CHEST Guidelines-A-Novel-Approach-to-Equitable-Distribution-of-Scar

A-Novel-Approach-to-Equitable-Distribution-of-Scar

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In November 2020, monoclonal antibodies (mAbs) like bamlanivimab received emergency use authorization for treating COVID-19 in outpatients at high risk of severe disease. To promote fair distribution amid anticipated scarcity, Massachusetts introduced a reserve system prioritizing socially vulnerable patients for 20% of mAb infusions. This system was implemented by the Mass General Brigham (MGB) health system.<br /><br />The study examines the deployment of this reserve system, aiming to enhance equitable access to mAbs among vulnerable groups. The system involved a mixed approach of automatic and manual referrals for mAbs therapy based on patient eligibility and social vulnerability criteria. Eligible patients were entered into a lottery for appointment slots, with 20% reserved for those from high Social Vulnerability Index (SVI) areas.<br /><br />The retrospective analysis revealed that the reserve system led to a significantly higher proportion of socially vulnerable patients being offered and receiving mAb therapy compared to a pure lottery system. Specifically, 27% of patients offered therapy under the reserve system were socially vulnerable, compared to 19.8% under a non-reserve system. Though operational challenges existed, such as ensuring patients were made aware of and agreed to treatment, the system succeeded in improving access for socially vulnerable groups.<br /><br />The findings suggest that a reserve system with lottery components for distributing scarce therapeutics is viable when aiming to enhance access for disadvantaged groups. Despite the challenges, particularly in outreach and patient engagement, the approach helped align distribution more closely with the disease's social impact, demonstrating a pragmatic model for equitable healthcare resource allocation in crisis times. This approach could serve as a framework for future allocation of scarce medical resources, emphasizing the integration of social equity in healthcare delivery.

Keywords

monoclonal antibodies

COVID-19 treatment

emergency use authorization

Massachusetts reserve system

social vulnerability

Mass General Brigham

Social Vulnerability Index

equitable access

healthcare resource allocation

disadvantaged groups