Grant: Project Grant - PA: Pandemic Preparedness and Health Emergencies Research

The COVID-19 pandemic created an urgent need for effective therapeutics to treat hospitalized patients with severe COVID-19. In less than two years, new drugs were developed, and existing medications were repurposed to provide a range of treatment approaches: anticoagulation, antivirals, immune-modulators, and mono-clonal antibodies. These medications were demonstrated to be effective across a range of metrics: reducing the intensity of illness and duration of symptoms, reducing the need for ICU admission and ventilator use, and reducing mortality. However, many of these medications were in extremely short supply as there was intense global demand and only limited production capacity. The impact of drug shortages on the equity of inpatient care for patients with COVID-19 is unknown. Equity means getting the treatment you need when you need it. It is clear that marginalized populations have faced a disproportionate impact from COVID-19, and inequitable allocation of scarce COVID-19 therapies has already been established in the USA. In a Canadian context, there is a pressing need to understand how patient, physician, hospital, and regional factors intersected with inequity in medication use. Our aim is to investigate the equitable allocation of scarce COVID-19 therapies in GEMINI data from 30 Ontario hospitals representing ~60% of all adult medical/intensive care beds in the province. We will use these results to develop a novel ethical framework for when multiple drugs for the same condition are in short supply - a situation that occurred during the pandemic - and will evaluate our ethical framework using advanced simulation modeling. This research will support the ongoing management of COVID-19 as drug shortages persist due to global demand, supply chain disruptions, and variant-driven surges emerge. Equitable distribution policies will also be an essential part of supporting our already-strained healthcare system and preparing us for future health emergencies.