Access to Coronavirus Disease 2019 Clinical Trials by English and Non-English Speakers Is Needed

To the Editor—We applaud the Infectious Diseases Society of America for publishing recommendations on treatment of coronavirus disease 2019 (COVID-19) [1]. All 7 recommendations call for enrolling people with COVID-19 into clinical trials. While access to clinical trials may be limited at some hospitals, providers and hospital systems are encouraged to collect needed data to elucidate the pathogenesis of the disease and aid in determining effective therapeutic responses.

In standing up for therapeutic trials at University of Texas Southwestern, we, unfortunately, reviewed protocols from some pharmaceutical companies that specifically excluded non-English speakers from trial participation. While acknowledging that speed is of the essence in opening these trials and translation of informed consent and questionnaires may prolong time to trial startup and add expense, the cost for translation is overall nominal and there are numerous high-quality rapid translation services available. There is already a racial disparity observed in those hospitalized with COVID-19, and according to Centers for Disease Control and Prevention statistics, minorities make up the largest population being hospitalized [2]. Excluding non-English-speaking people from participation is not acceptable. Moreover, if results from trials are to be considered generalizable to the population as a whole, the trial populations should be both diverse and inclusive.

There is a large Hispanic population in this country, many of whom have jobs that are part of the essential workforce and do not allow for remote access. Spanish speakers, as do other underrepresented minorities, often share high-density living quarters, use public transportation, and lack access to early healthcare. Thus, we are seeing disproportionately high numbers of these minority populations in our hospitals. We should not allow these, or any other groups, to be excluded from therapeutic drug trials. We are struggling with this pandemic as a global society, not as groups of individuals of different ethnicity or spoken language. We ask that pharmaceutical companies do their part to make access to clinical trials equitable to all regardless of language.

Note

Potential conflicts of interest. M. K. J. reports institutional grants from Gilead Sciences and Regeneron, outside the submitted work. R. J. reports consulting fees from Vertex Pharmaceuticals and Gilead Sciences, outside the submitted work. N. R. reports no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.