Covid vaccines and antivirals are not enough

Because Covid cases and hospitalizations are no longer front-page news, many Americans might be surprised to learn that we are in the midst of a mini-surge.

The latest data from the Centers for Disease Control and Prevention, from Aug. 12, confirm a 21.6% increase in Covid-19 hospitalizations from the prior week and a 21.4% increase in Covid-related deaths, demonstrating that Covid is not over and that Latinos and Blacks have reason to be concerned.

Covid-19 devastated Latino and Black communities, exacerbating existing health and economic inequities that resulted in fatal consequences. In a survey by the health policy think tank KFF, Latinos, Blacks, and Americans with lower incomes were more likely to express concern about the White House ending the public health emergency than white Americans and households with higher incomes.

Health inequities in communities of color have persisted throughout the last three years. Even though Covid-related health outcomes improved as the pandemic progressed, critical health disparities contributing to high Covid mortality rates remain a serious concern in brown and Black communities.

Latinos, for example, are 19% of the population but account for more than 24% of Covid cases in the United States. When the CDC used weighted population distributions, Latinos comprised 33% of Covid deaths, highlighting the serious disproportionate impact of Covid on this community.

A new round of Covid vaccines is expected later this fall. Vaccines have been highly successful in saving millions of lives. Still, the status of Latino and Black communities three years after Covid suggests that a broader range of treatment and protection options is needed to deal with the continued impact of the disease on marginalized and vulnerable populations.

Prevalent chronic diseases, like diabetes, cancers, and heart disease, combined with poverty and lack of access to health care, further exacerbate higher Covid infections and deaths in communities of color. Addressing these underlying health inequities must be a priority of the national public health strategy to combat the impact of Covid.

So should consideration for a more comprehensive Covid treatment approach beyond vaccines and antivirals.

Despite their efficacy, there has also been a particularly polarizing public response to the Covid vaccines. Only 34% of Americans are fully vaccinated and boosted. And 20% of Americans have opted not to get vaccinated for various reasons. Latinos and Black Americans, in particular, have historically had a mistrust of public health authorities, and many are more likely to be wary of vaccines. Improving the Covid-19 vaccine uptake continues to be a critical line of defense against the virus, but safeguarding all Americans from Covid will require more than a vaccine-only approach.

In a recent letter to the Food and Drug Administration, national union leaders stressed that expanding treatment options for Covid is not only a work safety priority but is also a health equity concern, especially now that more workers, 40% of whom are people of color, are being asked to return to work. They urged the agency to expedite the approval process for new treatments, including monoclonal antibody treatments. The FDA had granted emergency authorization for five monoclonal antibody treatments. Unfortunately, their effectiveness has waned due to the rapidly mutating Covid variants, underscoring the need to develop a broad range of new, more resilient tools to prevent and treat Covid.

There is good news on that front: the Department of Health and Human Services announced Aug. 22 that as part of its Project NextGen, intended to accelerate a new generation of Covid tools and technologies to protect against Covid, it will invest $326 million in the development of monoclonal antibody therapies. While this is a very promising development, the amount represents only 7% of the initial $5 billion investment, announced by the Biden administration earlier this year, to accelerate the development of a new generation of vaccines and treatments to combat Covid.

Monoclonal antibodies, or mAB, were an effective treatment against Covid at first. Monoclonal antibodies are molecules that scientists develop in a lab and mimic the natural antibodies the body makes to fight against a virus or an infection, and have successfully eased Covid complications in immunocompromised patients. These therapies are also known to have a lower risk of interacting with drugs and are a good option for people suffering from chronic disease and taking multiple medications.

And given the disproportionate impact of the virus on minorities and other vulnerable populations, the CDC statistics demonstrate the need to prioritize even more funding for innovative treatments through “Project Next Gen” to combat Covid now.

Millions of Americans are unable to take antiviral medication. Paxlovid, the most common antiviral prescribed, effectively reduces the effects of Covid but is also known to interact with many medications used to treat a host of chronic illnesses.

Moreover, immunocompromised Americans tend to have a higher risk for severe Covid-related complications, and vaccines may not provide a viable option. Even if immunocompromised patients receive the vaccine, they may not get the same benefits from vaccines as people with a healthy immune system.

So, it is especially promising that the new strategy includes developing more durable and resilient monoclonal antibodies that can withstand new variants. Importantly, the success of this initiative will require that the agencies tasked with leading the project remain committed to investing resources in a strategy built to develop an array of vaccines and therapeutics in both the short and the longer term.

Considering Covid’s continued disproportionate effect on Latinos and other communities of color, success in combatting Covid also requires that these communities receive timely, culturally competent information about and equitable access to monoclonal treatment options as an alternative to vaccines.

Even as most of us return to our pre-Covid activities, recent CDC data shows that Covid hospitalizations and deaths have been trending upward this summer, and public health officials are tracking three new Covid-19 variants, further evidence that for millions of Americans, the threat of Covid remains.

Irasema Garza served as acting assistant secretary for policy at the U.S. Department of Labor under President Obama. Guadalupe Pacheco is the former senior health adviser to the Director of the Office of Minority Health in the U.S. Health and Human Services Department and managed OMH’s cultural competency and emergency preparedness portfolios.