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The Biden Administration is preparing for a slow rollout of new polices on COVID, after the national public health emergency prompted by the pandemic ends in May. News reports and government statements suggest that tests, vaccines, and treatments will become less available for free over time as the response to COVID becomes similar to the way Americans handle other diseases, as part of traditional health care delivery system.

According to a report in Politico, COVID will remain a public health priority for the federal government, with a focus on still providing tests, vaccines, and treatments free or at low cost to lower-income Americans, while the private market takes over the majority of the response.

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"Biden officials expect the so-called commercialization process to start in the second half of this year," the story says. "But under its tentative plan, the administration would stockpile a limited supply of shots, treatments and tests that could be distributed freely to the uninsured well after the U.S. transitions out of its current crisis era."

A May deadline, but a slow transition

Government officials say the public health emergency, first declared on March 13, 2020, will officially expire on May 11.

In his State of the Union speech on Feb. 7, President Joe Biden called on Congress to work with his administration in navigating the way forward with COVID. He said Congress should fund efforts to monitor variants of the disease and support new vaccines and treatments.

"While the virus is not gone, thanks to the resilience of the American people, we have broken COVID's grip on us," Biden says. "COVID deaths are down nearly 90%. We've saved millions of lives and opened our country back up."

The federal government's next steps were outlined in a statement released two days later. The release from the U.S. Department of Health and Humans Services stressed that many Americans would continue to have access to free vaccines.

"When this transition to traditional health care coverage occurs later this year, many Americans will continue to pay nothing out-of-pocket for the COVID-19 vaccine," the statement says. Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are a preventive health service for most private insurance plans and will be fully covered without a co-pay. Currently, COVID-19 vaccinations are covered under Medicare Part B without cost sharing, and this will continue. Medicaid will continue to cover all COVID-19 vaccinations without a co-pay or cost sharing through September 30, 2024, and will cover ACIP-recommended vaccines for most beneficiaries thereafter."

Some drug manufacturers have proactively declared their vaccines will remain free of charge for the uninsured. ABC News reported that Moderna will keep its vaccine free to those who lack insurance, regardless of government policy. "Everyone in the United States will have access to Moderna's COVID-19 vaccine regardless of their ability to pay," the company says in a statement.

Vaccines: good news, bad news, and controversy

The story of the COVID vaccine continues to be one of the most politically-charged issues in American health care history. Fierce opposition to vaccination — often fueled by misinformation and rumor — continues among some Americans.

The "Died Suddenly" movie trended on social media in early 2023, only to be debunked as the weeks went on. Speculation over the cause of NFL player Damar Hamlin's collapse during a game included some social media posts saying that his vaccination status played a role (this has not been presented as a cause by medical personnel who treated him.)

All the controversy over vaccines probably has played a role in the relatively low uptake of the latest booster shots. The American Medical Association recently referred to "vaccine booster fatigue," with the group publishing an interview with Preeti Malani, MD, an infectious disease specialist, who says that even doctors are getting tired of discussing the pros and cons of COVID vaccines.

Malani notes that the available vaccines and boosters are not perfect — their protection decreases over time, for example. But he says it's important to make getting booster shots as easy as possible. "In our emergency department… there's a sign that says: 'If you haven't had your COVID-19 booster, let us know. We can give it to you on your way out.' It has to be the type of thing where we have vaccines available in places that people go. Like we did with flu shots — schools and workplaces have been central."

As time goes on, more research is being done on vaccines and boosters. A recently released report from the Centers of Disease Control and Prevention (CDC) found that the latest boosters show slightly higher protection against infection in general and significantly higher protection against death among those who contract COVID.

In addition, research from the school of medicine at Mount Sinai in New York City linked COVID vaccination with fewer heart attacks, strokes, and other cardiovascular issues among those who contract the disease. The findings matched those of an earlier study in Korea.

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