Inclusion of Minority Communities in COVID-19 Antiviral Drug Trials from 2020–2023

Abstract

Minority representation in clinical trials matters because it ultimately affects health outcomes. In many instances, there is an overrepresentation of minority populations in Phase I, but they are vastly underrepresented in the subsequent phases. However, with the onset of the novel coronavirus in recent years, there is still more to be explored about the demographics of those clinical trials, especially considering that the impact of the COVID-19 pandemic has been more severe for communities of color. My paper addresses minority representation in COVID-19 drug trials, specifically for the drugs molnupiravir (Lagevrio), nirmatrelvir-ritonavir (Paxlovid), and remdesivir (Veklury). I searched the Clinicaltrials.gov database using parameters that led me to studies involving these drugs. I compared the results of 17 studies with findings from existing literature to evaluate representation patterns. I argue that clinical trials conducted during the pandemic were not more representative than trials that occurred in nonemergency times, and this is because of structural barriers that prevent people with fewer resources from accessing the same services and utilities as people with high resources. I analyze the issue of representation and flaws in the implementation of the NIH Revitalization Act, such as using race as a category in biomedical research. I advocate for a shift toward addressing structural issues rather than individual behaviors. Specifically, I suggest collecting socioeconomic status (SES) data to address the fundamental cause of health disparities.