The U.S. COVID-19 public health emergency is ending. What does that mean?

In January 2020, the U.S. government declared COVID-19 a public health emergency. Now, with coronavirus cases and deaths on the decline, that declaration is quickly approaching a predetermined expiration date. 

Set to end on May 11, the public health emergency aimed to curb the coronavirus’ spread. In the pandemic’s earliest days, the declaration imposed temporary measures such as quarantines for people exposed to the virus (SN: 1/31/20). Later, it allowed federal officials to make tests, drugs and vaccines authorized by the U.S. Food and Drug Administration freely available to the public. 

“Ending the public health emergency signals that we think we’ve turned a corner in what was a pretty dark time in America,” says health policy researcher Leighton Ku, who heads the Center for Health Policy Research at George Washington University in Washington, D.C. (It’s not the first pandemic-related declaration to end. On April 10, President Joe Biden signed legislation ending the national emergency, which had been issued in March 2020 to waive some requirements for federal health insurance programs, such as to allow coverage of telehealth visits.) 

Even as the public health emergency becomes yet another relic of a traumatic period, COVID-19 isn’t going away. More than 1,000 people in the United States died from COVID-19 from April 20 to April 26, according to the U.S. Centers for Disease Control and Prevention. And the coronavirus continues to evolve. Although not all new variants are worrisome, some can be (SN: 10/17/22). So it remains to be seen whether now is the time to let our guard down, Ku says.

Tests, drugs and vaccines will remain important tools to control the virus’ spread, and researchers hope to improve our arsenal. Here’s what the end of the public health emergency means for these efforts.  

Millions of people may lose access to free testing

COVID tests — at-home and lab versions — that were authorized by the FDA over the last three years will remain available. These tests were granted emergency use authorizations, or EUAs, which allow public access to tests that are not formally approved by the FDA. Instead of expiring with the public health emergency, the FDA can decide when it wants to end individual EUAs, and it can still issue EUAs for any new tests that might be developed. 

What may change is who pays for tests and diagnostics. It all comes down to insurance.

For those with private insurance, costs will depend on individual insurers. Starting in January 2022, the Biden administration required insurers to pay for eight at-home tests per covered individual per month. Ending the public health emergency means that at-home and lab tests, even if ordered by a physician, are no longer guaranteed to be fully covered. 

The shift also affects those enrolled in federal health insurance programs — Medicare for those 65 and older and Medicaid for those below a certain income level.

Like those with private insurance, Medicare Part B users will also lose access to their eight free at-home tests per month. The program will, however, continue covering lab tests if ordered by a health professional, although test seekers may need to pay for the associated doctor’s visit. People with Medicaid will still receive free at-home and lab tests through September 2024. After that, costs may vary by state.

Currently, uninsured people in most states pay full price for at-home rapid tests, roughly $10 each, and lab tests, around $150 per standard PCR test. And that pool of people is about to grow. 

States can now start disenrolling people from Medicaid and its equivalent for kids, the Children’s Health Insurance Program, which covered nearly 95 million individuals as of January 2023. Congress passed legislation in 2020 prohibiting states from removing people’s Medicaid or CHIP coverage during the pandemic, even if they were no longer eligible. That provision ended in March and could result in 17 million people losing insurance by May 2024, according to an April 26 analysis by KFF, a health policy research organization based in San Francisco.

Uninsured individuals may still have access to testing at free clinics and the limited supply of at-home tests previously stockpiled by the government. Depending on resource availability, the CDC Increasing Community Access to Testing program will continue offering tests to those without insurance. 

Regardless, millions more will soon join this group of individuals who, for the most part, probably cannot afford testing. SARS-CoV-2 can run rampant in communities when people don’t test themselves for the virus and unknowingly spread it (SN: 7/7/22). “History in general shows us that disadvantaged, minority, poor populations get hurt the worst,”  Ku says. “So that’s likely to be what happens.”

Availability of COVID vaccines and treatments won’t change (for now)

The end of the national emergency did not impact people’s ability to access vaccines and antiviral treatments. Nor will the end of the public health emergency.

Vaccines and treatments will “generally not be affected,” the U.S. Department of Health and Human Service, or HHS, says. The FDA can also continue issuing EUAs for any new vaccines or treatments that might be developed to fight future variants. 

However another big shift looms later this year. Throughout the pandemic, the U.S. government stockpiled vaccines and treatments to fight COVID-19 and provided them to the public for free. Congress has decided not to continue funding these efforts. Stockpiles for COVID-19 vaccines and treatments are expected to run out this summer or fall, White House COVID-19 Response Coordinator Ashish Jha said in an interview with the University of California, San Francisco earlier this year.

On the vaccine front, the government previously bought shots at a discounted cost of around $21 per shot from pharmaceutical companies, according to data from KFF. When supplies run out, health care providers will have to buy them directly from companies. Pfizer and Moderna, which manufacture the widely used mRNA shots, both estimate that the commercial cost will range between $110 to $130 per shot. 

How will those costs impact patients? Again, it depends on what kind of insurance you have.

Medicaid will continue to cover shots through September 30, 2024. Vaccines will remain covered for patients enrolled in Medicare Part B. The CDC’s Vaccines for Kids program will also continue to provide the COVID-19 vaccines to uninsured children. 

Otherwise, costs will vary based on the state you live in and your insurance company. HHS claims that because COVID-19 vaccination is recommended by the CDC’s Advisory Committee on Immunization Practices, it counts as preventative health care, which would be covered without a co-pay by most private insurance companies. On April 18, HHS also announced a new program to continue vaccine and treatment access for uninsured people through partnerships with pharmacies with funding through December 2024.

On the treatment front, antivirals purchased by the government will remain free as long as government stockpiles last. After that, pharmacies will have to purchase them directly from companies. Medicaid will continue to cover treatments until September 2024, but after that costs may vary by state. Medicare Part D, the prescription medication arm of the insurance program for seniors, covers only drugs with full FDA approval, which could impact treatments available through an EUA. 

Paxlovid, a popular antiviral medication that curbs COVID-19 symptoms and reduces the risk of long covid (SN: 3/31/23), was originally purchased by the government at price of $530 per dose. Pfizer has not disclosed how much it plans to charge on the commercial market, KFF Health News reports. The company has also applied to get a formal thumbs up from the FDA, and an advisory committee voted in March to recommend approval of Paxlovid. 

Research into new COVID vaccines and treatments will continue

The bulk of the funding for coronavirus research wasn’t tied directly to the public health emergency, so ongoing and future studies won’t come to a halt. What will change is how some data get reported to the CDC.

While most CDC data tracking isn’t directly affected by the public health emergency’s end, daily reports of COVID-related hospitalizations may come less frequently, according to the agency. Labs will also no longer be required to report COVID-19 lab test results, making it harder to figure out what percentage of tests are positive — a metric that’s useful for monitoring new surges of infections. Reports of increasing cases and hospitalizations may be slightly delayed for places that don’t regularly release the information to the CDC, potentially making it more difficult for people to know exactly when cases start rising in their community and it’s time to start wearing masks again.   

As immune protection fades — particularly in older people or those who are immunocompromised — or the virus evolves in ways that can make vaccines less effective at protecting people from severe disease, researchers are on the hunt for variant-proof vaccines and treatments. The Biden administration is setting aside more than $5 billion for “Project Next Gen” to speed up the search. 

The program aims to develop mucosal vaccines that might protect noses and throats from infection and reduce the chances a sick person will pass the virus on to others (SN: 6/10/22). 

Another objective is to develop long-lasting, lab-engineered antibodies that could be used to treat infected people. Such monoclonal antibodies proved effective at preventing severe disease in newly infected people in clinical trials but no longer work because the virus has changed too much (SN: 1/13/23). Now, the plan is to develop new ones that attack parts of the virus that don’t often change as the virus evolves.   

Also on the wish list is to craft universal coronavirus vaccines that protect people from not only newly emerging variants but also other types of coronaviruses (SN: 9/29/22). The virus that causes COVID-19 isn’t going anywhere, and there are plenty of other coronaviruses circulating among animals such as bats that might also pose a threat to people. 

Having one vaccine to protect against a broad swath of related viruses could help prevent coronaviruses from sparking another round of health emergencies in the future. Time will tell whether that goal becomes reality.