Prioritizing equity when resources are scarce: Innovating solutions during the COVID-19 pandemic

The coronavirus disease (COVID-19) pandemic has been particularly devastating for minority communities, with Black, Hispanic, and Indigenous people disproportionately affected by severe disease and death. In March 2020, the U.S. Department of Health and Human Services authorized emergency use of unapproved treatments for COVID-19. Around this time, early evidence had emerged suggesting the efficacy of the antiviral medication remdesivir for reducing the severity of COVID-19. It wasn’t until May 2020 that the U.S. Food and Drug Administration (FDA) passed an Emergency Use Authorization (EUA) in the hope that remdesivir might help turn the tide of the battle against COVID-19. However, the delay between the urgent need for remdesivir and its EUA put healthcare providers in the unenviable position of deciding which patients should receive the scarce medication. Uncertainty at that time was palpable, and while bedside providers awaited more robust clinical trials to identify who would most benefit, health systems were tasked with how to allocate remdesivir in a way that was fair, just, and equitable.