As Dr. David Relman commented in the 2020 Proceedings of the National Academy of Sciences, given the catastrophic severity of the COVID-19 pandemic, “…disturbingly, we still do not know how it began.” Recently, Frontline reported, “It’s not known whether the (Wuhan) market was where the virus first made the leap from animals to humans,” and a WHO expert team has been in China searching for answers.
Origin questions and concerns that variants could become more virulent and transmissible have led experts to call for acceleration of vaccinations and additional public health mitigation (e.g., distancing) to reduce viral replications and mutations. Noting that “…viruses cannot mutate if they don’t replicate,” Dr. Anthony Fauci has called nationally for quick, expeditious vaccination. Dr. Megan Ranney asserted, “…we are in an absolute race against time with these variants….”
Social Determinants of Health (SDOH) and COVID-19
The urgency is exacerbated by “inequities in the social determinants of health that increase the risk of death from COVID-19 for racial and ethnic minority groups,” including “…a consistent pattern of Black and Hispanic people receiving smaller shares of vaccination….” Missing data also obscure comprehensive identification of disparities. Thus, addressing SDOH is imperative for safely establishing community immunity.
2021: Tackling SDOH, COVID-19, Comorbidities
Below are just a few of the steps pharma, health plans, and integrated delivery networks (IDNs) can take to address SDOH adversely impacting the COVID-19 crisis and our “race against time.” Many of the examples pertain to COVID-19 and vaccination; the steps also apply to SDOH linked to comorbidities associated with worse COVID-19 outcomes.
- Develop a community-based strategic plan for addressing SDOH that includes safe door-to-door engagements. Given the rapidly evolving nature of the COVID-19 crisis, closing care gaps to minimize viral replication must assume primary strategic importance.
- Use analytics to assign social risk to populations and communities and develop logistical models that allocate medical and peer resources to “vaccine deserts” and communities with high comorbidities (e.g., diabetes).
- Establish patient-centric networks and apps to facilitate medical and peer referrals for in-home and community services. Using the West African Ebola experience as a paradigm, deploy peer, multilingual navigators and community health workers living within high-need communities to facilitate access to testing, vaccines, therapies, and clinical trials. The influence of social networks was illustrated with animated, graphic representations of the Framingham Heart Study.
- Extend the continuum. According to a PRECISIONvalue survey, health plans and systems are interested in collaborating with pharma to address access to medications, health literacy, food insufficiency, and COVID-19 vaccine support. Efforts can be augmented by community collaborations, including social, faith-based, business and government organizations. Consider service co-location (e.g., mobile vaccine administration with food pantries).
- The pandemic is abetted by an infodemic of misinformation/disinformation. One can draw upon lessons learned from the Ebola crisis and the history of advertising for messaging solutions and trusted messengers conveying authentic, altruistic commitment to public service.
Aggressive population health outreach to impact adverse SDOH represents a vital public health strategy to reduce disparities, comorbidities, and vaccination gaps. Moving with alacrity may require integrated networks of pharma, medical, community, government, and business, somewhat reminiscent of Framingham Massachusetts’ commitment to heart health, to reduce viral replication, mutation, and deaths, and reinvigorate the economy.