Covid drugs: The GOP's new culture war

How race and identity are shaping politics, policy and power.

Jan 25, 2022 View in browser   By Brakkton Booker, Alice Miranda Ollstein and Megan Messerly With help from Rishika Dugyala, Marissa Martinez and Teresa Wiltz A doctor holds a Regeneron monoclonal antibody infusion bag during a news conference in August 2021 at a Florida hospital. | Joe Cavaretta/South Florida Sun-Sentinel via AP, File What up Recast family! Some 8,500 U.S. military personnel are on heightened alert, ready to deploy to Eastern Europe as fears of a Russian invasion of Ukraine appear imminent. A federal court blocks Alabama's proposed redistricting map and President Joe Biden apologizes for calling a Fox News reporter "a stupid son of a bitch." But we kick things off with the fight over race and access to a scarce coronavirus therapy.  A new battle in the political culture wars is taking shape.   The latest front is over recommendations that allow physicians to consider the race or ethnicity of a patient when deciding who can receive a hard-to-get drug to treat Covid. People of color may be at higher risk of severe Covid-19. Conservatives argue the fact that race is even a consideration when deciding how to allocate scarce Covid drugs is discriminatory toward white folks. My colleagues Alice Miranda Ollstein and Megan Messerly explore how this is an emerging strategy for Republicans designed to put Democrats on the defensive heading into the midterm elections this year. Conservatives view this as a sweet spot, with parallels to the claims that Virginia students were being indoctrinated in critical race theory — which helped propel Republican Glenn Youngkin to the governor's mansion last year. Then-Virginia Republican gubernatorial candidate Glenn Youngkin walks onstage during an election-night rally in November 2021. | Anna Moneymaker/Getty Images "We saw that critical race theory had been creeping into our public schools, and the dam broke in a kind of response, as we saw in the Virginia elections," Roger Severino, who led HHS' Office of Civil Rights under the Trump administration, told POLITICO. "Parents, once they found out, said they had enough of it and if the same move starts happening in health care, you will see the same visceral reaction," he added. (Most public school officials across the country say they do not teach critical race theory, even in districts where lawmakers are seeking to ban it.) The strategic germ took hold after the Food and Drug Administration released new guidance on the use of a monoclonal antibody with a hard-to-pronounce name. Sotrovimab is the only version of that treatment that has shown effectiveness against the Omicron variant. It takes months to produce. And while demand outweighs supply, the Biden administration recommended that doctors can, but are not required to, consider race or ethnicity among a series of other health factors like weight, age and comorbidities including cancer or diabetes, when doling out the therapy. Many Republicans quickly expressed outrage. Even a report from the CDC last week indicating white Americans remain far more likely to receive the treatment than Black, Latino or Asian Americans, hasn't calmed the rhetoric. Former President Donald Trump departs after speaking at a rally on Jan. 15 in Florence, Arizona. | Mario Tama/Getty Images "If you're white, you go right to the back of the line," former President Donald Trump told his supporters at a rally in Arizona earlier this month. "The left is now rationing life-saving therapeutics based on race, discriminating against and denigrating, just denigrating, white people to determine who lives and who dies," Trump said. Sen. Marco Rubio (R-Fla.), who is Latino and up for reelection this year, wrote a terse letter to the head of FDA , arguing the recommendations are "racist and un-American." "This is outrageously illegal, unconstitutional, immoral, and tyrannical," Stephen Miller, a former Trump adviser said in a statement announcing he is suing New York over how it calculates who gets the monoclonal drug. Miller, who heads the conservative advocacy organization America First Legal, also threatened to sue Utah and Minnesota before each of those states dropped race and ethnicity from its criteria. "It's the responsibility of our public health system to address the racial inequities that we're seeing in Covid-19," said Rachel Hardeman, who is director of the Center for Antiracism Research for Health Equity at the University of Minnesota. Removing race from the decision-making process, Hardeman said, would be "taking a step backwards in that process." Given the fight over monoclonal antibodies, the ongoing battle over race in school curricula and the Supreme Court's case challenging the use of affirmative action in college admissions, the list of items galvanizing an anxious conservative base is growing. "I don't know if [the monoclonal antibodies fight] in and of itself becomes the most important or more important than any of the others," said Republican pollster Christine Matthews. "It's just a reinforcement for the mindset that there is discrimination against whites." Democrats should be concerned, says Basil Smikle, a political strategist and the former executive director of the New York State Democratic Party. "People vote for one of two reasons: pride or anger," Smikle told The Recast. "I don't know that Democrats have a counter on this specific issue." As always, we'll be watching. All the best, The Recast Team   Power dynamics are changing. With The Recast, you'll get a twice-weekly breakdown of how race and identity are the DNA of American politics and policy. Was this forwarded to you by a friend? Subscribe to the newsletter here.   THE ROUNDTABLE A free monoclonal treatment site located in a tent is open for patients at the Miami Dade College North Campus on Jan. 20. | Joe Raedle/Getty Images For more on why the monoclonal antibodies are in such high demand and the political fight it's spurring, we turn to two members of POLITICO's health care team, Alice Miranda Ollstein and Megan Messerly. THE RECAST: This argument that race should be a factor in distributing monoclonal antibodies has cropped up recently because there's a shortage of one drug that's been effective against the Omicron variant. Can you explain the drug and why there's a scarcity of it? OLLSTEIN: The federal government authorized the use of three different drugs known as monoclonal antibodies to treat high-risk Covid patients, but only one of them — sotrovimab — has been proven effective against Omicron. Because there currently isn't enough of the drug to meet the demand, both the Biden administration and some states have created advice for doctors on how to decide which people to prioritize. The shortage comes both from supply-chain issues and crazy-high demand because of the current number of Covid infections nationwide. THE RECAST: And because there isn't a ton of availability for sotrovimab, the Biden administration recommended that race, among a slew of factors, should be considered when determining which patients get the treatment? OLLSTEIN: The federal guidance just says that race can be considered among lots of other factors like age and underlying medical conditions. But some states have developed point systems that explicitly prioritize people of color. MESSERLY: In Utah and Minnesota, state health officials developed these risk-scoring systems that considered race or ethnicity as a preferential factor for divvying up treatments. New York didn't develop a calculator but released its own guidance telling health care providers that they should consider "non-white race or Hispanic/Latino ethnicity" as a Covid-risk factor. So essentially those state-level policies built on the federal guidance by going a step further. A Covid-19 testing van sits along a Manhattan street on Jan. 21. | Spencer Platt/Getty Images THE RECAST: So how did this become an issue of anti-white discrimination? OLLSTEIN: Republicans criticizing and bringing lawsuits against the policies say they want to prevent healthy people of color being moved ahead of higher-risk elderly or sick white people for treatment. But doctors treating patients on the ground and the experts who developed these policies say that's not happening — and won't happen. One prominent Black infectious disease doctor we spoke to for our story said that basically all attempts to rectify racial disparities (or even when public health officials highlight the issue exists!) draw protests from the white power structure. MESSERLY: It's also worth noting the federal government's emergency use authorization for sotrovimab is pretty broad. Anyone who is overweight can receive the treatment, for instance. That means that, practically speaking, most people would qualify for the drug based on something other than their race. Defenders of the policies note it's essentially just a tool for doctors to make sure they're prescribing treatments to the widest array of people who need it — and not excluding a person of color who, for instance, has an undiagnosed illness that puts them at risk for severe Covid outcomes. OLLSTEIN: Exactly, especially since there's lots of data that people of color are more likely to have undiagnosed illnesses! People protest outside the New Mexico Public Education Department's office in 2021 after proposed changes to the social studies curriculum. Critics described the changes as a veiled attempt to teach critical race theory. | AP Photo/Cedar Attanasio, File THE RECAST: Many are drawing parallels in the argument over the distribution of the sotrovimab to the outrage surrounding critical race theory in public schools. It's seen as a wedge issue in an election year in an attempt to stoke fear and division among certain voters. What are you hearing and is there evidence this may continue to be an issue throughout this year's midterm cycle? OLLSTEIN: Republicans were pretty honest with us that they see a political advantage in this fight and told us to expect more lawsuits and more actions on Capitol Hill to make Democrats squirm on it. MESSERLY: It's worth pointing out that conservatives genuinely believe these policies are racist and creating more divisions in the health care space when they believe that clinical judgments should be totally race blind. There are a lot of parallels to the fight over affirmative action here, for anyone who has followed that issue closely over the years. But of course there's a political element, too, like Alice noted. While state health officials have defended their policies, we've already seen Utah and Minnesota remove race as a criterion under pressure of legal threat from America First Legal, the conservative group founded by former White House policy adviser Stephen Miller. Miller, it's worth noting, has taken a hard-line position on a number of issues, including immigration. .   HIT 'EM WITH YOUR BEST SHOT A woman from the Dominican Republic waits with immigrants ages 55 and over wait to receive a Covid-19 vaccine in March 2021 in Stamford, Connecticut. | John Moore/Getty Images Both U.S.-born Dominican Americans and Dominican immigrant populations respond favorably to public health recommendations related to the pandemic, according to a recently released survey. POLITICO Fellow Marissa Martinez breaks down the key findings. The study demonstrates the need to study the effects of the pandemic on different ethnic groups within the U.S., instead of "protocols that blindly appeal to everyone," Ramona Hernández, director of the CUNY Dominican Studies Institute told POLITICO. The City College of New York's CUNY Dominican Studies Institute and CUNY School of Medicine found that 77 percent of those surveyed reported they had been vaccinated — while just four percent said they were not planning to get the jab. Nearly 8 in 10 reported they "always or almost always" wore a mask in indoor settings during the early days of the pandemic, especially in states where Covid-19 rates exploded like New York. The Dominican population has been steadily increasing in the United States for decades, jumping by 33 percent since the 2010 census, according to the Migration Policy Institute. The CUNY study included almost 800 respondents from New York, New Jersey, Florida, Massachusetts, Pennsylvania, Rhode Island and Connecticut — states where 85 percent of Dominicans reside. "Despite their substantial heterogeneity, Latina/o/x populations living in the U.S. are frequently treated as a single group in health research," said Nancy Sohler, an associate professor of epidemiology in the CUNY School of Medicine. "The needs of these populations cannot be addressed if adequate data does not exist to inform policy decisions."   ICYMI @ POLITICO Prior to winning the White House, Joe Biden was known as a straight shooter with, on occasion, a propensity of putting his foot in his mouth. Well his mouth made headlines on Monday, when he directed an expletive at a Fox News reporter. POLITICO's Myah Ward breaks down how it all unfolded. Video: 'Stupid son of a …': Biden doesn't like question from Fox News reporter Defense Secretary Lloyd Austin has placed a range of units in the U.S. on heightened preparedness to deploy to Ukraine, according to a Pentagon spokesperson. POLITICO's Quint Forgey has more on the tense standoff in Eastern Europe. And this from our congressional team on how the number of senators working on the bipartisan overhaul to the Electoral Count Act has doubled.   THE RECAST RECOMMENDS Federal judges in Alabama rejected the GOP-backed redistricting map. AL.com is reporting the panel of federal judges found the plaintiffs are "substantially likely to establish" that the proposed map violates the Voting Rights Act. Judges in Georgia cleared the way for Fulton County DA Fani Willis to impanel a grand jury in her investigation of former president Trump's efforts to overturn the election results in 2020. Fulton County District Attorney Fani Willis poses among boxes containing thousands of primal cases at her office. | AP Photo/John Bazemore, File Claims of racial discrimination have dogged the U.S. Marshals Service for years. An administrative judge for the Equal Employment Opportunity Commission could soon hear evidence in the case. The Washington Post profiles current and former employees of the agency about their experiences. Wajahat Ali has a new book, "Go Back to Where You Came From: And Other Helpful Recommendations about how to Become an American," a humorous, painful, memoir about growing up brown and Muslim in a post-9-11 world. "Swan Song," a film starring the incomparable Mahershala Ali, is a quiet meditation on love and loss wrapped in the guise of a sci-fi drama about clones. It poses the question: What would you do to protect your family from the trauma of watching you die? So go watch it. And while you're at it, check out this profile of him. Tuesday vibes: Kaytranada and H.E.R. performing "Intimidated," on The Tonight Show with Jimmy Fallon. TikTok of the Day: The Catel life chose them.   Follow us on Twitter Brakkton Booker @brakktonbooker Rishika Dugyala @rishikadugyala Teresa Wiltz @teresawiltz   Follow us

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