Stark disparities in the impact of the COVID-19 pandemic on minority populations in the U.S. have sparked a partnership between Gilead Sciences Inc. and Atlanta's Morehouse College to dig deeper into the data and expose the cause and extent of the inequality in real time.
"The whole of Black America wasn't surprised when they learned that COVID was striking disproportionately in the Black community," said Daniel Dawes, director of Morehouse's Satcher Institute, in an interview.
Gilead agreed at the end of July to fund the institute with $1 million to develop a health equity data platform to further investigate the effect that COVID-19 and other crises have had on communities of color.
Earlier research has demonstrated the initial impact of the pandemic in some areas, including in cities like Richmond, Va., and Milwaukee, Wis., where Dawes said every person who died from COVID-19 in the beginning was Black.
"It showed us exactly what we thought we'd see," Dawes said. With big data becoming more accessible through technology, Dawes said the time is right to form a more concrete understanding of systemic racial inequalities inherent in U.S. healthcare.
The Satcher Institute and Gilead have convened a group of people representing civil rights organizations to collect and report data disaggregated by race and ethnicity to lead healthcare policy into addressing the issue more fully.
"This is 2020 — we have the technological capability, and we know that we have this track record of not addressing these entrenched inequities," Dawes said. "We said enough is enough."
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"What we want to do is not only track the inequities relative to COVID-19, but be able to track when folks present to hospitals, whether they're receiving the care they need," Dawes said. "Are they able to get an ICU bed? If they get a bed, do they have access to remdesivir and other treatments? A ventilator? We want to understand the equitable distribution and what communities of color have access to."
"The whole of Black America wasn't surprised when they learned that COVID was striking disproportionately in the Black community." — Daniel Dawes, director of Morehouse's Satcher Institute
Often, the same people are affected disproportionately: "Black individuals, Native American individuals, immigrant communities, people with disabilities," according to Dawes.
"It's not until after the event, once that pandemic or epidemic subsides, that we realize who's on the downside of advantage and opportunity," Dawes said. "It's the same groups, and so one of the issues we recognized was it seems to us there's a problem with getting that data in real time."
In the past, policy makers have made the case that they are not quite sure who is most impacted by a health crisis, and "they always made the excuse" of not having enough evidence to align resources with communities that were being most affected, Dawes said.
An article published in the Journal of the American Medical Association in August showed that in 12 U.S. states, the percentage of hospitalizations of Black people substantially outweighed their representation in the population.
A study from Johns Hopkins University similarly showed that African Americans in Milwaukee County make up 70% of deaths due to the coronavirus, but they are 26% of the county's population.
Part of equal opportunity for all is ensuring access to quality care for minority populations, including access to treatments and future vaccines proportionate to the impact the pandemic is having on those communities, Dawes said.
Satcher Health Leadership Institute Director Daniel Dawes
Source: Satcher Health Leadership Institute
Gilead Executive Director of Community Engagement Douglas Brooks
Source: Elizabeth Taylor AIDS Foundation
Tackling a systemic access problem
The ultimate goal of the Gilead-Morehouse partnership is to amass further evidence that could lead to policy changes providing resources and support for communities of color, Gilead's Executive Director of Community Engagement Douglas Brooks said in an interview. Brooks spent two years in the Obama administration as director of the Office of National AIDS Policy, a disease that also disproportionately affects minority groups in the U.S.
Gilead specializes in drugs to treat and prevent infectious disease like AIDS and hepatitis C. Brooks said the company sees the effort to reduce healthcare inequity as a worthy investment to address communities affected by those diseases in addition to COVID-19. Additionally, Gilead's remdesivir was the first antiviral medication permitted under emergency use authorization in May to treat patients infected with the coronavirus.
Other big pharmaceutical companies have committed to exploring racial disparities in healthcare more generally in the wake of the COVID-19 pandemic. Bristol-Myers Squibb Co. invested $300 million to address health disparities, increase clinical trial diversity and increase representation of minority populations at the company.
"We have seen that when you invest in organizations that have good leadership and good, deep commitment and connection to their communities, well, lo and behold, they can make a difference," Brooks said. "And they can make more people aware of disease and prevention and help eliminate stigma."
Social determinants of health include not only pre-existing conditions such as asthma, heart disease or obesity, but the underlying social structures leading to their higher presence in Black communities and other minority populations.
"We know there are these structural conditions in which Black and brown folks live, where they're born and live and play, where they're educated and employed, that these all have a disproportionate impact on their health status," Dawes said.
Included in the research the Satcher Institute and Gilead have begun is a look into infrastructure, which includes urban planning and historical distrust and stigma surrounding a minority population's outlook on the health system.
"The policy is broken," Brooks said. "But a programmatic and structurally designed system can ensure that everyone has equal opportunity to get good quality healthcare."