Maximizing the Benefit of COVID-19 Therapeutics: Considerations for State Public Health Officials

COVID-19 therapeutics offer a critical tool for mitigating COVID-19’s impact on individuals and communities at risk of severe disease and mortality, as well as for reducing the potential impact of future COVID-19 surges on the health system, economy, and communities. COVID-19 therapeutics include monoclonal antibodies (mAbs) and antiviral therapies. These therapeutics have proven effective in reducing hospitalization and death, though new data show some therapeutics have reduced efficacy against Omicron BA.2. The effectiveness of currently distributed (as of mid-April 2022) COVID-19 therapeutics depends on timely provision either prior to exposure (in the case of Evusheld) or within 5-7 days of symptom onset, depending on the therapeutic. The Biden Administration’s National COVID-19 Preparedness Plan includes a nationwide Test to Treat initiative to improve rapid access to oral antiviral therapies. State strategies to facilitate reliable access to testing and treatments will be critical now and in the future to support equitable therapeutic access and uptake.

While states have implemented many strategies for improving equitable testing and therapeutic access, systemic inequities such as limited pharmacy or primary care access continue to prevent historically marginalized populations from receiving therapeutics at rates proportional to COVID-19 cases and mortality. Focusing exclusively on health systems as points of distribution means that many historically marginalized populations may lack access to therapeutics. Reducing inequities in therapeutic access by race, ethnicity, primary language, and socioeconomic status, as well as improving outcomes for individuals with underlying medical conditions associated with a higher risk for severe COVID-19, requires focused efforts to increase the amount of testing and therapeutic resources available to communities experiencing greatest risk; engage and educate providers and communities with current information on therapeutic availability, safety, and eligibility to facilitate utilization; and decrease barriers to testing and therapeutic access through one-stop Test to Treat models or community-based models that extend the reach of conventional health systems.

Effectively deploying COVID-19 therapeutics requires public health officials to navigate shifts in therapeutic supply and demand, logistical challenges in allocating mAbs and antivirals as well as co-locating therapeutics and testing resources, and systemic barriers that have led to underutilization by historically marginalized populations who continue to experience greater risk of severe consequences from COVID-19. This challenge is especially relevant due to greater uncertainty regarding support for these programs when the public health emergency ends. The Duke-Margolis Center for Health Policy and the Association of State and Territorial Health Officials (ASTHO) interviewed state public health officials and reviewed publicly available materials to understand promising approaches to maximize the benefit of therapeutics. This brief highlights promising strategies and considerations to address current challenges in therapeutic distribution and improve timely and equitable access. Common strategies emerged to reach communities who may benefit the most from rapid access to therapeutics. These strategies include:

• Directing therapeutic resources to communities and individuals experiencing highest risk of severe disease.
• Supporting rapid Test to Treat care pathways and reducing barriers to care.
• Increasing provider capacity and awareness of COVID-19 therapeutics.
• Engaging communities and improving public awareness of COVID-19 therapeutics.

ASTHO Authors

Marcus Plescia, Chief Medical Officer

Jessica Baggett, COVID-19 Response Director