
The pandemic has forced policymakers to go to new lengths to build trust through grassroots channels. That playbook needs to be an integral part of outreach to underserved communities after the pandemic.
If underrepresented groups need to be the focus of more consistent outreach, they also need to be more prominently included earlier on, when therapies are undergoing clinical research. The lack of minority patient participation in clinical trials limits important treatment data and misses an opportunity to create awareness and buy-in with those patient groups from the start.
Regulations generally require patients in clinical trials to travel to the study site, making participation difficult for low-income, minority, and rural individuals who may live far away, lack access to reliable transportation, or have unpredictable and inflexible work and family responsibilities. But the pandemic provides a way forward here as well.
As enrollment in clinical trials dropped sharply last spring, the Food and Drug Administration issued numerous guidelines so that researchers could accommodate participants unable or reluctant to travel to research study sites. As recently recounted in Nature, participants have been allowed by the FDA to give consent to participation online, to have investigational medicines delivered to them at home, and in some cases, use their local physician for procedures and assessments, rather than travel to the study site.
While additional analysis is necessary to ensure that research quality has not been compromised by these accommodations, the larger point is clear: The pandemic provided the impetus to lower barriers to clinical trial participation in ways that may not have been seriously considered before the pandemic upended the traditional clinical trial ecosystem. Changes made to bolster clinical trial participation during the pandemic can perhaps be used to increase the participation of underserved groups in the future.
MAKING MEDICINES AVAILABLE AND AFFORDABLE
The ready availability of affordable medicines is another critical component for achieving equity in health care access. Shortages of generic drugs have been a persistent problem for years—long before the pandemic focused public attention on the vulnerabilities of global pharmaceutical supply chains. Here, too, policy developments brought on by the pandemic may provide much-needed improvements.
In response to the pandemic's disruption of supply chains in pharmaceuticals and other critical areas, the Biden administration released in June its recommendations for improving supply-chain resiliency. The report notes both the critical role that generics play in health care access and the various market forces that have weakened the generic drug supply chain and outlines steps to make supply chains more transparent and economically viable.
Outreach, clinical trials, generic drug availability—in each of these areas, the pandemic forced policymakers to develop new, innovative solutions that can have a lasting impact on health care access. But perhaps the pandemic's biggest legacy on access isn't a particular strategy, but a new way of thinking.
MULTIFACETED SOLUTIONS NEEDED
Policy discussions and solutions tend to be decentralized because health care in the U.S. is so decentralized. But the pandemic, and the breadth of the policy response to it, illustrates the extent to which health care access is a multifaceted problem that involves everything from product development to product shortages.
Improvements to a single element are unlikely to create the systemic changes needed. Successfully tackling the challenges of health care access to underserved communities requires both an end-to-end perspective and solutions that reach beyond assumed limitations. The pandemic has shown how we can do both.
This article was originally published in Bloomberg Law. Reprinted with permission. Any opinions in this article are not those of Winston & Strawn or its clients. The opinions in this article are the author's opinions only.
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