Public health experts were appalled Monday to hear an idea that many of them consider vital — making at-home rapid antigen tests for Covid-19 free for all Americans — dismissed as ridiculous by President Joe Biden’s press secretary, Jen Psaki.
In an oddly combative exchange with Mara Liasson of NPR, who asked why the United States chose not to emulate countries like the United Kingdom, which sends packs of seven free rapid tests to anyone who asks for them, the president’s spokesperson first suggested, wrongly, that the tests used in other countries might not work. Psaki then boasted that the U.S. had gotten some retailers to lower costs and would soon require private insurance companies to start reimbursing clients who buy rapid tests.
Many are ridiculing this dismissive and out of touch take by @PressSec on Covid tests.
But for me it’s the ‘how much does it cost’ part.
We spent BILLIONS AND BILLIONS on vaccines that we would never consider charging for.
Tests should be no different.pic.twitter.com/bf7JnpYTbH
— Craig Spencer MD MPH (@Craig_A_Spencer) December 7, 2021
“That’s kind of complicated, though,” Liasson said. “Why not just make ’em free and give ’em out, make them available everywhere?”
“Should we just send one to every American?” Psaki shot back, her voice dripping with sarcasm.
“Maybe,” Liasson replied.
“Then what happens if you, if every American has one test? How much does that cost?” Psaki asked, suggesting that sending Americans tests to regularly screen themselves for the virus would be prohibitively expensive.
Experts who have pushed for the Biden administration to flood the country with free rapid tests, as a way of finding asymptomatic cases to slow the spread of the virus, were particularly outraged that the president’s spokesperson suggested that the initiative would be too costly.
“By dismissing the idea of sending every American a rapid test due to cost, she seems to imply that the insurance reimbursement plan won’t come close to doing that,” Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins Coronavirus Resource Center, commented on Twitter. Nuzzo had complained to The Hill earlier this week that the administration was placing “barriers” in front of people by not simply buying tests for all Americans. “The most preferable option would be to make these goddamn things free or close to free and make them widely available so people can just pick them up,” she said.
“Rapid tests are hard to get, expensive & could be a key intervention in fighting #COVID19,” Gregg Gonsalves, an associate professor of epidemiology at Yale Medical School, wrote in a tweet addressed to Psaki and Jeff Zients, the White House Covid-19 response coordinator. “Other countries have figured out better ways to get these tools into the hands of their citizens. Do better.”
“Give out rapid tests to every household? Yessss! Of course, we should!” Oni Blackstock, a doctor who once led New York City’s response to the HIV/AIDS epidemic, chimed in on Twitter. “That this appears to be some quixotic idea to the administration is incredibly concerning and a reminder of why we have not been able to get control this pandemic here in the US.”
Michael Mina, a physician who teaches at the Harvard T.H. Chan School of Public Health, estimated more than a year ago that the spread of Covid-19 could be dramatically curtailed if just half of the U.S. population tested themselves every four days with at-home rapid kits that could cost the U.S. government as little as $5 billion.
Mina, who argues that the U.S. government should mail rapid tests to every American household, suggested that Psaki’s comments reveal that the administration is unwilling to take emergency measures to fight the coronavirus pandemic that might challenge the nation’s fundamentally for-profit health care system. “Maybe at some point our FDA, CDC and administration will understand finally this is a PUBLIC HEALTH problem, and not a Medical problem to make $$ off of,” Mina tweeted. “Maybe.”
What Psaki’s comments accidentally drew attention to is that even during a pandemic, Americans are still paying more for health care than their counterparts in countries with socialized medicine or single-payer systems.
Experts like Mina and Nuzzo have urged the U.S. government to use its leverage to press test-makers to sell the kits for between $1 and $5 each. But because the Biden administration has tried to work within the constraints of America’s profit-driven system, commercially available rapid tests are considerably more expensive for consumers and often hard to find in stores. Abbott Laboratories’ BinaxNOW kit, for instance, can be purchased by the government for $5 each but costs consumers $11.99 a test at CVS or Walgreens.
The U.S. government’s reticence to use emergency powers to get the testing kits made for less contrasts sharply with the situation in Europe, where more efficient government-run health care systems are the norm.
In September, for instance, the Biden administration struck a deal with Walmart, Amazon and Kroger to sell Abbott’s tests at the discount price of $7 each for three months. But Reuters reports that the British government is paying about $5.80 each for similar test kits (which cost about $2 each to make) that it distributes for free.
As a result of the distribution of free tests, and a public information campaign showing citizens how to use the test kits, the British government reports that about 4 million rapid tests are now being done at home each week in England. Anyone who tests positive on a rapid test, which is sensitive but less accurate than a PCR test, is instructed to self-isolate to keep from spreading the virus and given a lab-processed PCR test to confirm the diagnosis. So far, those PCR tests show that the rapid tests are accurate about 90 percent of the time.
Because the U.K.’s National Health Service makes it easy to report the home test results, the country’s health authorities also have a better idea of how many of its citizens are infected with SARS-C0V-2, the virus that causes covid-19, than their U.S. counterparts.
In Germany, the government used its buying power to offer rapid tests to the public for less than $1 each — although the outgoing government recently ended the subsidy for adults, as part of a drive to encourage people to get vaccinated instead of relying on cheap tests. (Germans can also get high-quality face masks that work as well as N95s for $1.50 each.)
While employers in the U.S. are struggling to buy enough tests to meet government mandates to test unvaccinated workers, Canada’s government simply provides rapid tests to businesses for free.
In October, the Food and Drug Administration finally agreed to issue an emergency use authorization for Acon Laboratories’ Flowflex antigen home test, which was already widely available in Europe and is made by a company based in San Diego. That test currently retails at CVS in the U.S. for $9.99. Photographs of the same American company’s test being stocked on shelves in the Netherlands last week showed it on offer for about one-third of that price, $3.37 (2.99 euros).
At a press briefing on Tuesday, Zients, the White House Covid-19 response coordinator, was asked to explain Psaki’s comments from the day before about why the U.S. does not simply follow the lead of the U.K. by sending Americans free at-home rapid tests. Zients said that the administration’s plan was “more nuanced than that” and suggested that it would be inefficient to mail tests to everyone since some might go unused.
Zients went on to defend the approach Biden had laid out in a speech last week, stressing that home tests for Americans with private health insurance would soon be effectively free — once they pay the retail price and then do the paperwork to get reimbursed by their insurers — and that the administration plans to send out 50 million rapid tests to clinics this month for the uninsured and those on Medicare and Medicaid.
Zients also stressed that the administration had overseen FDA approval of 13 different rapid tests this year. “With more competition,” Zients said, using the language of the market, “that leads to innovation, that leads to prices coming down.”
There is broad agreement among career scientists in the government that getting far more Americans to use rapid tests would be a big advance. “Rapid antigen testing at home, two to three times per week, is a powerful and convenient way for individuals to screen for Covid-19 infection,” Bruce Tromberg, director of the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health, said in July. “With schools and businesses reopening, an individual’s risk of infection can change from day to day. Serial antigen testing can help people manage this risk and quickly take action to prevent spread of the virus,” he added.
There is broad agreement among career scientists in the government that getting far more Americans to use rapid tests would be a big advance.
Health policy experts, however, say that even a recent federal investment of $3 billion, meant to spur the production of enough rapid tests for all Americans who want to use them, is still inadequate. In October, the Department of Health and Human Services estimated that “President Biden’s recent announcement to quadruple supply of at-home tests by the end of the year by investing a total of $3 billion in rapid testing” would lead to a supply of “up to 200 million at-home tests per month by the end of the year.”
When the FDA approved the use of the Acon Laboratories Flowflex home test, that estimate was increased to a potential supply of 300 million rapid tests being produced in the U.S. each month by February. But as Lindsey Dawson, an associate director at the Kaiser Family Foundation, wrote last month: The “new U.S. investment, even if resulting in 300 million rapid tests per month, would be less than one test per month per person in the U.S. For two times per week testing, it would cover less than 40 million individuals. If everyone older than 11 were tested twice per week per the UK’s recommendation, we would need 2.3 billion tests per month. If just half the U.S. population tested weekly, that would translate to a need for more than 150 million tests per week, around 600 million per month.”
To reach that number of tests, the cost to consumers will have to plummet, but there is currently no sign that the Biden administration has any plans to compel the companies that make the tests to slash prices in a way that would dent their profits.
“I just did a BBC interview. The host said that in the U.K. you can just walk into a pharmacy and pick up free tests,” Craig Spencer, an emergency medicine doctor in New York who teaches public health at Columbia University, tweeted last week. “I informed him that at-home tests in the US cost $8-$10 each — if you can find them — and I’m not sure but I think maybe his head exploded.”
“But don’t worry, next month in the U.S., if you’re lucky enough to have private health insurance, you MIGHT have the opportunity to submit the costs of SOME at-home tests to an insurance company whose only motive is profit,” Spencer added.