Covid-19 Pandemic Produces Shift In U.S. Policy On Providing Free Access To Tests, Vaccines, And Treatments During Public Health Emergencies – Forbes

Syringes and Covid-19 vaccine ampoule lying on top of a pile of money

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Last night, in the State of the Union speech, President Biden announced the launch of a new initiative called the “Test to Treat” program, which enables Americans to test for Covid-19 at a pharmacy and, if positive, receive free oral therapeutics – Paxlovid (nirmatrelvir) or Lagevrio (molnupiravir) – on the spot.

U.S. federal policy has come a long way from just two years ago when government officials declared that the pricing and affordability of Covid-19 vaccines should be left to the free market. At the time, Secretary of Health and Human Services Alex Azar even refused to guarantee that the coronavirus vaccine would be affordable to all.

Not ensuring affordability to Covid-19 vaccines would have implied that ability to pay, or a person’s health insurance coverage, would determine who gets access to a vaccine and who doesn’t. Similarly, without a guarantee of free access to coronavirus tests and Covid-19 treatments, ability to pay would have determined who gets tested and treated and who doesn’t. The consensus today is that this would be considered unethical during a communicable disease pandemic.

During a Congressional budget hearing in February 2020, former Secretary Azar said he wouldn’t promise a vaccine for the novel coronavirus will be affordable. Azar went on to state that “we would want to ensure that we work to make it affordable. [But] we can’t control that price because we need the private sector to invest. Price controls won’t get us there.”

Arguments against instituting drug and vaccine price controls have support among economists and policymakers. Opponents of price controls maintain that such government interventions stifle research and development in the private sector. Nevertheless, on the separate issue of guaranteed affordability, Azar’s comments have little if any backing.

Not ensuring affordability implies that ability to pay, or a person’s health insurance coverage, could determine who gets access to a vaccine, coronavirus test, or Covid-19 treatment, and who doesn’t.

Most would argue that tiered access, contingent on socioeconomic status, is unethical, especially during an infectious disease public health emergency. Moreover, proponents of guaranteed affordability contend that vaccines, diagnostic tests, and treatments, that are developed (in part) with U.S. taxpayer dollars should be accessible to everyone.

Indeed, this was precisely the argument made at the February 2020 hearing to counter Azar’s non-guarantee of affordability. Historically, Senator Roy Blunt (R-Missouri) stated that affordability has “never been a problem with pandemic vaccines. They’re usually developed with a lot of government assistance, and there’s no example of a pandemic vaccine that wasn’t affordable.”

And so, throughout the pandemic, the U.S. federal government has been a guarantor of free vaccines. Likewise, it has also provided for free coronavirus testing and treatments. Notably, a number of subtle changes have occurred in policy. For example, healthcare insurers are no longer required to provide Covid-19 treatments completely free of charge. In the fall of 2021, many insurers reinstituted deductibles and co-payments for treatments and healthcare services related to Covid-19.

All of this raises questions about future policy. Does the federal government step in to pay for diagnostic tests, vaccines, and therapeutics only during a communicable disease outbreak and one that’s been declared a public health emergency? Or, will there also be other situations in which the government will intervene to be a guarantor of universally free access? And, to what extent, if any, will this depend on how involved the government was in funding research and development for diagnostics, therapeutics, and vaccines.

Covid-19 is not the last public health threat of its kind. Furthermore, in future there may be non-communicable public health emergencies which require government intervention to secure universal access to testing and treatment.

The Covid-19 pandemic has brought forth a changed attitude towards the role of government, specifically with respect to its responsibility as underwriter of at least part of the research, development and manufacturing costs, as well as all of the costs of tests, treatments, and vaccines in hospitals, clinics, and pharmacies.

Moving forward, the federal government will have to establish clear parameters on the circumstances, such as public health emergencies, which would warrant provision of free access to diagnostics, therapeutics, and vaccines.

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