Letter to Hon. Xavier Becerra, Secretary of the Department of Health and Human Services, and Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention - As Omicron Variant Dominates New Cases, Markey, Warren, Pressley, Lee Call on CDC, HHS to Resume Comprehensive Data Collection on COVID-19 Breakthrough Cases Without comprehensive data c

Letter

Dear Secretary Becerra and Director Walensky:

We write to call on the U.S. Department of Health and Human Services (HHS) and the Centers
for Disease Control and Prevention (CDC) to monitor, report, and address racial and other
demographic disparities in COVID-19 breakthrough cases nationwide. Existing racial disparities
in health outcomes and health care access have compounded the risks of COVID-19 for
communities of color, resulting in a disproportionate share of COVID-19 infections and fatalities
in those communities. We are concerned that this may also be true for breakthrough infections,
but without comprehensive data collection, experts are unable to identify and track racial
disparities or other trends in these cases.

Public health experts have explained that additional data on breakthrough cases could provide
critical information regarding the spread of new variants in the country, including the Omicron
variant. David Kessler, Chief Science Officer of the White House COVID-19 Response Team,
suggested that the presence of the Omicron variant in the United States would likely be coupled
with an increase in breakthrough cases, and early evidence has shown that breakthrough
infections due to Omicron, though less severe than infections among people who are not fully
vaccinated, are growing. For these reasons, we urge the CDC to collect and monitor racial and
other demographic data related to COVID-19 breakthrough cases nationwide.

The COVID-19 pandemic has revealed longstanding, systemic racial and ethnic inequities in the
U.S. health care system. Since the onset of the pandemic, over 50 million Americans have been
infected by SARS-CoV-2, and more than 800,000 have died from COVID-19. We began
advocating for public disclosure of racial and ethnic demographic data in March 2020, and the
subsequent release of these data made clear that COVID-19 disproportionately affects
communities of color.

For example, Black, Latino, and Indigenous communities continue to experience a
disproportionate burden of COVID-19 cases and deaths. Age-adjusted data also show that, since
the start of the pandemic, Black, American Indian and Alaska Native, and Latino people have
been at least twice as likely to die from COVID-19 as their white counterparts. People of color
are more likely to have many of the chronic health conditions that the CDC has identified as risk
factors for complications from COVID-19. Black, Latino, and Indigenous communities have
been at increased risk of hospitalization, face greater barriers to testing, and in many areas, make
up the majority of frontline workers who are at risk for increased exposure to the virus. The
CDC has also identified "many inequities in social determinants of health that put racial and
ethnic minority groups at increased risk of getting sick and dying from COVID-19," including:
discrimination, barriers to health care access, decreased utilization of health care,
disproportionate representation in jobs classified as "essential workers," higher likelihood of
living in crowded housing, and higher poverty rates.

The rapid development and deployment of COVID-19 vaccines resulted in a dramatic drop in
COVID-19 hospitalizations and deaths. And we were glad that, in February, Secretary Becerra committed to improving data collection for COVID-19 vaccine distribution. However, given
the inordinate vulnerability of people of color throughout this public health emergency, we are
concerned that there may be racial disparities among Americans experiencing COVID-19
breakthrough cases.

While most states publicly report some data on breakthrough infections, only four report data by
race and ethnicity. But this limited data already suggest the existence of racial and ethnic
inequities. For example, in King County, Washington, the data indicates that hospitalization rates
tied to breakthrough infections are higher for Black, Indigenous, and Pacific Islander residents
than their white counterparts.

At the federal level, the CDC stopped reporting robust national data on all breakthrough cases in
May. The CDC now only reports national data on severe breakthrough cases that result in
hospitalization or death -- and these data are not publicly available by race or ethnicity.

And because health care falls within the federal government's trust and treaty obligations to
tribal nations, the government has an obligation to determine how COVID-19 breakthrough
cases are affecting Indian Country and to report this information to tribal governments and
Congress.

For these reasons, we urge you to resume collecting data on COVID-19 breakthrough infections
nationwide with breakdowns by race, ethnicity, and other demographic characteristics and to
make this data publicly available as soon as possible. Comprehensive data collection would
allow experts to better understand patterns in breakthrough cases, identify COVID-19 variants
earlier, and analyze the potential effect of compounding "racial and ethnic inequities in wealth,
health, education, work, housing, and medical care" on vaccine response.

We also request answers to the following questions by January 11, 2022:

1. Are HHS and CDC identifying racial, ethnic, and other demographic disparities in severe
COVID-19 breakthrough cases?
a. Are HHS and CDC using existing data on severe breakthrough cases to identify
patterns in breakthrough infections, COVID-19 variants, and/or vaccine response?
2. Do HHS and CDC have plans to collect and publicly report racial, ethnic, and other
demographic data for all COVID-19 breakthrough cases? If not, why not?
a. If so, do HHS and CDC have plans to use this data to identify the presence and
risks of new variants, including Omicron?

Thank you for your consideration of this urgent matter.

Sincerely,