The COVID-19 pandemic has exposed many of the cracks in our healthcare system. According to Maurie Markman, MD, MS, FACP, FASCO, President, Medicine and Science, Cancer Treatment Centers of America, COVID-19 disproportionately affects the elderly, those with comorbidities, and racial and ethnic minority populations, all of whom are more likely to have serious or fatal illness. At the 10th Annual Summit of the Association for Value-Based Cancer Care (AVBCC) in 2020, Dr Markman served as a co-moderator of a session about minority representation in clinical trials.
“The proportion of minorities in clinical trials [relative] to the proportion that is represented by the disease itself is not a small statistical difference, it’s a huge difference,” said Barry Fortner, PhD, Former President, Specialty Physician Services, AmerisourceBergen, and co-moderator of the session.
Tamar Thompson, MS, Vice President, US Government Affairs and Policy, Alexion Pharmaceuticals, and Chairman of the Board, Alexion Charitable Foundation, said that the historical mistrust between ethnic minority populations and the medical field is deeply rooted. Social determinants of health are directly linked to systemic racism, and progress in health disparities cannot be made until we confront the issue of trust between minority populations and the US healthcare system.
This mistrust toward the healthcare system has led to underrepresentation of minorities in clinical trials. Barbara Bierer, MD, Faculty Director, Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard, Cambridge, MA, noted that when studies have been done that examine the rates of participation in clinical trials among patients with cancer, the proportion of Hispanic and black patients who agree to participate is the same as the proportion of white patients.
The problem is that US patients of racial and ethnic minorities are not being asked to participate in clinical trials in the first place, Dr Bierer emphasized.
Andy Lee, MS, Senior Vice President and Head, Global Clinical Trial Operations, Merck, agreed that there is still a great deal to be done in reducing health disparities. Mr Lee is striving toward a more inclusive future for clinical trials, including mandating diversity training for his team and requiring that the clinical trials he is involved with have a strategic plan to include underrepresented populations, and he is working toward providing the tools and resources needed to achieve those objectives.