Achieving Widespread COVID-19 Vaccination, Part Two

Show Notes

Although the COVID-19 vaccine rollout has had a successful start, major health inequities still exist in vaccine access for underserved communities and underrepresented minorities. 2 million Americans are being vaccinated a day, but less than 20% are underrepresented minorities. In this episode, guest host Claire Winiarek sits down with Dr. Elena Rios, President and CEO of the National Hispanic Medical Association (NHMA), and Dr. Sree Chaguturu, Senior Vice President and Chief Medical Officer of CVS Caremark. Claire, Dr. Rios, and Dr. Chaguturu discuss the unique social determinants for why these inequities exist, why it’s important to reframe COVID-19 vaccination campaigns for specific demographic groups, and how PBMs are working to educate underserved populations on the safety and efficacy of the COVID-19 vaccine. 

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Claire Winiarek (00:09):
Welcome to the Pharmacy Benefit, a podcast that highlights the role of PBMs in serving millions of patients and consumers throughout the country. I'm Claire Winiarek, sitting in for JC Scott.

Claire Winiarek (00:19):
Because issues surrounding the equitable distribution of the COVID-19 vaccine rollout are so timely and deeply important we want to make sure we're giving them the attention and focus they deserve. That's why we're going to continue our conversation today with two guests working very closely on issues of healthcare disparities and vaccine access.

Claire Winiarek (00:38):
Joining me are Dr. Elena Rios, president and CEO of the National Hispanic Medical Association, and Dr. Sree Chaguturu, Senior Vice President and Chief Medical Officer at CVS Caremark. We encourage our listeners, if you haven't done so yet, to go back and listen to our last episode. For now, let's continue.

Claire Winiarek (00:57):
Elena, through NHMA's work, including the Vaccinate For All campaign, you mentioned trusted messengers in particular, and you mentioned this concept of all families should be vaccinated and going to the vaccination sites together. Did the themes that Sree has shared resonate with what you have heard and what you've been hearing? And how can we double down on some of this really effective messaging?

Elena Rios (01:24):
Yes, I have to agree with Sree. I think the importance of being transparent about the vaccine development. People know that we fast tracked these vaccines. Project Warp Speed was all over the media. What people don't realize is how much clinical studies were done. 40,000 people from Pfizer, 40,000 people from the Moderna, and 95% effectiveness. That outstanding metrics and people have to understand there were no deaths, and there was over sampling of the populations that have the health equity issues, the blacks and Hispanics and Native Americans.

Elena Rios (02:08):
I do think that safety, efficacy, is very, very important to convince people that these new vaccines can take care of this new virus. It's just, everybody thinks it's new. I also think the other important concept that people don't hear enough of is that it's free. It's a free vaccine. And also that there will be more and everybody's going to get vaccinated. All adults right now are going to get vaccinated, it's just a matter of waiting your turn for an appointment. Knowing that the vaccine is only good for so many hours, so there has to be an appointment process.

Claire Winiarek (02:53):
Let's turn to some of those practical barriers. We have used this really effective messaging to help build confidence, and trust, and understanding in the vaccine, but still, and Elena, you articulated these so well, we still have other barriers, including technology, that have particular ramifications for underserved communities. What can we do to help address those barriers?

Elena Rios (03:21):
One thing is, everybody has cell phones, and I think that phone calls and text messages would work a lot more than having to go to websites that are complicated and where you need a big screen to find all the buttons.

Elena Rios (03:38):
The other thing I think, for the Hispanic community, is there is a fear of immigration still, especially because of the public charge law that was put, or I guess it was not a law, but the public charge was changed so that many, many people that even had green cards were feeling that they were going to get deported because of the public charge change that said that if you were using Medicaid or housing vouchers or even food stamps, the SNAP program, that you might be considered a public charge and that you would be deported, even for people that have been paying taxes and working here for years.

Elena Rios (04:17):
Let alone the US/Mexico border on the news and having more problems that have to be dealt with by the new administration, I think that people are still fearful that immigration is a front and center issue. And in some places where there is less sensitivity to people, there's more fear.

Elena Rios (04:41):
I thin to get rid of that is, again, the messages have to be that there's a very much a privacy issue when the pharmacies and the places of vaccination sites and the people that are trained to be able to get just basic information to follow the patient, make sure they get their second dose if they're getting a two dose vaccine, and that there won't be any problems with privacy or trust in terms of that, in terms of being deported.

Elena Rios (05:11):
I guess the other issue is language and having people at vaccination sites be aware of people with different languages. But I think that in the public health world, there's always been a focus on access to the poor and hopefully we'll learn from that as we move into all these different places to get vaccines, the mobile clinics, the pharmacies, the mega clinics put up by FEMA.

Elena Rios (05:39):
I know that there's a lot more emphasis right now on getting more jobs for community health workers, not just the clinicians, but for people within the public health arena, to be able to give vaccines and help with expanding the success of the effort to get more people vaccinated faster.

Claire Winiarek (05:59):
Sree, similarly, you mentioned the ongoing research that CVS has been conducting, the surveys, you've done multiple variations of these, and no doubt you're learning more with each round. And of course, we've got a changing population to be vaccinated, we're reaching certain communities and not others, as you said so well early on, that less than 20% of those that have been vaccinated are from underrepresented minority communities. How are PBMs, plan sponsors, and others, evolving their own outreach and support approaches to meet the next community that we haven't yet reached?

Sree Chaguturu (06:40):
Ongoing data collection, and by data collection, it's looking at internal PBM data and understanding who's been vaccinated, helping plan sponsors to understand uptake rates, being able to support plan sponsors, health plan employers, with the appropriate messaging that they can use to help educate their own members, these are all critical pieces that PBMs can play.

Sree Chaguturu (07:05):
At CVS Caremark, we'll continue to do our ongoing surveys to understand the changing trends. And even earlier in this conversation, I talked about how rapidly sentiment has changed in three, four short months, and we'll continue to see that changing over time. So this is important to have a trusted partner for plan sponsors in being able to navigate this rapidly changing environment.

Sree Chaguturu (07:33):
We also talked about the importance of understanding safety and efficacy, and PBMs are very closely monitoring drug pipelines, the rigor of what they do. And so our ability to look at clinical data, and at CVS Caremark we have spent a significant amount of time working with the manufacturers to understand the clinical trials and the implications for plan sponsors and what the different trials demonstrate, which, to Dr. Rios' point, are all uniformly showing safe and effective.

Sree Chaguturu (08:12):
In addition to that, we are seeing real world evidence. So we had 40,000 people that were in these trials, 40 to 50,000, we now have 50 plus million people who've been vaccine in this country, and millions more across the globe. So we're seeing this not only in trials, but in real world evidence. And being able to help plan sponsors in that storytelling is really important as well.

Claire Winiarek (08:35):
We're learning so much. I think Elena and Sree you've we've both shared this. We're learning as we embark on these campaigns and these outreach initiatives, as we talk with individuals and families about their vaccination experiences and, pre-vaccine, what their concerns are.

Claire Winiarek (08:51):
I'm curious, Elena, what is increasingly top of mind for you as we look at what we know, what we're learning, what has been done, what can be done? You mentioned the public charge rule and how that's been rescinded, and that's been a helpful step in addressing some of those concerns. What more do you think can and should be done, whether through public policy or just practical on the ground public health efforts?

Elena Rios (09:19):
Well, I think the importance of clinicians working together in an interdisciplinary approach, and also I think our students, medical students, pharmacy students, nursing students, we have a wealth of excitement about COVID-19. We're living through history as clinicians, and I do think that helping with the vaccine effort is important, whether it's students or clinicians or our community health workers just helping to get the patients to the pharmacies or to the onsite vaccination where they can get vaccinated. In other words, more local community approaches.

Elena Rios (10:05):
I would hope that the Biden administration understands the importance of having more jobs created at the local levels that I think are important to expand the public health infrastructure that we have not paid attention to for decades. Public health clinics have been closed down and public health has remained pretty much just a surveillance institution, whereas the pharmacies have taken over.

Elena Rios (10:36):
We're talking about CVS here, and I think it's important to know that CVS has done a great job with educating people, pharmacists get trained to talk to the patients, and I think more patients welcome that, having more local out of the doctor's office exchange of lifestyle information, nutrition, and being able to have a better quality of life. I think everybody wants that, but some of our communities, they're so busy working a couple of jobs and taking care of all their children, they don't have time to take care of themselves, and so I think that the whole mindset needs to change that health is in the community. To be healthy you have to be better able to care for yourself and get information about health in the community and the pharmacy, or in the gym, in the schools for families to learn from their kids at school. I think that's what we're going to see, and I think that's what's really needed. Giving vaccinations is really a teaching moment for these families.

Claire Winiarek (11:39):
We certainly are. We are seeing just how essential our public health infrastructure is. And of course, local partnerships as well. Sree, similar question to you, what is increasingly top of mind for you as we look at what we've learned and what's to come, particularly as we address some of these health disparities that have really become... They were always there, of course, but they've become so much more visible, and wonderfully so, now we can take action on them in a more meaningful way. What is really top of mind for you as we look forward, based on what we've learned and seen to date?

Sree Chaguturu (12:15):
Healthcare is increasingly becoming local, and I think Dr. Rios very well articulated out the need for us to have access points to healthcare locally. And as we think about CVS Health's footprint, we have nearly 10,000 retail locations, of which 85% of the population is within 10 miles of a CVS pharmacy.

Sree Chaguturu (12:39):
When we look at where those pharmacies are located, they are equally distributed across the CDC's social vulnerability index, so we see an even split by quartile. And then what's important is that the workforce is a diverse workforce, and our pharmacists and pharmacy technicians, 40% of our pharmacists are people of color, over 50% of pharmacy technicians are people of color, largely from the neighborhoods that they are working in. And so that's important to be located in the community and people who are from the community working in those locations that can understand the needs.

Sree Chaguturu (13:17):
We have, over the course of the pandemic, have recognized new ways of having to deliver care and to be able to provide benefit continuity for individuals given the disruption in traditional ways of providing care. So if we think about the specific roles of PBMs, it's been to promote mail, to promote 90 day fills of chronic disease medications at CVS, and to maintain the drug supply chain at CVS Caremark. Early on the pandemic, we made a number of changes to ensure that continuity of care.

Sree Chaguturu (13:52):
Then moving forward, it's how do we make sure we take those lessons about providing continuity of care for chronic disease management, so beyond COVID, but also ensuring that knowing that the pandemic is, unfortunately, far from over and looks like we will have continued community transmission for months and maybe years to come, at least through 2021 and well into 2022, ensuring coverage and accessibility to testing and vaccines will continue to be important.

Sree Chaguturu (14:27):
There's a lot of lessons learned here, Claire, and I think it will be tragic if what we have just gone through is not a charge for all of us to learn and be better and to make sure that that excellence we talked about at the top of this call is available to all.

Claire Winiarek (14:46):
I think we have really talked through so many essential questions and issues, but there's much more that we could discuss and spend time on, but we'll wrap it there for today. I just want to thank you both so much, Elena and Sree, for your time today.

Claire Winiarek (15:04):
Of course, as a reminder to all of our listeners, to find out more about what PBMs are doing to help Americans get vaccinated, please visit pcmanet.org. We'll also post the links to the Vaccinate For All campaign that Elena mentioned in the show notes, as well as links to the CVS analysis so that you have those resources to support your own work.

Claire Winiarek (15:25):
Of course, thank you all for listening. I encourage you to subscribe to the Pharmacy Benefit and download all of our podcast episodes, so you can do that on Google Podcasts, Apple Podcasts, or wherever you find your favorite podcast. I'm Claire Winiarek. Thanks for joining me.