On Sept 18, 2022, US President Joe Biden declared the pandemic over in the USA. The remarks, in a television interview, come after the US Department of Health and Human Services (HHS) announced that it could stop purchasing and providing SARS-CoV-2 vaccines and antiviral treatments as early as January, 2023, because of insufficient funds from Congress, which would mean that individuals would be able to obtain vaccines and treatment only via their insurers or by paying for it themselves. Administration officials claimed, however, that the President’s comments did not reflect a change in policy and COVID-19 is still a public health emergency.

The withdrawal of low-cost or no-cost COVID-19 care does not take into consideration the 30 million Americans of all ages who do not have health insurance (2021 data), despite the role of the Affordable Care Act in helping more people to afford coverage. Without affordable access to testing, vaccines, and treatment, those who are uninsured are at risk of being left without the necessary protection against SARS-CoV-2 infection and severe COVID-19. In analyses of the ethnicity of people who are uninsured, Hispanic adults are most likely to have no coverage, followed by non-Hispanic Black, non-Hispanic White, and non-Hispanic Asian adults. Racial and ethnic minority groups have poorer overall health than their White counterparts in the USA, and it is perhaps unsurprising that the demographic of those who are uninsured aligns with that of people with worse health outcomes. However, the HHS did announce that it was starting an initiative to help uninsured and underinsured Americans to access the COVID-19 monoclonal antibody treatment bebtelovimab, despite it now being available on the commercial market.

The move away from government funding for COVID-19 prevention and care comes at a time when inflation in the USA is at its highest since 1981, and the associated increases in the cost of living and health-care costs mean that individuals are experiencing an unprecedented strain on their finances. High health-care costs have led to approximately 98 million Americans skipping medical treatment, cutting back on other essentials, or even taking out loans to pay for medical bills.

Over the past few months, the US health-care industry has been lobbying for increased federal spending in response to the pandemic and increased inflation; as a result, Medicare boosted its payments to hospitals by the highest amount since 1998. Although much of this funding has been invaluable to facilities in dire need of support, such as hospitals in rural areas, other hospitals have used these COVID-19 relief subsidies as a way to acquire further facilities or practices. As larger hospitals and health systems increase their market share, the average price of health services provided also increases (by 6–18%), with no associated increase in quality of care. Americans, who have seen a decrease in their overall life expectancy from 78·8 years in 2019 to 76·1 years in 2021—the lowest since 1996—are bearing the brunt of the health sector’s focus on financial gain, by paying more for worse health.

During the pandemic, some of the worst-hit communities have been low-income households and people of colour; solutions to improve health outcomes in these groups must be implemented now, before the onset of winter and the approaching flu season. In the USA, steps must be taken to make health care and preventive care more affordable and accessible for underserved communities, including increasing the availability of Medicare and considering restrictions on the price of health products or services. A thorough review of the current systems in place is urgently needed to understand why, despite the USA spending more on health care (as a proportion of GDP) than other high-income countries, the performance of health services and health outcome measures are so poor. With new SARS-CoV-2 vaccines for omicron variants recently approved by the US Food and Drug Administration, one could argue that this is not the time to declare the pandemic over and to stop government-funded vaccination and treatment, as this could discourage compliance with COVID-19 measures currently in place.