what does advocacy look like in COVID time?

At a recent staff meeting, we were informed that Paxlovid, a new oral medication for COVID-19, is only available in 3 pharmacies in Allegheny County. We were given criteria to identify the appropriate patients who would benefit from Paxlovid, etc. A colleague mentioned that she is concerned about equity and that our most vulnerable patients won’t have access to this medication. The response is always lukewarm–yes, we should think about how to improve access, etc. When you have a medication that is in short supply, you have rationing, you will increase disparities in access, in treatment, in outcomes. Inequity is built into the process. The logistics of supply & distribution should be designed with equity in mind. In addition to risk factors that would make a patient a good candidate for this medication such as age, CKD, liver disease, smoker, immunosuppressive treatment, we could add social risk factors such as lack of transportation, no social support, homelessness, etc. Should the State have a protocol where a patient with COVID symptoms call a hotline if s/he has no PCP and no way to get to a clinic so that a medical personnel could be dispatched to do inhome testing and dispense medications as appropriate? Too luxurious, too costly you say? who will do it? The patient can always wait until s/he is sicker and call 911 and get admitted to an ICU? What about preferential distribution to FQHCs and free clinics that serve a particularly vulnerable patient population? In meetings when we discuss new protocl, procedure, as a physician and “frontline worker,” I am inheriting the adverse downstream inequitable policies from someone higher up in the chain of command–our state and federal government, the drug company? I often teach my students to go upstream to address social determinants of health but we don’t often rise up in disgust, call, write, post (well I’m posting now). Addressing social needs and SDH is not enough, we have to tackle the political and economic determinants of health.