Biden's plan for ending the emergency declaration for COVID-19 signals a pivotal point in the pandemic – 4 questions answered

President Joe Biden announced on Jan. 30, 2023, that he intends to end^[1] both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023.

Biden’s announcement came on the same day that the World Health Organization said it still considers the COVID-19 pandemic^[2] to be a public health emergency of international concern, or PHEIC^[3], a status that is reassessed every three months. The WHO’s advisory committee noted that although the pandemic is at a turning point, “COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems.”

The Conversation asked public health experts Marian Moser Jones^[4] and Amy Lauren Fairchild^[5] to put these statements into context and to explain their ramifications for the next stage of the pandemic.

What does ending the emergency phase of the COVID-19 pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency^[6], first declared on Jan. 31, 2020, and the COVID-19 national emergency^[7] that President Donald Trump announced on March 13, 2020 – will be allowed to expire in May 2023.

Declaring those emergencies enabled the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently. For instance, the declarations allowed funds to be made available^[8] so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made resources available to launch investigations into the “cause, treatment or prevention^[9]” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements^[10] for accessing Medicare, Medicaid and the Children’s Health Program. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid^[11] and Medicare to more easily cover telehealth services^[12].

What policy changes will occur once the emergency is declared over?

The end to the federal emergency could substantially reduce^[13] the number of people insured under Medicaid. Before the pandemic, states required people to prove every year that they met income and other eligibility requirements.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. In a December 2022 appropriations bill, Congress passed a provision that will end continuous enrollment on March 31, 2023.

The Biden administration has defended this time frame as sufficient^[14] to ensure that “patients do not lose access to care unpredictably” and that state Medicaid budgets – which have been infused with emergency funds since 2020 – “don’t face a radical cliff.” But many people with Medicaid may be unaware of these changes until they actually lose their benefits.

Some states have already indicated that they will begin disenrolling members in April 2023^[15] or require members to apply to be considered for renewal^[16]. This could result in between 5 million and 14 million people^[17] losing coverage.

People with Medicare do not have to worry about losing their benefits, since this program is age-based, not income-based. The array of telehealth services that Medicare began covering during the pandemic^[18] will continue to be covered through December 2023. Medicare coverage for many telehealth services could also be made permanent^[19] after this year.

The end of the emergency could additionally curb access to COVID-19 drugs, tests and vaccines. Federal emergency funding for free treatment or vaccination will end when the emergency status is lifted on May 11. If such programs are to continue, the cost will fall^[20] to state and local health agencies or insurance companies.

We are concerned that the withdrawal of federal emergency funds for vaccination may further slow the already sluggish uptake of boosters. As of Jan. 25, 2023, about 20% of the population ages 5 and up^[21] and only 40.1%^[22] of those 65 and older – who are at the highest risk of death from COVID-19^[23] – had received an updated bivalent booster^[24] dose. Once the emergency ends, measures that allowed^[25] a broad array of health providers – from pharmacist interns to retired nurses and even veterinarians – to administer vaccines will expire, which could lead to decreased access to vaccination in many parts of the U.S.

What does this mean for the status of the pandemic?

A pandemic declaration^[26] represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more states and that controlling it requires an international response.

At some point the WHO will end its pandemic declaration. On Jan. 30, 2023, World Health Organization Director-General Tedros Adhanom Ghebreyesus described the pandemic as being “at a transition point^[27].” But the WHO’s assessment is that the risks are still considerable. Ghebreyesus noted that COVID-19 continues to strain health care systems, exacerbate health care workforce shortages and exceed surveillance system capacities.

The U.S. remains one of the global COVID-19 hot spots^[28]. With more than 3,500 hospitalizations per week on average^[29] in January 2023, and 3,452 deaths per week as of early February 2023, the U.S. has among the highest deaths per capita in the world^[30].

How does the Biden administration’s stance differ from the WHO’s position?

In some ways they are very similar. The WHO is looking at the pandemic from a global perspective while the Biden administration is examining it from a national perspective. The WHO’s stance reflects the assessment that the world is not sufficiently vaccinated, that health care systems remain vulnerable and that unchecked disease transmission in some parts of the world should remain a source of international concern and attention.

China’s massive outbreak after the lifting of its zero-COVID policy^[31] in early December 2022 has received a great deal of media attention^[32]. But less noted is the fact that vaccination rates across^[33] African nations average 40%, and that vaccination rates are very low in countries that are experiencing conflict, such as Syria, where only 15% of the population has received any COVID-19 vaccine.

The WHO’s continuation of the global pandemic status signals that there is more international coordination and work to be done. In contrast, the Biden administration is making a social and political judgment that it is time to wind down the federal role.

Biden’s order will not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions^[34] allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Almost all U.S. states, however, have ended their own public health emergency^[35] declarations. Eight states – California, Colorado, Delaware, Georgia, Illinois, New Mexico, Rhode Island and Texas – still have emergency declarations in effect, but all of them will expire by the end of February 2023 unless renewed.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, it could be a long time before either politicians or the public regain an appetite for any emergency orders directly related to COVID-19.

References

1. ^{^} he intends to end (www.whitehouse.gov)
2. ^{^} considers the COVID-19 pandemic (www.who.int)
3. ^{^} public health emergency of international concern, or PHEIC (www.who.int)
4. ^{^} Marian Moser Jones (cph.osu.edu)
5. ^{^} Amy Lauren Fairchild (cph.osu.edu)
6. ^{^} federal Public Health Emergency (www.phe.gov)
7. ^{^} COVID-19 national emergency (www.whitehouse.gov)
8. ^{^} funds to be made available (aspr.hhs.gov)
9. ^{^} cause, treatment or prevention (aspr.hhs.gov)
10. ^{^} suspending many requirements (aspr.hhs.gov)
11. ^{^} enabled Medicaid (www.medicaid.gov)
12. ^{^} more easily cover telehealth services (telehealth.hhs.gov)
13. ^{^} could substantially reduce (theconversation.com)
14. ^{^} defended this time frame as sufficient (www.whitehouse.gov)
15. ^{^} begin disenrolling members in April 2023 (medicaid.ohio.gov)
16. ^{^} apply to be considered for renewal (www.hhs.texas.gov)
17. ^{^} 5 million and 14 million people (www.kff.org)
18. ^{^} covering during the pandemic (telehealth.hhs.gov)
19. ^{^} be made permanent (www.cms.gov)
20. ^{^} the cost will fall (www.kff.org)
21. ^{^} about 20% of the population ages 5 and up (www.cdc.gov)
22. ^{^} only 40.1% (covid.cdc.gov)
23. ^{^} at the highest risk of death from COVID-19 (doi.org)
24. ^{^} updated bivalent booster (theconversation.com)
25. ^{^} measures that allowed (doi.org)
26. ^{^} A pandemic declaration (www.ncbi.nlm.nih.gov)
27. ^{^} at a transition point (www.cnn.com)
28. ^{^} global COVID-19 hot spots (covid19.who.int)
29. ^{^} 3,500 hospitalizations per week on average (covid.cdc.gov)
30. ^{^} among the highest deaths per capita in the world (www.nytimes.com)
31. ^{^} lifting of its zero-COVID policy (www.npr.org)
32. ^{^} received a great deal of media attention (www.bbc.com)
33. ^{^} vaccination rates across (ourworldindata.org)
34. ^{^} included provisions (telehealth.hhs.gov)
35. ^{^} ended their own public health emergency (nashp.org)