A8 The BulleTin • Wednesday, March 31, 2021
EDITORIALS & OPINIONS
AN INDEPENDENT NEWSPAPER
Heidi Wright
Gerry O’Brien
Richard Coe
Publisher
Editor
Editorial Page Editor
Join the race to get
people vaccinated
I
t’s a race to get more COVID-19 vaccines in more people’s
arms. The winner will be all of us.
Vaccines won’t be the sole savior,
but getting more people vaccinated
should enable Oregon to get more
back to normal.
Among the caregivers at St.
Charles Health System 72% were
vaccinated for COVID-19 as of
Monday. That’s 3,058 who are fully
vaccinated. Another 49 have their
first shot.
More would be better. We’ll take it.
Mosaic Medical Clinic has managed
to get more than 90% of its primary
care providers vaccinated out of a to-
tal of 31. Let’s see the rest of Central
Oregon match that. Heck, let’s beat it.
Getting to herd immunity, where
enough people are immune to the
virus to stop it from spreading, won’t
be easy. It may require more than a
70% vaccination rate for the commu-
nity. And this is a race we don’t want
to lose.
There’s always going to be some
vaccine hesitancy. There’s hesi-
tancy among some caregivers at St.
Charles. There are going to be people
who will never be vaccinated. There
are people who should not be.
There are some things you can do
to encourage more people to get vac-
cinated. Talk about your plans to get
vaccinated. Post about it on social
media. That helps make it the thing
to do.
If you have concerns, talk to your
doctor. They know you, your medi-
cal history and they know about the
vaccines. The Oregon Health Au-
thority has a detailed list of questions
and answers about the vaccines here:
tinyurl.com/OHAfaq The Centers
for Disease Control and Prevention
has a good website here: tinyurl.com/
CDCcovidfaq.
In Deschutes County you can
pre-register for a vaccination even
if you are not yet eligible. Go to cen-
traloregoncovidvaccine.com to sign
up. Please sign up. Do it for yourself,
your family, your friends and the rest
of us.
Oregon must do more to
protect residents in
long-term care facilities
M
ore than half of Oregon’s
COVID-19 deaths oc-
curred in long-term care
facilities. It was more than 1,100
people as of late February.
Even if you take the pandemic out
of it, long-term care facilities in Or-
egon had 50 times as many flu out-
breaks as hospitals in the last five
years.
People who are in long-term care
are at high risk from communica-
ble diseases and Oregon needs to do
more about it. The Oregon Secre-
tary of State’s Office went looking for
answers and released a report this
month.
To be clear, long-term care includes
nursing, assisted living, residential
care, memory care communities and
adult foster care. If you want the de-
tails about the advisory report’s anal-
ysis of the background of the prob-
lems, the report is available online.
We want to focus on what the Or-
egon Department of Human Ser-
vices, the Oregon Health Author-
ity and the Legislature need to do.
The report recommended a host of
changes. There are basically three
components:
• Public reporting. Requiring
long-term care facilities to publicly
report the number and percentages
of residents and staff who have re-
ceived COVID-19 vaccinations. That
will, at least, create public pressure to
ensure the residents are protected.
• More monitoring visits by the
state. Looking into if the state needs
more people to monitor and inves-
tigate the performance of long-term
care facilities.
• Better tracking. Tracking perfor-
mance infection control, vaccinations
and emergency preparedness at the
facilities.
There are costs, of course. There
may also be pushback against some
of these suggestions. Public reporting
of vaccination rates and staff could
be resisted. When that change was
first implemented for schools in Or-
egon, there were concerns. But the
greater public transparency has led
to important improvements in un-
derstanding. For instance, although
statewide vaccination rates are high
for schools — around 90% — there
is considerable variation within indi-
vidual schools.
What are Oregon legislators go-
ing to do to ensure residents of long-
term care are better protected? It’s not
something the state can afford to con-
tinue to get wrong.
GUEST COLUMN
Consumers need more
reasonable drug prices
BY JOAN MORGAN AND MIKE NIELSEN
W
hen it comes to prescrip-
tion drugs, there are some
fundamental truths we
can’t deny: There’s no price someone
wouldn’t pay for medications that
would extend his or her life or the
lives of loved ones, AND there’s no
limit to how far pharmaceutical com-
panies will go to deny responsibility
for skyrocketing medications costs.
As you read this, Big Pharma is hit-
ting back against any effort to regulate
the industry. The companies are using
their unlimited funds — gained from
their out-of-control pricing — to run
advertisements and testify in Salem in
hopes of killing legislation that might
harm their highly profitable bottom
lines.
As consumers, we’ve personally ex-
perienced the ever-increasing costs
of prescription drugs. For instance,
Mavyret — a curative treatment for
hepatitis C — costs $13,200 for 84
pills. So $13,200 divided by 30 days –
which is roughly $440/day, or 3 pills
daily at $157/pill. Then there’s Gilotrif
(or Afatinib) — a life-saving cancer
drug. It costs $11,000 a month in Or-
egon for a 30-day supply. This same
drug — which costs $82 a month in
the Netherlands — was “only” $4,000
a month in 2018. That’s a 175% in-
crease in two years.
The truth is, not all of us have the
privilege of wealth or outside assis-
tance to afford drugs. Instead, Or-
egon’s most vulnerable populations
have to make dire sacrifices — de-
ciding between paying housing costs,
Letters policy: We welcome your
Editorials reflect the views of The Bulletin’s editorial board, Publisher Heidi Wright, Editor
Gerry O’Brien and Editorial Page Editor Richard Coe. They are written by Richard Coe.
letters. Letters should be limited to one
issue, contain no more than 250 words
and include the writer’s signature, phone
Morgan
Nielsen
buying food and other essentials, or
getting their medications. There is no
doubt that this way of living is detri-
mental to the health, safety and qual-
ity of life of all Oregonians.
There is a solution. The Oregon
Legislature is considering a package
of bills that would work together to
lower the cost of prescription drugs:
SB 763, SB 764, and SB 844.
SB 763 would lift the veil on drug
sale practices — requiring pharma-
ceutical representatives to register
with the state in order to market their
products. This would work to rein in
prescription drug costs by making
closed door meetings and financial
transactions transparent to Oregon
consumers.
SB 764 would prohibit a practice
known as “pay-for-delay” — in which
big pharmaceutical companies often
pay generic drug manufacturers to
delay distribution of medications at
a substantially lower cost. By passing
this bill, Oregon will ensure that less
expensive medications become avail-
able sooner. It will give our state the
power to take action against pharma-
ceutical companies that fail to comply.
number and address for verification. We
edit letters for brevity, grammar, taste and
legal reasons. We reject poetry, personal
attacks, form letters, letters submitted
Most importantly, SB 844 would es-
tablish an Oregon Prescription Drug
Affordability Board that would iden-
tify prescription drug products that
create affordability challenges; set an
upper payment limit for excessively
priced drugs; and penalize emergency
price gouging.
The pharmaceutical industry will
tell you that these are all radical ideas,
but our state already performs simi-
lar scrutiny on health insurance rate
increases – saving Oregon consum-
ers hundreds of millions of dollars in
unjustified premium increases over
the last decade. We believe it’s time
for drug prices to get the same level
of scrutiny. For far too long, pharma-
ceutical companies have played an
aggressive game of “Not Us” when it
comes to drug pricing, even though
the vast majority of drug prices start
with the price they set. We cannot let
them continue to exploit the lack of
regulation on their industry — pad-
ding their profits and forcing those
who need prescriptions to accept un-
affordable price increases or suffer
without those drugs.
The Oregon Legislature should do
the right thing for Oregonians and
pass SB 763, SB 764, and SB 844.
Joan Morgan is a health care worker and caregiver
for her father, who has late-stage lung cancer, and
her mother, who has Parkinson’s. She lives in Happy
Valley. Mike Nielsen is a Vietnam veteran and lives
in Bend. He spent a year working to secure funds for
medication for his wife, Jacki, who was diagnosed
with hepatitis C. Their submission is part of an effort
by the Oregon Coalition for Affordable Prescriptions,
affordablerxnow.org.
elsewhere and those appropriate for other
sections of The Bulletin. Writers are limited
to one letter or guest column every 30
days. Email: letters@bendbulletin.com
States must ensure COVID-19 vaccine distribution is done equitably
BY HARALD SCHMIDT, LAWRENCE
GOSTIN AND MICHELLE WILLIAMS
Special to The Washington Post
P
resident Joe Biden’s announce-
ment that all U.S. adults will
be eligible for coronavirus vac-
cines by May 1 is, in many ways, good
news. But opening the gates does not
mean that the debate about equitable
and fair allocation is over. Far from it.
To ensure equitable allocation and
mitigate the pandemic’s dispropor-
tionate impact on disadvantaged
communities, three things are cen-
tral: prioritizing more vulnerable
communities; conveying that doing
so is good for both public health and
equity; and making clear that equity
is not the enemy of efficiency. These
steps will matter as much once we
open up vaccine eligibility to the gen-
eral population as they do now.
State policies on who gets the vac-
cine have been the subject of much
controversy over the past few months.
Kitchen tables across the country
have featured a recurrent question:
“When is it my turn?”
By May 1, these questions will end.
At least 50 million people who were
not included in any of the previous
priority groups will qualify. But they
will be competing for doses against
those who were eligible for vaccines
earlier, and who, for one reason or
another, remained unvaccinated. This
includes people who wanted a vac-
cine but weren’t able to get one, as
well as those with reservations about
the injection. Surveys suggest this
group includes at least 30% of those
in all priority groups, or about 70 mil-
lion people.
In other words, at least 100 million
people will likely still not be vacci-
nated on May 1. Getting shots into
those arms will take time, and al-
though we will no longer have prior-
ity groups based on age or profession,
it is imperative to still prioritize those
for whom vaccines matter the most.
For many who have not yet been
vaccinated, waiting another month or
longer will be an inconvenience that
can be handled safely. But others will
continue to be at greater risk of the
virus and may no longer be able to
withstand the pandemic’s economic
impact. We also know that because
of structural racism, that latter group
will include much larger shares of
people of color, who not only lag be-
hind in vaccination coverage but also
have suffered far higher rates of un-
employment, infections and deaths,
as well as structurally curtailed eco-
nomic opportunities.
Data bear out that the worse-off
people are, the more dramatic the
consequences of COVID-19. A recent
study using the Social Vulnerabil-
ity Index — a measure developed by
the Centers of Disease Control and
Prevention that compiles a bunch of
factors (such as income, quality of
housing and education) into a single
score for a region’s overall vulnera-
bility — found that an increase of 0.1
point in the SVI score was associated
with a 14.3% increase in COVID-19
incidence and a 13.7% increase in
mortality rate.
Such disadvantage indices can and
should be used to guide allocations
within and across states. Encourag-
ingly, in a review we conducted with
colleagues in November, we found
that 19 states used an index such as
the SVI. By late January, this number
had increased to 29, allowing state
planners to identify where to place
vaccination sites; to tailor commu-
nication and outreach strategies so
that they are responsive to the specific
communities; and to monitor and
adjust allocations as needed to make
sure disadvantaged groups are not
left out.
Such data prove that promoting
equity and protecting public health
are flip sides of the same coin: Mean-
ingful herd immunity is not achieved
by simply vaccinating the largest
number of people, but by vaccinating
more of those people who are most
likely to get and spread the infection.
The increasing uptake by states is
promising, and hopefully will become
universal.
It also demonstrates the false di-
chotomy that equity comes at the
expense of efficiency. For exam-
ple, adjusting allocation quotas in a
spreadsheet so that disadvantaged ar-
eas receive larger amounts of vaccine
doses can be done in an instant. All
it takes is intentionality and attention
to details.
It is understandable that most peo-
ple take a first-person approach to the
pandemic. But the pandemic is not
just about us as individuals; rather, it
is about all of us as an interconnected
collective.
Twenty-eight states have already
expanded their eligibility to all adults,
or will do so before the second week
of April. Yet 17 of these states are be-
low average in terms of the popula-
tion share that has received vaccines.
And in general, vaccination rates
are lower in counties that have been
hit harder by COVID-19 and have
higher poverty rates or larger shares
of Black and Hispanic populations.
We all stand to benefit if those states
and regional health departments use
data to ensure, at minimum, that
vaccination rates among the nation’s
most vulnerable are not lower than
among the more privileged groups —
both for public health reasons and for
social justice.
Harald Schmidt is an assistant professor of medical
ethics and health policy at the University of
Pennsylvania. Lawrence Gostin is a professor and
director of the O’Neill Institute for National and
Global Health Law at Georgetown University Law
Center. Michelle Williams is dean of the Harvard
T.H. Chan School of Public Health.