Can mailing free Covid-19 tests turn Biden’s pandemic response around?

WASHINGTON — In an effort to regain the trust of the American public when it comes to his pandemic response, President Biden is launching a massive, slapdash effort to distribute Covid-19 tests by mail.

Given the complicated distribution logistics, supply chain questions, and uncertainty about where the pandemic will go next, however, there are real questions about whether the push will succeed — or backfire for Biden.

Biden’s overall approval rating has been underwater since last summer, but polls still showed that most Americans supported his handling of the Covid-19 pandemic — until last week.

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As the Omicron variant has caused a mammoth surge in cases, dwarfing prior pandemic waves, hospitals are overwhelmed. People are scared. And two years into the pandemic, many can’t find Covid-19 tests.

Enter the Biden administration’s new plan to distribute 1 billion at-home, rapid Covid-19 tests by mail. Demand is high: Even before its official rollout, the site accounted for more than half of the traffic to all government websites on Tuesday. Aside from a few glitches, all seems to be going fairly smoothly so far. If the White House can deliver, it could be a far-reaching victory that could practically help people make safer decisions about their health.

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“While the debate about most issues lives in an echo chamber around Washington, this is the type of issue people are talking about over their dinner at night,” said Jesse Ferguson, a campaign expert and longtime Democratic operative.

But if the White House falters — if people can’t get tests, or can’t get them for months — it could be a serious blow. Biden campaigned on righting blunders in the Covid-19 response. Though he oversaw a successful effort to make vaccines widely available, now he’s playing catch-up with a rapidly changing threat.

“If it goes badly, he’s going to get blamed for it,” said Elaine Kamarck, a senior fellow at the Brookings Institution and an expert on electoral politics and public policy.

As the rollout continues, there are three areas to watch to determine whether this ambitious testing initiative could help build momentum in the Biden White House’s pandemic response, or prove an embarrassing misstep.

Distribution logistics

Manufacturers are scrambling to keep up with existing demand for Covid-19 at-home tests. And while Biden has promised to ship Americans 500 million tests starting in late January, there just aren’t 500 million tests laying around for the White House to buy up. As of late last week, the White House only had “tens of millions” of tests on hand, a senior administration official told reporters.

Right now, U.S. manufacturers will only be able to make about 1.14 billion at-home antigen tests between January and March, according to a group of academics, consultants, and volunteers who track the data called the Covid-19 Response Advisors — and not all of those will go to the White House effort.

The White House does have contracts to buy more than 420 million tests, according to the Department of Defense, but those tests don’t have to be delivered to the federal government until March 14.

This all means that it may be tough for the White House to ship out all the tests that are ordered seven to 12 days after orders are placed, as Biden has promised.

One important variable in the success of distribution will be the pace with which Americans order tests, said Mara Aspinall, a professor at Arizona State University and adviser to The Rockefeller Foundation on Covid diagnostics.

Limiting the tests to four per household should help stretch out demand long enough for the administration to get the rest of the tests, as long as the manufacturers can hold up their end of the deal. It’s also an opt-in process. Millions of Americans remain stubbornly unconcerned about the virus, and unlikely to order tests.

Commercial availability

The federal government told test manufacturers that supplying tests for the the order-by-mail initiative isn’t supposed to interfere with their commitments to state governments or commercial buyers. And the White House is asking more from manufacturers like iHealth and Roche, which only just saw their antigen tests authorized by the FDA. In theory, then, they should be able to make tests that aren’t already promised to other entities.

Demand for at-home Covid-19 tests was volatile throughout 2021, as more people got vaccinated through the spring. But variants began battering the nation again in the summer, fall, and winter. Critics of the administration’s approach argue that the massive purchase orders are pulling tests out of the market when there’s not enough supply to meet the current demand.

“They are sucking these tests out of the private market because they did not focus on increasing the supply of antigen testing during the summer and fall,” said Joe Grogan, the head of the White House Domestic Policy Council under former President Trump.

But testing experts said for the long term, it’s a good thing to ensure large government orders of tests over a period of time, as it provides more certainty to companies that are making investments to scale up manufacturing capacity that won’t be ready until after the current surge in cases has passed.

“Even now, it might end up being too late, but there are additional letters of the Greek alphabet,” said Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security.

Even if some tests are being pulled out of the market, a major advantage of the White House approach is that the tests are free. And because they will be distributed by the federal government, it mitigates policy differences that could be created by governors at the state level, Gronvall said.

Slowing the spread

Whether or not Americans receive tests quickly enough to be useful in this phase of the pandemic, it’s unclear how much increasing access to rapid tests would alleviate stress on the health care system or mitigate overall case rates.

Access to rapid tests is not the end-all be-all. The United Kingdom, for example, facilitated significant access to rapid tests but still had a massive spike in cases due to the Omicron variant, Gronvall said.

But giving someone a test can make a difference for people trying to make decisions about daily activities.

“For individuals, it offers peace of mind. We don’t know yet the impact from a broader public health perspective,” Aspinall said.

Americans are frustrated by the lack of available testing as yet another example of scientists and government officials being woefully unprepared for the latest twist in the Covid-19 pandemic. While the Biden administration had initially campaigned on a return to normalcy, that normal seems elusive. Simply having a few at-home tests available won’t fix the broader societal issues caused by the pandemic slog.

“The marker is not the tests. The marker is are we getting back to normal. It will reflect well on (Biden) if the tests help us keep schools open, and workplaces open,” said Kamarck.

Source: STAT