Why The White House Shouldn't Privatize Covid Vaccines

Three years into the pandemic, we’re still a far cry from a promised “new normal” that would come from “learning to live with the virus.” 

In the US, according to the CDC, more than 10,000 people died of COVID in December 2022, capping off a year that saw some 263,000 COVID deaths. As of this writing, 4,000 people have died of COVID in each of the last two weeks. As of this writing, average weekly deaths in the US account for 1 in every 5 COVID deaths reported globally. And deaths are, of course, not the only impact of the pandemic: Think tanks have highlighted that millions of people have long COVID and many are out of work as a result. 

Despite this, the Biden administration has spent years painting the situation as beyond their control and as something we will have to accept, resisting calls to advocate for universal masking or to push for state and local mask mandates even during a national surge. The administration has pursued a vaccine-only strategy, leaving layered protections like masking by the wayside while as many as 61% of COVID deaths in a given month are among the vaccinated. This downplaying of masking has been intentional: In a March 2022 update to their COVID preparedness plan they wrote that “masks have been a critical tool to protect ourselves, but they have a time and a place.”

Around the same time, the CDC changed its COVID guidance to tie federal masking recommendations to a baroque formula prioritizing hospital capacity and admissions, dramatically limiting the use of actual case spread as an indicator. Yet even with our hospitals currently overwhelmed and a wave of nurses' strikes protesting the dire conditions, the Biden administration remains uninterested in changing course. 

In January 2023, a year after the debut of the new system, White House coronavirus response coordinator Ashish Jha told the Washington Post he worries that “we are going to have, for years, our health system being pretty dysfunctional,” meaning deferred care and long wait times across the system “because we’re going to be so overwhelmed with respiratory viruses.” It is unclear whether Jha realized his statements were a tacit admission that it is still the “time and place” for ongoing COVID protections.

Now, the Biden administration is pursuing a major change that we argue will make the ongoing pandemic substantially worse and much more difficult to hold them accountable: They want to transfer responsibility for payment for COVID vaccines and therapeutics to the private market. This move has as yet received precious little public opposition, but it is of enormous importance that we do everything in our power to stop it from happening.

Since their debut in the US, COVID vaccines and therapeutics such as Paxlovid have been free to the public because the federal government has paid for them. The government maintains contracts with pharmaceutical companies like Pfizer and Moderna to buy the drugs in large quantities and distribute them across the country with the stipulation that they are provided to people for free.

The Biden administration plans to end this arrangement as soon as this year. While we saw multiple allusions to this plan last year, the clearest articulation of the Biden administration’s intentions came from Jha in an August 2022 live stream when he spoke to the corporate lobbying group the US Chamber of Commerce. Jha stated, “We need to get out of that business … My hope is that in 2023 you’re going to see the commercialization of almost all of these products … so we just move them into the regular health care system. This business of kind of day-to-day running of a pandemic, It needs to transition,” he added.

It is hard to overstate just how much of a disaster it would be if the Biden administration is allowed to successfully transfer its responsibilities here. Over the course of the pandemic, activists have been operating under conditions where the federal government has been the central point of leverage on the pandemic response. While state and local governments, businesses, and the courts have been important centers of activity, the Biden administration has held enormous responsibility for everything from vaccinations to setting the terms of public debate over the virus.

The moment that changes, the entire advocacy landscape around COVID will change. All of a sudden it’s not primarily the federal, state, and local governments we have to appeal to. Instead, it will be the government plus every private insurance company under the sun, Medicaid programs state by state, Pfizer, Moderna, the FDA, the courts, Walgreens, CVS, pharmacy benefit managers … the list goes on. We know that COVID advocacy will be forced to split in this way because it is how our existing political economy of health care currently distributes responsibility for everything else.

In other words, while we believe the Biden administration has failed on COVID in many respects, we know one thing for certain: If there is one thing built to fail more than the Biden administration, it’s “the regular health care system” in the US.

The most immediate impact of this move has been dramatically foreshadowed. In October 2022, Pfizer announced plans to increase the price of their vaccine to between $110 and $130 per dose. In early January of this year, Moderna made a nearly identical announcement that it plans to raise the price of its vaccines to the same price point per dose as Pfizer.

 This is where it becomes important to have an understanding of the many failures of the US health care system. If responsibility for COVID vaccines is kicked to the private market, the effects of Pfizer and Moderna raising their prices will be felt extraordinarily unevenly. For people with private insurance and Medicare, vaccines are supposed to be provided free of charge, as stipulated in the CARES Act. But this is only for in-network providers, which means determining the pharmacy chain that takes your insurance will become another administrative burden already adding time and frustration for people trying to get vaccinated or boosted. Further, when the public health emergency is declared over, private health insurance companies will be allowed to decide whether or not to continue to cover COVID testing, which they are currently required to provide for free.

For people with Medicaid, the public health insurance program for the poor, the future of coverage is similarly uncertain as it varies from state to state and Medicaid programs are only required to cover COVID vaccines, testing, and therapeutics until the official declaration that the public health emergency is over. After that, it will be up to each state to determine whether to cover COVID-related care and how generously, unless there is further federal intervention. According to recent reports, the Biden administration may end the public health emergency as soon as April.

The Biden administration has stressed that they intend to figure out some kind of targeted intervention for people without insurance. But no concrete plan has been shared and targeted programs have a long and established history of being insufficient and excluding the very people they are putatively intended for. This means some uninsured people are likely to be charged out of pocket for COVID vaccines and treatments like Paxlovid.

It’s important to note that the uninsured population is soon expected to grow. As of April 1, states can begin the process of redetermining Medicaid eligibility and disenrolling recipients, a process that was on pause during the early years of the pandemic. As many as 15 million people are expected to be kicked off of Medicaid.

 If the Biden administration is allowed to go through with this, fewer people will get vaccinated and boosted and fewer people will get treatments like Paxlovid when they are ill. More people will get sicker. More people will get long COVID. And more people will die.

 Even if you don’t believe that all COVID care should be free—or believe, as we do, that we should freely provide all care to all people—these factors alone should turn you against Biden’s plan to move COVID care to the private market. Vaccination rates are already unforgivably low in the US. Only 15.3% of the entire population has gotten an updated booster. At the end of last year, only 3% of kids aged six months to two years had been fully vaccinated, and only 5%  between two and four years old.

Endless arguments have been made that low vaccination rates are exclusively due to “vaccine hesitancy” or to party ideology, but we have collectively underappreciated how much the ordinary dynamics of our political economy have been a driving force. Vaccination rates tend to be lower in poorer communities, regardless of party affiliation, suggesting that the same people currently abandoned under our health care system have been underserved even when COVID vaccines and therapeutics are free. The Biden administration could be pushing for pop-up clinics in poor communities, or pursuing more proactive measures like programs that go door to door. Instead, they’re washing their hands of the whole thing.

All of these problems have an easy solution: Don’t let them happen.

The federal government already pays for dialysis for most people who need it regularly. While we believe the federal government should be the “single payer” for all health care, there’s no reason why the government shouldn’t continue to pay for all COVID vaccines and therapeutics. There’s also no reason the federal government shouldn’t have to pay for all COVID care in general, including hospitalization. In fact, a program existed to do exactly that for all uninsured people until the Biden administration unceremoniously ended it in March 2022. There’s also no reason for them not to pursue federally guaranteed paid sick leave or to broaden eligibility and enhance benefits for disability policies like SSI and SSDI to better support the people that desperately need them. And to keep people from getting sick in the first place, the Biden administration should be actively pushing masking policies along with programs that provide masks for free.

We can’t just let them do this. If the Biden administration sticks to the current strategy, it will consign us to a perpetual COVID crisis, a lasting pandemic it has refused to take seriously. And if they want a perpetual COVID crisis, they must at a minimum be responsible for paying for that crisis in perpetuity. Forcing them to maintain responsibility for the pandemic, for the state to bear the cost the Biden administration would force on all of us, is the very least we can do.