Abstract
BackgroundThe Emergency Use Authorization (EUA) of remdesivir for coronavirus disease 2019 raised questions on transparency of applied strategy, and how to equitably allocate and prioritize eligible patients given limited supply of the medication. The absence of federal oversight highlighted the critical role by states in health policymaking during a pandemic.ObjectiveTo identify public state-based protocols for remdesivir allocation and clinical guidance for prioritizing remdesivir use and assess approaches and inclusion of language promoting equitable access or mitigating health disparities.MethodsWe identified remdesivir allocation strategies and clinical use guidelines for all 50 states in the U.S. and the District of Columbia accessible on state health department websites or via internet searches. Public protocols dated between May 1, 2020 and September 30, 2020 were included in the study. We reviewed strategies for allocation and clinical use, including whether protocols contained explicit language on equitable access to remdesivir or mitigating health disparities.ResultsA total of 38 states had a remdesivir allocation strategy, with 33 states (87%) making these public. States used diverse allocation strategies, and only 10 (30%) of the 33 states included language on equitable allocation. A total of 30 states had remdesivir clinical use guidelines, where all were publicly accessible. All guidelines referenced recommendations by federal agencies but varied in their presentation format. Of the 30 states, 12 (40%) had guidelines that included language on equitable use. Neither an allocation strategy or clinical use guideline were identified (public or non-public) for 10 states and the District of Columbia during the study period.ConclusionsThe experience with the remdesivir EUA presents an opportunity for federal and state governments to develop transparent protocols promoting fair and equal access to treatments for future pandemics.
Highlights
During the coronavirus disease 2019 (COVID-19) pandemic, individual states have had some flexibility to customize responses for their local population
We identified remdesivir allocation strategies and clinical use guidelines for all 50 states in the U.S and the District of Columbia accessible on state health department websites or via internet searches
At the time the federal government began allocating remdesivir to states, over 50,000 Americans were hospitalized for COVID-19 [6]
Summary
During the coronavirus disease 2019 (COVID-19) pandemic, individual states have had some flexibility to customize responses for their local population. Following the Emergency Use Authorization (EUA) for remdesivir in May 2020 [1], transparency concerns about the federal government’s distribution strategy emerged [2, 3]. At the time the federal government began allocating remdesivir to states, over 50,000 Americans were hospitalized for COVID-19 [6]. All hospitalized adult and pediatric patients “with suspected or laboratory-confirmed COVID-19” met the eligibility criteria for remdesivir [7], potentially increasing demand further. The Emergency Use Authorization (EUA) of remdesivir for coronavirus disease 2019 raised questions on transparency of applied strategy, and how to equitably allocate and prioritize eligible patients given limited supply of the medication. The absence of federal oversight highlighted the critical role by states in health policymaking during a pandemic
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