Editorial
Withdrawal of COVID funding compounds health inequalities
On Sept 18, 2022, US President Joe Biden declared the
pandemic over in the USA. The remarks, in a television
interview, come after the US Department of Health and
Human Services (HHS) announced that it could stop
purchasing and providing SARS-CoV-2 vaccines and
antiviral treatments as early as January, 2023, because
of insufficient funds from Congress, which would
mean that individuals would be able to obtain vaccines
and treatment only via their insurers or by paying
for it themselves. Administration officials claimed,
however, that the President’s comments did not reflect
a change in policy and COVID-19 is still a public health
emergency.
The withdrawal of low-cost or no-cost COVID-19
care does not take into consideration the 30 million
Americans of all ages who do not have health insurance
(2021 data), despite the role of the Affordable Care Act
in helping more people to afford coverage. Without
affordable access to testing, vaccines, and treatment,
those who are uninsured are at risk of being left
without the necessary protection against SARS-CoV-2
infection and severe COVID-19. In analyses of the
ethnicity of people who are uninsured, Hispanic adults
are most likely to have no coverage, followed by non-
Hispanic Black, non-Hispanic White, and non-Hispanic
Asian adults. Racial and ethnic minority groups have
poorer overall health than their White counterparts
in the USA, and it is perhaps unsurprising that the
demographic of those who are uninsured aligns with
that of people with worse health outcomes. However,
the HHS did announce that it was starting an initiative
to help uninsured and underinsured Americans to
access the COVID-19 monoclonal antibody treatment
bebtelovimab, despite it now being available on the
commercial market.
The move away from government funding for
COVID-19 prevention and care comes at a time when
inflation in the USA is at its highest since 1981, and the
associated increases in the cost of living and health-
care costs mean that individuals are experiencing an
unprecedented strain on their finances. High health-
care costs have led to approximately 98 million
Americans skipping medical treatment, cutting back
on other essentials, or even taking out loans to pay for
medical bills.
www.thelancet.com/respiratory Vol 10 November 2022
Over the past few months, the US health-care
Digicomphoto/Science
industry has been lobbying for increased federal
spending in response to the pandemic and increased
Photo Library
inflation; as a result, Medicare boosted its payments
to hospitals by the highest amount since 1998.
Although much of this funding has been invaluable to Published Online
October 3, 2022
facilities in dire need of support, such as hospitals in https://doi.org/10.1016/
rural areas, other hospitals have used these COVID-19 S2213-2600(22)00399-X
relief subsidies as a way to acquire further facilities For Biden’s interview with CBS
news and transcript see
or practices. As larger hospitals and health systems https://cbsn.ws/3ShgdzR
increase their market share, the average price of health For more on the US Department
of Health and Human Services
services provided also increases (by 6–18%), with no
(HHS) remarks see
associated increase in quality of care. Americans, who https://bloom.bg/3LKuvqa
have seen a decrease in their overall life expectancy For data on health insurance
coverage see https://bit.
from 78·8 years in 2019 to 76·1 years in 2021—the ly/3UL9KPp and https://bit.
lowest since 1996—are bearing the brunt of the health ly/3fopebz
sector’s focus on financial gain, by paying more for For the HHS announcement see
https://bit.ly/3SEiPr4
worse health. For more on high health-care
During the pandemic, some of the worst-hit costs in the USA see https://bit.
ly/3UHrECv
communities have been low-income households and
For more on lobbying by
people of colour; solutions to improve health outcomes hospitals see https://bit.
in these groups must be implemented now, before ly/3DWZEEU
For more on increases in
the onset of winter and the approaching flu season. hospital prices see https://bit.
In the USA, steps must be taken to make health care ly/3fpMc2k
and preventive care more affordable and accessible for For more on health spending
and health outcomes in the
underserved communities, including increasing the USA see https://bit.ly/3DXpk4h
availability of Medicare and considering restrictions For more on FDA approval of
on the price of health products or services. A thorough updated vaccines see https://
bit.ly/3SjUvLs
review of the current systems in place is urgently
needed to understand why, despite the USA spending
more on health care (as a proportion of GDP) than other
high-income countries, the performance of health
services and health outcome measures are so poor. With
new SARS-CoV-2 vaccines for omicron variants recently
approved by the US Food and Drug Administration,
one could argue that this is not the time to declare
the pandemic over and to stop government-funded
vaccination and treatment, as this could discourage
compliance with COVID-19 measures currently in place.
During this period of economic uncertainty and as the
world continues to respond to the acute and long-term
health effects of SARS-CoV-2 infection and COVID-19,
access to adequate health care is of paramount
importance in promoting health equity in the USA and
beyond. ■ The Lancet Respiratory Medicine
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