Browse the corpus

The COVID-19 emergency in the USA is ending. On May 11, the US public health emergency declaration will expire, and other emergency authorisations have already stopped. As a result, sweeping provisions to support the COVID-19 response are ceasing. These changes have symbolic importance too. To say that the emergency is over is a watershed moment in one of the worst health disasters in the history of the USA. What happens now? The Department of Health and Human Services has provided a roadmap outlining the transition away from the public health emergency. Although COVID-19 vaccines will probably be covered at least until Sept 30, 2024, COVID-19 treatments and testing might require out-of-pocket expenses based on health insurance. Medicaid determination is being pushed back to individual states; several states have already begun roll-backs, leading to an estimated 15 million newly underinsured or uninsured people. The mandatory sharing of laboratory COVID-19 test results and local and state vaccine data with the US Centers for Disease Control and Prevention (CDC) will end. The government is also hoping to advance new health technologies through Project Next Gen, with US$5 billion to speed the development of next-generation COVID-19 vaccines and therapies.

boratory COVID-19 test results and local and state vaccine data with the US Centers for Disease Control and Prevention (CDC) will end. The government is also hoping to advance new health technologies through Project Next Gen, with US$5 billion to speed the development of next-generation COVID-19 vaccines and therapies. Moving forward also requires a reckoning with the mistakes of the past. For COVID-19, this means understanding the key contradiction at the heart of the pandemic in the USA. How did the world's richest country, ranked first in its ability to respond to pandemics according to the Global Health Security Index, see more than 1·1 million people die from COVID-19 and have one of the highest rates of death per capita in the world? First, COVID-19 laid bare the country's underlying health disparities. A study by Bollyky and colleagues in The Lancet shows that US states with higher percentages of Black or Hispanic Americans, higher poverty rates, lower levels of education, and less access to quality health insurance had increased COVID-19 mortality rates. This speaks to the syndemic nature of COVID-19: an interaction between viral infection and non-communicable diseases, operating against a backdrop of social and economic disparity. The USA's inequitable and variable population health, high levels of non-communicable diseases, and its lack of universal health coverage left the country susceptible.

nature of COVID-19: an interaction between viral infection and non-communicable diseases, operating against a backdrop of social and economic disparity. The USA's inequitable and variable population health, high levels of non-communicable diseases, and its lack of universal health coverage left the country susceptible. The immediate response to COVID-19 was characterised by poor leadership. The Trump administration's disdain for evidence-based decision making impeded the response to the pandemic. Partisanship in Congress frequently stalled much-needed COVID-19 relief packages, such as the CARES Act, leading to increased inequities. Heated debates on the benefits of measures such as masking served to conflate public health policy and political affiliation. Agencies such as the CDC struggled to operate effectively in such an environment. Rochelle Walensky, the current CDC director, says that the CDC was “responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications”, and has promised to reform the agency as a result. Polling has shown that trust in the CDC has fallen over the course of the pandemic—restoring this trust is essential. The introduction of a new White House Office of Pandemic Preparedness and Response Policy risks further fragmenting authority during future health emergencies.

promised to reform the agency as a result. Polling has shown that trust in the CDC has fallen over the course of the pandemic—restoring this trust is essential. The introduction of a new White House Office of Pandemic Preparedness and Response Policy risks further fragmenting authority during future health emergencies. Operation Warp Speed created novel COVID-19 vaccines and therapies in record time, yet the CDC estimates that COVID-19 vaccine hesitancy was over 25% in some areas during the pandemic. Vaccine misinformation was rampant and political affiliation during the 2020 election was correlated with lower COVID-19 vaccination rates. Low vaccine uptake is also linked to racial discrimination and racist structural barriers, which are all too common in the USA. Clearly, the US public health promotion of COVID-19 vaccines was inadequate. The Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA aims to provide a plan to support high acceptance of safe and effective vaccines in the country.

n and racist structural barriers, which are all too common in the USA. Clearly, the US public health promotion of COVID-19 vaccines was inadequate. The Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA aims to provide a plan to support high acceptance of safe and effective vaccines in the country. The USA has been through a traumatic event that should prompt deep reflection and open the way to transformative change. Yet the country seems at risk of falling prey to the cycle of panic and neglect that characterises the response to many health emergencies. The country may move on for now, but unless it faces up to the root causes of the harm COVID-19 did in the USA—health inequities, lack of access to health care, non-communicable diseases, a poisonous political discourse, and mistrust in public health institutions—it will likely find history repeating itself when the next pandemic comes. For more on COVID-19 vaccine misinformation see eClinicalMedicine 2021; 33: 100780 For more on COVID-19 vaccine misinformation see eClinicalMedicine 2021; 33: 100780 U.S. President Joe Biden puts on a protective mask after delivering remarks on the implementation of the American Rescue Plan in the State Dining Room of the White House in Washington, D.C., U.S., on Monday, March 15, 2021. Biden is planning the first major federal tax hike since 1993 to help pay for the long-term economic program designed as a follow-up to his pandemic-relief bill, according to people familiar with the matter. Photographer: Yuri Gripas/Abaca/Bloomberg via Getty Images © 2023 Bloomberg/Getty Images2023