Last week the Minnesota Department of Health (MDH) announced that it has switched to a scoring system that no longer considers race when determining which patients with COVID-19 should receive monoclonal antibodies. This change came on the heels of a threatened suit alleging unfair racial preference policies.
This purportedly "colorblind" decision is both disappointing and detrimental to communities of color across our state who have been disproportionately impacted by COVID-19 for nearly two years.
The harm of COVID-19 falls unequally due to structural racism. For example, a Minnesota state pandemic report this month showed that Black people, while comprising just 6% of Minnesota's population, were 11% of its COVID-19 hospitalizations in the prior week. White Minnesotans comprise 80% of Minnesota's population but shoulder a far smaller portion of COVID-19 hospitalizations and deaths.
Racialized impacts, highlighted in statistics like these, drove the Food and Drug Administration (FDA) just six months ago to declare it ethically appropriate to prioritize racial minorities for monoclonal antibody infusions. As recently as last week, the FDA urged health care providers to consider race or ethnicity as well as underlying medical conditions when classifying individuals as "high risk for progression to severe COVID-19 and qualifying for antibody treatment."
This equity-based approach recognizes that each person and each community has different circumstances, and it allocates resources and opportunities to reach a more equitable outcome.
It is the responsibility of our Minnesota public health system to address COVID-19's racial disparities by leading with equity. Meaning we must take an approach that confronts structural racism to help alleviate the unequal burden revealed over and over again in the data. MDH failed to center equity when they decided to go against federal recommendations and remove race in the decisionmaking process for priority access to monoclonal antibody treatment for COVID-19.
Tragically, we could see this coming. Health statistics throughout history have taught us to expect that inequities in COVID-19 would mirror the inequities we see in economic, educational and political opportunity in the U.S. and in our state. Data confirm that Black, brown, Indigenous and immigrant communities bear a disproportionate burden of COVID-19 illness and disability, and this unequal risk requires an appropriate public health response.
When data showed us that pregnant people who contract COVID-19 are at risk for poor outcomes, we prioritized pregnant people for monoclonal antibody treatment. Yet the same data led to a different decision for addressing racialized risk.
We support the rationale to protect the most vulnerable among us, which also extends to groups like people who are immunocompromised, older adults and individuals with conditions that increase the risk for severe COVID-19. And the statistics clearly show that this includes Minnesota's communities of color. As JP Leider explained to the Star Tribune, "There is no question that BIPOC [Black, Indigenous and People of Color] Minnesotans are dying of COVID-19 at higher rates and at younger ages compared to white Minnesotans." ("Race dropped as qualifier for monoclonals," Jan. 14.)
Health professionals have a duty to combat structural racism because structural racism is a threat to health. We have come together to combat the devastating toll COVID-19 has had on our state, country and world, and we must come together to address the pandemic of structural racism. Standing up against those who seek to undermine and undervalue the health of Minnesotans is good medicine; it is also a matter of fairness.
Our response to COVID-19 in Minnesota has highlighted the ongoing power of structural racism and its pervasiveness. Since the beginning of the pandemic, MDH has taken a "colorblind" age-based approach to testing and then to vaccine distribution. This approach inherently deprioritizes communities of color in Minnesota, within which life expectancies are shorter and thus the age distribution is younger.
Minnesota's communities of color are at greatest risk of harm, and our policies must prioritize access to all of the tools at our disposal to combat COVID-19, including vaccines, masking, social distancing, hospitalizations and treatments. Our policies should not compound the suffering of Minnesotan communities of color by ignoring the disproportionate impact of COVID-19. The data and the ethics are clear. Minnesota's COVID-19 policies must directly address inequities to promote racial justice.
Rachel R. Hardeman is Blue Cross Endowed Professor of Health and Racial Equity and founding director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health (Twitter: @RRHDr). Eduardo M. Medina is a family medicine physician at HealthPartners and Park Nicollet in Minneapolis and assistant professor in family medicine and community health, University of Minnesota Medical School (Twitter: @EmedinaEduardo).