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An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US

Educational Objective
To understand the ethical challenges of allocating scare impatient medications for COVID-19 patients
1 Credit CME

As researchers and drug manufacturers work tirelessly to find effective treatments for coronavirus disease 2019 (COVID-19), the media and the public await any report of a promising therapy. The antiviral drug remdesivir recently received Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA) for treatment of COVID-19. Many other new or existing therapies are under investigation, and the FDA has committed to expedited approval of proven new therapies. With patients and clinicians desperate for effective treatments, each new therapy will be in high demand. The need is projected to exceed the available supply, even as manufacturers strive to increase production,1 and shortages may be exacerbated by distribution problems and new waves of disease in the pandemic. When there is not enough of a new therapy available, frontline clinicians will need to rapidly identify which patients should receive it.

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Article Information

Corresponding Author: Bernard Lo, MD, The Greenwall Foundation, One Penn Plaza, Ste 4726, New York, NY 10119 (bernardlo@greenwall.org).

Published Online: May 15, 2020. doi:10.1001/jama.2020.8914

Conflict of Interest Disclosures: Dr DeJong reports being deposed as an expert witness in a 2018 legal action pertaining to drug and device industry marketing to physicians. Dr Chen reports employment by the California Health and Human Services Agency (CHHS) as Deputy Secretary of Policy and Planning and Director of Clinical Affairs. Dr Lo reports serving as an unpaid ethics consultant to Gilead Sciences.

Disclaimer: The opinions represented in this article are not representative of CHHS or the state of California.

Additional Contributions: We thank Laurie Dornbrand, MD, for her expert editing of the manuscript.

References
1.
Working to supply remdesivir for COVID-19. Gilead. Accessed May 9, 2020. https://www.gilead.com/purpose/advancing-global-health/covid-19/working-to-supply-remdesivir-for-covid-19
2.
Bollyky  TJ , Gostin  LO , Hamburg  MA .  The equitable distribution of COVID-19 therapeutics and vaccines.   JAMA. Published online May 7, 2020. doi:10.1001/jama.2020.6641PubMedGoogle Scholar
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White  DB , Lo  B .  A framework for rationing ventilators and critical care beds during the COVID-19 pandemic.   JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.5046PubMedGoogle Scholar
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National Academies of Sciences, Engineering, and Medicine.  Crisis Standards of Care: Ten Years of Successes and Challenges. Proceedings of a workshop. National Academies Press; 2020.
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Owen  WF  Jr , Carmona  R , Pomeroy  C .  Failing another national stress test on health disparities.   JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6547PubMedGoogle Scholar
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Office for Civil Rights. Emergency preparedness resources for persons from diverse cultural origins. Accessed May 9, 2020. https://www.hhs.gov/civil-rights/for-individuals/special-topics/emergency-preparedness/diverse-cultural-origins/index.html
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Back  A , Tulsky  JA , Arnold  RM .  Communication skills in the age of COVID-19.   Ann Intern Med. Published online April 2, 2020. doi:10.7326/M20-1376PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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