A Proposed Lottery System to Allocate Scarce COVID-19 Medications | Clinical Pharmacy and Pharmacology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

A Proposed Lottery System to Allocate Scarce COVID-19 MedicationsPromoting Fairness and Generating Knowledge

Educational Objective
To understand how implementing a lottery system to allocate scarce COVID-19 medications can help us learn more about the disease and potential treatments
1 Credit CME

On May 1, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization for the unapproved drug remdesivir to treat hospitalized patients with severe coronavirus disease 2019 (COVID-19). The authorization was based on a preliminary report from a randomized clinical trial in 1063 patients that found that remdesivir shortened the median time to recovery from 15 days to 11 days.1 Anticipating immediate worldwide demand, the maker of remdesivir, Gilead Sciences, donated 1.5 million doses of remdesivir to countries affected by the pandemic, including the US, which received 607 000 doses (enough to treat approximately 100 000 patients). However, the US and other countries have 2 major problems related to this drug. First, the supply of remdesivir is insufficient to treat all eligible patients, which has required hospitals to ration the drug.2 Second, there remain major gaps in knowledge about the efficacy of remdesivir, including whether it reduces mortality and what subgroups of patients may benefit the most.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Douglas B. White, MD, MAS, Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Scaife Hall, Room 608, HPU010604, Pittsburgh, PA 15261 (douglas.white@pitt.edu).

Published Online: June 24, 2020. doi:10.1001/jama.2020.11464

Conflict of Interest Disclosures: Dr White reported receipt of personal fees from the American Thoracic Society and UpToDate Inc. No other disclosures were reported.

Funding/Support: Dr White received funding for this work from National Institutes of Health grant K24 HL148314.

Role of the Funder/Sponsor: The National Institutes of Health had no role in the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication.

References
1.
NIH clinical trial shows remdesivir accelerates recovery from advanced COVID-19. National Institute of Allergy and Infectious Diseases website. Published April 29, 2020. Accessed June 1, 2020. https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19
2.
Evans  M , Walker  J . Hospitals are rationing remdesivir. Wall Street Journal. Published May 22, 2020. Accessed June 16, 2020. https://www.wsj.com/articles/location-plays-big-role-in-patient-access-to-first-covid-19-drug-11590157424
3.
Li  L , Zhang  W , Hu  Y ,  et al.  Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial.   JAMA. Published online June 3, 2020. doi:10.1001/jama.2020.10044PubMedGoogle Scholar
4.
Dunning  T .  Natural Experiments in the Social Sciences: A Design-Based Approach. Cambridge University Press; 2012. doi:10.1017/CBO9781139084444
5.
Ison  MG , Wolfe  C , Boucher  HW .  Emergency Use Authorization of remdesivir: the need for a transparent distribution process.   JAMA. 2020. doi:10.1001/jama.2020.8863PubMedGoogle Scholar
6.
Angrist  JD .  Lifetime earnings and the Vietnam draft lottery: evidence from Social Security administrative records.   Am Econ Rev. 1990;80(3):313-336.Google Scholar
7.
Yoshioka  A .  Use of randomisation in the Medical Research Council’s clinical trial of streptomycin in pulmonary tuberculosis in the 1940s.   BMJ. 1998;317(7167):1220-1223. doi:10.1136/bmj.317.7167.1220PubMedGoogle ScholarCrossref
8.
 Streptomycin treatment of pulmonary tuberculosis.   Br Med J. 1948;2(4582):769-782. doi:10.1136/bmj.2.4582.769PubMedGoogle ScholarCrossref
9.
White  DB , Schmidhofer  M , McCreary  M ,  et al. A Model Hospital Policy for Fair Allocation of Scarce Medications to Treat COVID-19. Published May 28, 2020. Accessed June 5, 2020. https://ccm.pitt.edu/node/1133
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close