Since the passage of the American Rescue Plan Act in March 2021, Congress has not met the Biden administration’s requests for additional COVID-19 relief funding. In March 2022, the White House requested $22.5 billion in fiscal year (FY) 2022 supplemental appropriations for booster shots, pediatric vaccines, tests, and treatments; research and development to identify new variants and prepare new vaccines to counter them; and global COVID-19 vaccination assistance. Congress instead advanced a spending package that excluded COVID-19 relief. Absent that funding, the administration announced in June 2022 that it was repurposing $10 billion in existing funding—originally allocated for testing, personal protective equipment (PPE), ventilators, and other needs—to purchase vaccines and therapeutics. In September 2022, the White House requested $18.4 billion for COVID-19 supplemental funding as one of the “critical needs” in its FY 2023 continuing resolution request, which sought to procure additional vaccines and therapeutics; support development of updated vaccines; continue free testing programs and sustain testing capacity; purchase medical supplies and equipment for the Strategic National Stockpile; cover vaccination costs for the uninsured and underinsured; improve access to treatment for people with long COVID; and monitor new variants.
The lack of additional funding for COVID-19 has also led to inadequate replenishing of at-home tests and PPE within the national stockpile, suspension of free test distribution, reduced domestic testing capacity, and lack of support for the development of new vaccines and treatments.
As the Biden administration’s requests for COVID-19 funding continue to go unanswered, it faces difficult decisions about how to spend dwindling resources, confirming its predictions about the consequences of failing to act. To secure the more than 170 million doses of bivalent vaccine available to the public this fall, the administration diverted funding from other programs. The White House says the lack of additional funding for COVID-19 has also led to inadequate replenishing of at-home tests and PPE within the national stockpile, suspension of free test distribution, reduced domestic testing capacity, and lack of support for the development of new vaccines and treatments. (see text box)
Timeline of COVID-19 response funding
March 2021: Congress included supplemental funding for COVID-19 response as part of the American Rescue Plan Act; it has not provided funding since then.
March 2, 2022: The White House requested $22.5 billion for COVID-19 response in FY 2022 supplemental appropriations.
March 22, 2022: Funding to cover testing and treatment through the Uninsured Program ran out. Some community testing sites turned people away because they could not sustain the costs to administer tests.
April 5, 2022: Funding to cover provider fees for vaccinations through the Uninsured Program ran out.
June 2022: The Biden administration announced it diverted $10 billion in funding for testing, PPE, and other needs to purchase vaccines and therapeutics.
August 17, 2022: Monoclonal antibody treatment bebtelovimab became available on the commercial market. The federal government began phasing out procurement and free distribution to states.
August 30, 2022: The Administration for Strategic Preparedness and Response announced an accelerated plan to commercialize COVID-19 products, with vaccines and therapeutics transitioning to the commercial market by early 2023, due to lack of additional funding.
September 2, 2022: The free U.S. Postal Service at-home COVID-19 test program was suspended due to a lack of funding needed to replenish the Strategic National Stockpile’s supply of tests.
As early as January 2023: Federal funding will be unavailable to purchase or distribute vaccines.
January 11, 2023: The public health emergency declaration will expire. If not renewed, in conjunction with the depletion of federal supplies, it will lead to cost sharing for COVID-19 vaccines for some individuals.
2023: Federal supplies of therapeutics are expected to run out; the preventive treatment Evusheld will run out as soon as early 2023, the antiviral Lagevrio will run out in the first half of 2023, and the antiviral Paxlovid will run out in mid-2023.
The consequences of failing to fund COVID-19 response
With no signs that Congress will meet the demand for additional funds, the federal government is preparing to shift costs of COVID-19 countermeasures to health insurers and the commercial market, leaving consumers to pay for treatments and tests. This threatens access for low-income and uninsured people. And although, due to the Affordable Care Act’s preventive services coverage standards, COVID-19 vaccines will remain free to individuals with public insurance and most individuals with private insurance even after the expiration of the public health emergency, those who are uninsured may be charged a portion or the full cost of vaccines, estimated between $110 and $130 per dose. The timeline to make this transition to the commercial market has accelerated due to lack of additional funding.
Even with a smooth transition to commercialize COVID-19 vaccines, tests, and treatments, shifting costs to the private sector will not eliminate the need for public funding. Without the federal government guaranteeing sales through advanced market commitments, the United States could face insufficient supplies of vaccines, treatments, and tests because private companies may be unwilling to bear the risk of producing supplies at high levels. For example, Abbott Laboratories destroyed rapid test components during summer 2021 in anticipation of a decline in demand after the Delta variant peaked. Yet when the Omicron variant emerged at the end of 2021, customers experienced long lines and limited supplies of tests. Without manufacturing capacity to ensure sufficient supplies, federal stockpiles could remain depleted, and states and insurers could find themselves in a situation similar to what states faced in 2020 when they bid against each other for limited medical equipment and PPE.
Federal investments in genomic sequencing systems that detect new variants and target disease control measures are critical to the nation’s continued readiness and response to the pandemic. The bivalent booster, for example, is an updated vaccine formula that targets new variants. Public funding is needed to support global COVID-19 vaccination and treatment and to counter long COVID. Failure to fund global vaccination and treatment puts everyone at risk of new variants that travel around the globe and harms America’s relationships with, and support from, other countries on other global issues. And with long COVID keeping as many as 4 million people out of work—with annual lost wages of around $170 billion per year—and 13.8 million people currently having some trouble carrying out daily activities as a result, Congress needs to invest in research and improve access to treatment for people with long COVID.
COVID-19 continues to be unpredictable. Failure to plan and invest in countermeasures, monitoring, and research and development threatens the ability of the United States to respond quickly, leaving the nation vulnerable to increased illness, disability, and death, as well as economic disruption. Congress must act to ensure that the United States has the resources to mount a robust COVID-19 response and is prepared for future pandemics.
The author would like to thank Emily Gee, Rose Khattar, Mia Ives-Rublee, Laura Rodriguez, and Madeline Shepherd for their review and feedback.