Oregon has offloaded most of its first-line supplies of Paxlovid, Pfizer’s promising new antiviral drug to treat COVID-19, to community health clinics across the state. The clinics, also known as Federally Qualified Health Centers, provide primary care to low-income, uninsured, rural, and historically disadvantaged populations.
Nationwide, the drug is extremely limited in availability due to the time it takes to manufacture it. Oregon had received just 680 doses of Paxlovid as of Tuesday.
The federal government allocates doses to states based on their populations, leaving states to decide how to distribute them.
Doses from the state’s original allocation also went to five hospitals that serve as regional centers of care in more rural parts of the state: Peacehealth Riverbend in Eugene, Grand Ronde Hospital in La Grande, Salem Health, St. Charles Health in Bend, and Asante Three Rivers Medical Center in Grants Pass. The Oregon Health Authority says a total of 24 locations have received some doses.
The major health care systems in the Portland area, Providence, Legacy Health, Kaiser Permanente, and Oregon Health & Science University, did not receive any. The OHSU Ambulatory Pharmacy made a request to this effect last week, but has yet to receive a response from the OHA.
As the Omicron wave sweeps the country, far fewer doses are currently available than patients who could benefit, forcing states to make tough allocation decisions.
National Institutes of Health rationing guidelines recommend prioritizing patients at greatest risk factors for progression to severe COVID-19, including older unvaccinated adults and moderately to severely immunocompromised individuals, regardless of their immunization status.
The U.S. Department of Health and Human Services, which provides the drug, encourages state health officials to be transparent about where the drug is going and to post on their websites sites that receive it.
The Oregon Health Department has published a brief outline of its equity-focused plan online, but has not released a list of all 24 sites that have received the potentially life-saving drug. OPB initially obtained more information about the state’s distribution plan through a public records request.
As additional doses become available in the coming weeks, OHA plans to expand the list of hospitals receiving the drug and make it available to a small group of long-term care facilities.
The drug, which received FDA emergency use approval last month, was 89% effective in preventing hospitalizations and deaths in high-risk patients.
It is approved for people aged 12 and over and must be administered within five days of the onset of symptoms.
The state is prioritizing areas in Oregon with the greatest exposure to COVID-19, targeting racial and ethnic minorities who, according to OHA’s distribution plan, have been hard hit by the pandemic.
“Community health centers serve everyone, regardless of your ability to pay, immigration status, insurance, or status in life,” said Marty Carty, director of government affairs at the Oregon Primary Care Association, the nonprofit organization that represents the state’s 34 community health centers.
“If the state is thinking about how to distribute equitably and achieve its health equity goals, community health centers are absolutely the right way to do it.”
Carty stressed that the amount of drug the centers have received is extremely limited and that the organizations distributing it are understaffed, and that public awareness concerns surrounding the new drug could negatively impact their work. The clinics don’t serve on a first come, first served basis.
Carty says community health centers, many of which offer testing, vaccinations and a wide range of primary care, are well-positioned to identify people who might need the drug and get it to them before they get so sick they can need to be hospitalized – and no longer qualify for treatment.
About 40% of patients in community health centers are Black, Indigenous or Colored. According to Carty, the COVID-19 test positivity rate for patients in community health centers was about double the state average.
Oregon’s targeted approach to distributing its limited supply contrasts with many other states.
New York, Virginia, Pennsylvania, and Arizona shipped all or most of their doses to commercial pharmacy chains. Tennessee shipped all of its cans to Walmart dispensaries.
The federal government has separately allocated 15% of its doses to community health clinics in each state.
Three clinics in the Portland area receive supplemental doses directly from the federal government: Multnomah County, Virginia Garcia Memorial Health Center, and the Native American Rehabilitation Association.