Biden’s new covid plan is a very American way of tackling disease

Masks off
Masks off
Image: Reuters/Sandra Sanders
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As 1,900 Americans a day continue to die of covid-19, the US government is starting a new approach to tackling the disease. It’s called “test to treat,” and it consists of testing people for the virus at pharmacies, and then immediately providing antiviral treatment with Pfizer’s drug Paxlovid (ritonavir) to anyone who tests positive.

The plan, announced by US president Joe Biden on March 1 during his first State of the Union address, is part of a new phase of the government’s covid-19 response strategy that puts a near-exclusive focus on vaccines and treatment. While high-quality masks will be made available for free to the immunocompromised, most mask requirements will be dropped, and contact tracing, which was never successfully implemented, will be stopped.

This signals a return to normal for US healthcare. After two years of extraordinary responses to an unprecedented pandemic, the new US approach to covid-19 is the one that has long characterized the country’s overall approach to medicine: treatment, rather than prevention, and individual responsibility over collective action.

Why prevent when you can treat?

Biden stressed that the change in approach doesn’t mean the country will have to learn to live with the virus. On the contrary, he said, the US will be ready to produce targeted vaccines should new variants emerge, and will continue to invest in treatments. It also will be ready with vaccines for children under five, if and when they are approved.

Yet the shift is clear. Rather than continuing to rely on communal containment measures—masking,  distancing, tracing—the US will double down only on pharmaceutical intervention, leaving to individuals the choice to protect themselves, and others.

By design, the US health system privileges treatment over prevention—all the better if it is new. Despite policy pushes to promote preventive measures in various areas of healthcare, their use in the US is still pretty low, with simple community health measures typically bypassed in favor of specialized intervention. After all, the financial rewards of selling drugs and other treatments are higher than those of not getting people sick in the first place.

Why “test to treat” isn’t enough

Dealing with a new virus had temporarily put the US in a situation where, until vaccines were available, non-pharmacological public health measures were essential. But Biden’s announcement—complete with a call for a return to in-person work—suggests that was an aberration that briefly allowed the virus to dictate how we live. It isn’t a coincidence that Pfizer—which expects $22 billion in revenue from Paxlovid—received two shout-outs in the president’s speech: for developing the drug, and for “working overtime” to produce it.

Of course, the availability of retroviral treatments is important, as is the ability to test in pharmacies. But without other containment measures, such as the requirement to wear a mask when in pharmacies, where presumably some people coming in to test will be positive—the risk of spreading preventable cases remains high.