Oregon has given most of its initial supply of Paxlovid, a promising new antiviral drug from Pfizer 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 in extremely limited supply due to the time it takes to manufacture it. Oregon had received just 680 doses of Paxlovid as of Tuesday.

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The federal government is allocating doses to states based on their population, and leaving it to states to decide how to distribute it.

This October 2021 image provided by Pfizer shows the company's Paxlovid pills, which U.S. regulators have authorized as the first pill against COVID-19. The take-at-home pill has the ability to help avoid the worst effects of the virus.

This October 2021 image provided by Pfizer shows the company's Paxlovid pills, which U.S. regulators have authorized as the first pill against COVID-19. The take-at-home pill has the ability to help avoid the worst effects of the virus.

Courtesy of Pfizer

Doses from the state’s initial allocation also went to five hospitals that serve as regional care hubs 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 24 sites in total received some doses.

The major health systems in the Portland metro area, Providence, Legacy Health, Kaiser Permanente, and Oregon Health & Science University did not receive any. OHSU’s outpatient pharmacy submitted a request for it last week but hasn’t received a response from OHA.

With the omicron wave sweeping across the nation, there are far fewer doses currently available than patients who might benefit from it, forcing states to make difficult decisions about allocation.

Rationing guidelines from the National Institute of Health recommend prioritizing patients who face the greatest risk factors for progression to severe COVID-19, including elderly unvaccinated adults and moderate to severely immunocompromised people, regardless of their vaccination status.

The U.S. Department of Health and Human Services, which provides the drug, is encouraging state health departments to be transparent about where the drug is going, and to post sites receiving it on their websites.

The Oregon Health Authority has shared a brief overview of its health equity focused plan online but has not publicly posted a list of all 24 sites that have received the potentially life saving drug. OPB initially received more information about the state’s distribution plan through a public records request.

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As additional doses become available in the coming weeks, OHA said it is planning to expand the list of hospitals receiving the drug and make it available to a small group of long term care “surge” facilities.

The drug, which received FDA emergency use authorization last month, was 89% effective in preventing hospitalization and death in high risk patients.

It is approved for people 12 and older, and has to be given within five days of symptom onset.

The state is prioritizing areas of Oregon with the largest burden of COVID-19 and targeting racial and ethnic minority groups that have been hit hard by the pandemic, according to OHA’s distribution plan.

“Community health centers serve everyone, regardless of your ability to pay, your immigration status, your insurance, or your status in life,” said Marty Carty, government affairs director at the Oregon Primary Care Association, the nonprofit representing the state’s 34 community health centers.

“When the state is thinking about how to equitably distribute, and targeting their health equity goals, community health centers is the absolute right way to do this.”

Carty stressed that the amount of the drug the centers have received is extremely limited, and that the organizations handing it out are short staffed and concerned publicity around the new drug could have a negative impact on their work. The clinics are not dispensing it on a first-come, first-serve basis.

Carty says community health centers, many of which offer testing, vaccination, 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 become so sick they need to be to hospitalized — and no longer qualify for the treatment.

About 40% of patients at community health centers are Black, Indigenous, or people of color. The COVID-19 test positivity rate for patients at community health centers has been about twice the state average, according to Carty.

Oregon’s targeted approach to distributing its limited supply contrasts with many other states.

New York, Virginia, Pennsylvania and Arizona sent all or most of their doses to commercial pharmacy chains. Tennessee sent all of its doses to Walmart pharmacies.

The federal government has separately allocated 15% of its doses to community health clinics in every state.

Three clinics in the Portland metro area will receive additional doses directly from the federal government: Multnomah County, Virginia Garcia Memorial Health Center and the Native American Rehabilitation Association.

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