The worst public health crisis in a century has focused a harsh light on the inequities in our nation’s health care delivery. Washington, D.C., is a prime example. Throughout the COVID-19 pandemic, the District’s racial and ethnic minorities, elderly, and low-income communities have experienced more severe health effects and difficulty accessing health services.
Fortunately, a vital lifeline has helped fill these needs: local pharmacies, where many find services to protect themselves from the deadly virus and other health complications. But that very resource could be threatened when health authorities lift the COVID-19 public health emergency as soon as early January. Congress should take immediate action to ensure patients have long-term access to essential services provided by pharmacists, such as testing and vaccination for COVID-19 and other infectious diseases.
Here in D.C., income, housing, and transportation tell much of the story about the gaps in health access and equity. The median income for the District’s white households is $50,000 greater than that of Hispanic households and $40,000 more than that of Asian Americans. Over the past three decades, the city’s African American population has dropped nearly 20 percent as families move to more affordable areas. A larger percentage of Hispanic (34 percent) and African American residents (27 percent) than whites (14 percent) rely on public transit to commute to and from work, however, Hispanics and African Americans are underrepresented in neighborhoods near rail stops. These factors help explain why Hispanics and Asian Americans in D.C. show a significantly higher infant mortality rate and why African Americans in D.C. have the lowest life expectancy and highest prevalence of chronic disease conditions.
The prevailing disparities in our city have impacted health outcomes throughout the pandemic. Although African Americans comprise 45 percent of the D.C. population, they make up 75 percent of its COVID-19 deaths. Hispanic and Asian American people are at one and a half times greater risk of COVID-19 infection than White people, and Asian American, Hispanic, and Black people are about twice as likely to die from COVID-19 as their White counterparts. The largest proportion of African Americans in D.C. live in wards 7 and 8, which respectively have the highest and second highest area deprivation index, a multidimensional measure of socioeconomic conditions linked to health outcomes. Nearly two-thirds (65 percent) of the District’s elderly residents identify as African American, making them disproportionately more vulnerable to serious COVID-19 infections and more reliant on available health care. The population of Hispanic Americans over 65 is expected to increase dramatically, from 8 percent in 2018 to 22 percent of the population by 2060, which will lead to the need for additional health services.
Pharmacists are essential in bridging barriers to care for these vulnerable communities in the District. Despite socioeconomic challenges, more than 91% of seniors in D.C. have received a COVID-19 vaccine, many of them administered by pharmacists. Beyond the challenges of a pandemic, pharmacists throughout D.C. help residents to manage diabetes, cholesterol, and other chronic ailments that require timely and accessible care.
Pharmacists established mobile vaccination sites to ensure equitable access to COVID-19 tests and vaccinations in medically underserved and economically disadvantaged communities in the city. These efforts have been important in reversing trends during the first months of the vaccination program when highly vulnerable areas had lower COVID-19 vaccine coverage than other areas.
Pharmacists are a trusted, reliable, and accessible source of care to the District’s most vulnerable and underserved communities and have answered the call to protect our neighbors from COVID-19. But when the public health emergency declaration for COVID-19 is lifted as soon as January, many patients who face socioeconomic barriers to care could be left in the cold. Pharmacists will no longer be authorized to provide critical services that those in D.C. and around the country rely on in an already overburdened healthcare system.
Congress has an immediate opportunity to advance health equity and protect patient access for older Americans by supporting H.R. 7213. This bipartisan legislation would preserve patient access to pharmacist services for Medicare beneficiaries, such as testing and vaccination for COVID-19, influenza, and other infectious diseases. This bill would also ensure Medicare beneficiaries maintain access to pharmacist-provided services during future public health emergencies. According to a recent national survey, four in every five older Americans want access to testing, vaccination, and treatment at the pharmacy during COVID-19 and other health emergencies.
Pharmacists in the District are not only a first line of defense for residents during challenging times, but also a trusted source of care and support to help them manage complex health needs. Lawmakers have an opportunity to ensure patients can continue to rely on local pharmacists for essential health services. H.R. 7213 represents a small but meaningful solution to improve equity and address longstanding health access challenges in the nation’s capital.
Michael Kim, PharmD, owns and manages multiple pharmacies in the District of Columbia and Maryland and is the President of the Washington D.C. Pharmacy Association. Juan Medrano, PharmD, was born and raised in the District of Columbia and practices at Giant Pharmacy in Columbia Heights. Medrano is the Immediate Past President of the Washington D.C. Pharmacy Association.