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Fellow Focus - GIM Section

January 31, 2022
by Reshma Ramachandran

Thanks to the wonderful faculty of the National Clinician Scholars Program (NCSP) and especially my mentor, Joseph S. Ross, MD, MHS, I have learned how to wield research to effect policy change that is meaningful for patients. The focus of my work has been primarily on realigning incentives toward ensuring patients equitable access to truly safe and effective health technologies. As with many other issues, COVID-19 quickly became illustrative of the continued global disparities in access to newly developed and effective vaccines, therapeutics, and diagnostics. In the summer of 2020 when I was just starting fellowship, vaccine manufacturers were already making public statements about the possibility of COVID-19 becoming endemic, requiring routine boosters set at higher prices than the current “pandemic prices.”

Working with Ross and Jason Schwartz, PhD, I led a study examining 20-year pricing trends of a parallel vaccine for another endemic disease, influenza, and found that public and private sector prices rose steadily and beyond inflation despite a larger supply distributed and increased number of products and manufacturers. I discussed the implications of these findings on potential future pricing trends for COVID-19 vaccines before Congress as an invited witness earlier last year. In another study on COVID-19 vaccines with Jennifer E. Miller, PhD, and Ross, we found that among countries who hosted clinical trials for COVID-19 vaccines, high-income countries received disproportionately greater doses to vaccinate their populations compared to low- and middle-income country counterparts.

Besides COVID-19, I have also studied FDA’s enforcement of clinical trials results information reporting as mandated by law, whether the priority review voucher awarded by the FDA is a necessary incentive, changes in out-of-pocket prescription drug costs for common conditions affecting Medicare beneficiaries, and the impact of regulatory decisions and proposals on patients. I’ve had the fortunate opportunity to engage policymakers on this research and offer recommendations on various proposals. In addition to rigorous methodological skills, the NCSP has also provided me training on how to translate research effectively to a broader audience through editorials in news media. Finally, a tremendously rewarding part of this fellowship has been the opportunity to work closely with so many stellar students and trainees, allowing me to pay it forward in a small way for the incredible mentorship and sponsorship I’ve received here at Yale through the NCSP.

Submitted by Vivian DuBrava on January 31, 2022