National supply shortages of COVID-19 antiviral pills have limited access to the potentially lifesaving drugs in New York, rekindling battles over rural medical deserts and racism in medicine waged throughout the pandemic.

As the highly contagious omicron variant infected thousands of New Yorkers daily, the statewide supply of the Pfizer and Merck antiviral pills currently covered about 34,000 patients, according to a USA TODAY Network New York review of federal data.

The state also has 9,200 courses of a monoclonal antibody treatment, called Evusheld, manufactured by Astra Zeneca, in its growing arsenal of drugs to combat COVID-19.

State policy distributed the prescription medication regionally based on population, but most doses went to pharmacies in cities and surrounding suburbs, leaving access gaps in many rural communities across upstate counties, the data show.

Meanwhile, authorities are racing to boost supplies of the antiviral pills, which gained federal emergency use authorization in December as a treatment to stop the progression of COVID-19 from mild to severe symptoms in people at high risk.

Nationally, the goal includes delivering the first 10 million treatment courses of the Pfizer pill by the end of June, federal officials said recently, adding the original deadline was September.

The federal government has purchased 20 million total Pfizer pill treatment courses, which have proven the most effective of the new antiviral treatments against COVID-19.

Gov. Kathy Hochul has urged the Biden administration to speed up distribution of the medications, saying she was “encouraged by the federal government’s actions to ramp up access to promising antiviral treatments” following a White House meeting Monday.

More: In a Rust Belt city split by inequality, New Yorkers are battling for health care justice.

What to know about COVID antiviral drugs and race, ethnicity

The COVID-19 antiviral medication rollout, in some ways, evoked memories of the early supply chain struggles for COVID-19 vaccines.

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Initially, the vaccines were limited to the elderly and frontline workers in early 2021. And as supplies slowly improved, millions of New Yorkers scrambled to book shots before drug makers caught up with demand.

Now, patients are competing over the scarce antiviral pills. But in New York and some other states, health guidelines for prioritizing access to the medications have sparked national debate over the role race and ethnicity should play in prescribing the drugs.

Central to the issue is a state Department of Health memo on Dec. 27, which advised medical providers in New York to consider various medical conditions and risk factors when prescribing the pills.

The memo in part noted: “Non-white race or Hispanic/Latino ethnicity should be considered a risk factor, as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19.”

A federal lawsuit filed last month by a Cornell University law professor, William Jacobson, asserted New York’s guidelines give “automatic priority to ‘non-whites’ and individuals with ‘Hispanic/Latino ethnicity’ in distributing life-saving COVID-19 treatment,” court records show.

In calling on the court to block the guidelines, Jacobson claimed: “New York’s use of racial preferences to distribute COVID-19 treatments violates the Constitution and numerous federal statutes.”

State health officials declined to address the ongoing lawsuit, but the agency in general asserted the guidelines advised health care providers to consider a number of health-based risk factors when providing the antiviral pills, according to Health Department spokesperson Erin Silk.

These are neither qualifications, nor requirements for treatments, Silk said in a statement, adding qualifying risk factors include a long list of medical conditions, as well as age and vaccination status.

Further, the inclusion of race and ethnicity as one of many risk factors to be considered is based on Centers for Disease Control and Prevention guidelines that show COVID-19 mortality rates are higher among certain demographic groups, including senior citizens, immunocompromised individuals and non-white/Hispanic communi
ties, Silk said.

“No one in New York who is otherwise qualified based on their individual risk factors will be turned away from life-saving treatment because of their race or any demographic identifier,” Silk added.

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How COVID-19 antiviral drugs are distributed in NY

The flow of new COVID-19 antiviral medications to New York is reported through a federal program tracking the Pfizer and Merck pills, called Paxlovid and molnupiravir, respectively.

The tally of COVID-19 drugs also included an Astra Zeneca monoclonal antibody treatment, called Evusheld, that is intended for people with weakened immune systems.

New York has about 62,000 treatment courses overall of the Pfizer and Merck pills and the Astra Zeneca drug, with about 43,000 courses available as of Wednesday, federal data show.

New York City has elected to receive its distribution of the Pfizer and Merck pills to one pharmacy that will do home delivery to all boroughs in New York City, state records show.

The rest of the state’s nine regions opted to have their doses delivered to pharmacies throughout their respective counties. Pharmacies were chosen based upon population density, as well as Medicaid population density, the records show. Hospitals and medical centers also received doses as part of the effort.

The mid-Hudson region’s tally of antiviral treatments as of Wednesday included:

• Westchester County’s total of about 2,100 courses, with 1,600 available.

• Dutchess County had nearly 1,200, with 740 available.

• Orange County’s tally of about 820, with 800 available.

• Rockland County had about 770, with 500 available.

In upstate, the antiviral treatment course breakdown included:

• Monroe County’s total of about 2,000 courses, with 1,000 available.

• Oneida County had 620, with about 450 available.

• Broome County had about 280, with 207 available.

• Chemung County had about 370, with about 360 available.

But some New Yorkers living in large swaths of upstate face hours-long drives to the closest pharmacies with available antiviral pills, the federal data show.

Other potential access hurdles include long-standing primary care deserts in some rural communities, which limit residents’ ability to obtain prescriptions.

Complex affiliations amongst health providers, health insurers and pharmacies could also influence who gets the pills, with large health systems historically wielding more power than small community-based providers.

White House COVID-19 Response Coordinator Jeff Zients noted recently that 15% of the Pfizer antiviral pills distributed nationally are going to community health centers. He said that would help ensure the drugs get to “those who are harder to reach, in more vulnerable locations, and that our response is fair and equitable.”

The state Health Department also worked with local officials to identify pharmacies to include the effort, Silk said, adding some sites were readjusted after discussion with local county commissioners and public health directors.

Two other monoclonal antibody drugs have proven effective against the omicron variant but remain in far shorter supply. Several drugs that were used earlier in the pandemic have also since proven ineffective against omicron and lost federal approvals.

USA TODAY Network contributed to this report.

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached at drobinson@gannett.com and followed on Twitter: @DrobinsonLoHud

This article originally appeared on New York State Team: COVID antiviral pills in NY: What to know about supply shortages