The Biden administration is planning to end the COVID emergency declarations on May 11, and expects to run out of government-bought vaccines and treatments as soon as this summer and fall. Those moves could spell the end for a wide range of efforts launched by health authorities over the past few years to curb the virus, although Congress and the federal government have moved to ensure some can outlive the formal end of the COVID-19 emergency. Here's the latest on what we know about what's in store.
Can health authorities still track COVID spread and infections?
Some data the Centers for Medicare and Medicaid Services requires to be reported about COVID-19 will still be uploaded through at least 2024, according to rules finalized last year. This includes data tracking infections from hospitals and nursing homes.
"For over a year, CMS has been working alongside states, public health departments, and stakeholders for a smooth transition" an agency spokesperson said in a statement.
The outside group of modelers that the Centers for Disease Control and Prevention relies on to forecast trends in the virus are also planning to continue producing their projections with the agency.
"We do expect to continue running COVID hospitalization and likely death forecasts too for perhaps at least another year. Case forecasts I'm not as sure about," Nicholas Reich, professor of biostatistics at the University of Massachusetts, said in an email about the ensemble effort.
The federal government can continue to tally some data from states and territories, such as death certificates, which it had the ability to do before the pandemic. However, the CDC had relied on programs set up for the pandemic to track a range of other details reported by health departments, like vaccinations and emergency room visits.
"State health departments are tired, and they're exhausted," said Dr. Anne Zink, Alaska's chief medical officer and president of the Association for State and Territorial Health Officials, "and we're all looking at fairly large financial cliffs, at the end of the 2023-2024 budget cycle, as a lot of the COVID funding has and will be wrapping up."
State and local officials have been in talks with the CDC about agreements that could allow COVID-19 data to be shared after the end of the emergency. Sharing that data was invaluable for states to learn from each other about the crisis, Zink said.
"The reality is that the authorities to share data really relies within the states, not within the federal government and the current structure. And so, there are not mechanisms to force or to employ that data sharing without it potentially being tied to funding," Zink said.
Will COVID vaccines, treatments, and tests still be available?
Emergency use authorizations the Food and Drug Administration granted to COVID-19 vaccines, drugs and tests do not automatically expire once the "public health emergency" is over.
That means they can continue to be used even after those federal declarations are no longer renewed, the FDA says, and new ones could still be issued for COVID-19. Similar emergency authorities remain in effect for a range of past outbreaks, from Anthrax to Zika Virus.
However, the FDA does plan to revise its guidance governing how companies can seek the regulator's sign-off for new COVID-19 products.
"If there is an end of emergency, we don't think that will have any impact on current EUAs. It will have an impact on issuing new EUAs," Pfizer CEO Albert Bourla told investors last month.
Liability protections offered to cover providers giving these COVID-19 vaccines and treatments can also continue past the end of the emergency. These had effectively expanded the pool of Americans able to enlist as vaccinators, like pharmacists and paramedics.
Drug stores have called for the Biden administration to extend these protections through at least October 2024, as states rejigger a patchwork of laws and regulations for pharmacists administering COVID shots.
"We are extremely concerned that action still has not been taken to prevent Americans' loss of pharmacy access and equity, which inevitably will result when the public health emergency ends or when COVID-19 vaccinations move to the commercial markets," the National Association of Chain Drug Stores wrote in a December letter.
How much will COVID vaccines and drugs cost with insurance?
Once government-bought supplies run out or expire later this year, Pfizer-BioNTech and Moderna both plan to begin selling their products on the private market.
When that happens, most will continue to pay nothing when getting a COVID-19 shot. The Affordable Care Act requires that insurance companies cover preventive services at no out-of-pocket cost, including immunizations.
However, similar to the annual flu shot, free options will shrink. To avoid a bill, Americans will need to check with their insurers to find out which places to get the shot will be in-network.
Treatments like Pfizer's Paxlovid are not guaranteed for free after federal stocks run out. The company has not yet announced its list price for the pills, as it kicks off the kind of talks that determine drug costs every day throughout the private market.
"There's another drug called molnupiravir, but it's not as effective. And so in a way, they have a monopoly, certainly on the most effective treatment option. And that gives them a lot of negotiating power," said Dr. Steven Pearson, president of the Institute for Clinical and Economic Review.
In December, Pearson's organization estimated a cost-effective price would be between $563 to $906. That is close to the $529 per course in 2021 that the Biden administration paid for Paxlovid.
Pfizer's planned private market price for their COVID-19 vaccine starts at $110 per dose, more than triple the $31 per dose that the Biden administration paid for its bulk purchase last summer.
If Pfizer does choose to substantially hike the starting price of Paxlovid, Pearson said that it could make it harder to get the drug if insurers set up hurdles to limit costly prescriptions.
"In some ways, we really don't want that, we want people to be able to get rapid access if they are at high risk and really can benefit from this treatment. So, everybody would hope to shoot for a price that is both a value, but also in the near term affordable," said Pearson.
Will uninsured Americans be able to get COVID vaccines or drugs?
The Biden administration has pledged to find a way to make COVID-19 vaccines and treatments accessible to uninsured Americans after they go to the private market, though no details have so far been announced.
"None of that needs to be implemented like next month, because first the PHE doesn't end until May. But even after that, this stuff will be available for the uninsured and for everybody else for a while," White House COVID-19 Coordinator Dr. Ashish Jha said last week.
The CDC has already paved the way for its Vaccines for Children to cover COVID-19 vaccines, like they do for other pediatric shots given to uninsured kids.
State and local health departments might also be able to devote funds to purchase COVID-19 vaccines for uninsured adults, though the timing of the federal transition could come too late for this coming season.
"Unfortunately, states tend to have a very limited window to be able to ask for funds or to change the way the programs are set up, and that's right now during the legislative session," said Zink, head of the group representing state health officials.
Zink said some health departments already offer adult vaccines like flu for uninsured residents. However, setting up those programs can take more than a year to roll out.
"Not knowing how much is this going to cost, when is this exactly, when are we going to run out, what is it going to look like for the fall, is going to make planning for this harder," Zink said.
How will I be able to get a COVID test?
During the emergency, the federal government required insurance companies to cover COVID-19 tests ordered by doctors at no cost. The Centers for Medicare and Medicaid Services expanded that requirement to over-the-counter rapid COVID-19 test kits that can be done at home last year.
Spokespeople for drug store chains like Walgreens and CVS both say they plan to continue offering COVID-19 tests after the end of the emergency.
However, the requirement for insurers to cover the cost of these tests will end with the declaration expiring. That leaves COVID-19 diagnostics in the same bucket as other viral tests that insurers may not foot all of the bill for.
However, Jha hinted that they might be able to persuade insurers to continue covering some home testing.
"This is one where it's going to be working with insurance companies, working with payers, providers, reminding people that for the last two years the U.S. government has paid for all of this with taxpayer money," Jha said last week.
The federal government has subsidized free lab tests through pharmacies and other vendors throughout the pandemic, in addition to mailing out free test kits. State and local authorities had also offered tests, though many are now winding down their efforts.
"That has been a boon for insurance companies that haven't had to pay for any of this stuff. And it's also about talking to the manufacturers about prices. So there's just a lot of work ahead,"Jha said.