The Covid-19 pandemic is producing a shift in US policy on providing free access to tests, vaccines and treatment during public health emergencies
Last night in the State of the Union address, President Biden announced the launch of a new initiative called the “Test to Treat” program, which allows Americans to test for Covid-19 at a pharmacy and , if they are positive, to receive free oral therapy. – Paxlovid (nirmatrelvir) or Lagevrio (molnupiravir) – on the spot.
US federal policy has come a long way in just two years, when government officials declared that pricing and the affordability of Covid-19 vaccines should be left to the free market. At the time, Health and Human Services Secretary Alex Azar refused to even guarantee that the coronavirus vaccine would be affordable for everyone.
Failing to ensure the affordability of Covid-19 vaccines would have implied that a person’s ability to pay, or health insurance coverage, would determine who has access to a vaccine and who does not. Likewise, without a guarantee of free access to coronavirus testing and Covid-19 treatment, the ability to pay would have determined who is tested and treated and who is not. 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 would not promise that a vaccine for the novel coronavirus would be affordable. Azar went on to say that “we would like to make sure that we work to make it affordable. [But] we cannot control this price because we need the private sector to invest. Price controls will not get us there.
Arguments against the introduction of price controls for medicines and vaccines are supported by economists and political decision-makers. Opponents of price controls argue that such government interventions stifle research and development in the private sector. Nonetheless, on the separate issue of guaranteed affordability, Azar’s comments have little to no support.
Failing to ensure affordability implies that a person’s ability to pay, or health insurance coverage, could determine who has access to a vaccine, coronavirus test or Covid-19 treatment, and who does not. no.
Most would argue that tiered access contingent on socioeconomic status is unethical, especially during a public health emergency related to an infectious disease. Additionally, proponents of guaranteed affordability argue that vaccines, diagnostic tests, and treatments, which are developed (in part) with US taxpayer dollars, should be available to everyone.
Indeed, this was precisely the argument advanced during the February 2020 hearing to counter Azar’s lack of affordability guarantee. Historically, Sen. Roy Blunt (R-Missouri) said affordability has “never been an issue with pandemic vaccines. They’re usually developed with a lot of government help, and there’s no example of a pandemic vaccine that wasn’t affordable.
Thus, throughout the pandemic, the American federal government has been the guarantor of free vaccines. Likewise, it has also provided free coronavirus testing and treatment. Notably, a number of subtle changes have occurred in politics. For example, health insurers are no longer required to provide completely free Covid-19 treatments. In the fall of 2021, many insurers reinstated deductibles and co-payments for Covid-19-related healthcare treatments and services.
All of this raises questions about future policy. Does the federal government step in to pay for diagnostic tests, vaccines and treatments only during a communicable disease outbreak and public health emergency? Or, will there also be other situations in which the government will intervene to be the guarantor of universal gratuity? And, to what extent, if any, will depend on government involvement in funding research and development for diagnostics, therapies and vaccines.
Covid-19 is not the last such public health threat. Additionally, in the future, there may be non-communicable public health emergencies that would require government intervention to ensure universal access to testing and treatment.
The Covid-19 pandemic has led to a change in attitude towards the role of government, particularly with regard to its responsibility as an underwriter of at least some of the costs of research, development and manufacturing, as well as all costs for tests, treatments, and vaccines in hospitals, clinics, and pharmacies.
Going forward, the federal government will need to set clear parameters on the circumstances, such as public health emergencies, that would justify providing free access to diagnostics, therapies, and vaccines.
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