Why Are At-Home Rapid Antigen Tests Hard To Find In The US? : Consider This from NPR Almost two years into the pandemic, at-home rapid tests can still be difficult to find in the U.S. If you do find them, they're often expensive. Other countries are faring better, like the U.K. and South Korea, which provide free tests each day to anyone who wants them.

Why is the U.S. different? NPR's Yuki Noguchi reports.

In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

Hunting A Rapid COVID Test For The Holidays? Good Luck With That

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It's going to happen. In the next few weeks just before a big holiday gathering, someone's going to feel sick. Is it COVID, a winter cold? In theory, there would be an easy way to find out.


UNIDENTIFIED PERSON #1: But if you've tried to find an at-home rapid test, it may have been a challenge.

SHAPIRO: Yeah, at least in most of the United States.


UNIDENTIFIED PERSON #2: Many Americans are having difficulty...

UNIDENTIFIED PERSON #3: ...Increasingly difficult...

UNIDENTIFIED PERSON #4: ...Very difficult to find right now.

UNIDENTIFIED PERSON #5: ...Hard to find.

UNIDENTIFIED PERSON #2: ...Finding over-the-counter rapid tests for at-home use.

SHAPIRO: Now, Colorado, Iowa and Massachusetts are among the states with free rapid testing programs. And counties scattered across the U.S. have them, too. But for most Americans, that is not the current reality. This month, President Biden said there would be some new solutions.


PRESIDENT JOE BIDEN: The bottom line, this winter, you'll be able to test for free in the comfort of your home and have some peace of mind.

SHAPIRO: Biden said the government would make free rapid tests a key pillar of his administration's winter COVID strategy, in part by requiring health insurance providers to pay for them and by investing in more free testing sites. But public health experts say it's not enough.


CELINE GOUNDER: If you want people to use rapid testing frequently and to incorporate that into their regular routines, it really needs to be free. It needs to be easy.

SHAPIRO: Dr. Celine Gounder at New York University has advised the Biden administration on its COVID response.


GOUNDER: And the added step of having to get your insurance company to reimburse you for it is really making this far too difficult.

SHAPIRO: CONSIDER THIS. Almost two years into the pandemic, rapid at-home tests are still not a mainstream public health tool in the U.S. We'll explain why and why other countries are faring better.


SHAPIRO: From NPR, I'm Ari Shapiro. It's Monday, December 13.

It's CONSIDER THIS FROM NPR. It's not just that at-home COVID tests can be hard to find. If you do find one, they're not cheap. Like in the U.S., they can run 25 bucks for a box of two tests, which is why NPR's Mara Liasson asked White House Press Secretary Jen Psaki this question in a press briefing at the White House last week.


MARA LIASSON, BYLINE: But there's still a lot of countries like Germany and the U.K. and South Korea that basically have massive testing, free of charge or for a nominal fee. Why can't that be done in the United States?

JEN PSAKI: Well, I would say first, you know, we have eight tests that have been approved by the FDA here.

SHAPIRO: That's not a big number when you consider that in Europe, there are at least 46 rapid tests available for in-home use. Psaki said tests approved in the U.S. may be more reliable than others overseas, and she pointed to the administration's efforts to get free rapid tests to community health centers and rural clinics, as well as the new requirement for private insurance to cover them - well, reimburse people for them.


LIASSON: ...Kind of complicated, though. Why not just make them free and give them out to - and have them available everywhere?

PSAKI: Should we just send one to every American?


PSAKI: Then what - then what happens if you - if every American has one test? How much does that cost? And then what happens after that?

SHAPIRO: A lot of public health experts took note of that exchange. And some of them have told NPR, yes, sending every American COVID tests would be a great idea. It's basically what the U.K. does. There, the government provides seven free tests per day to anyone who wants them. It's so popular the U.K. had to pause new online orders for at-home tests today. But think about it. You could test yourself each day before going to work, throwing a holiday party or gathering with family. Just offer everybody a test when they arrive, before they take off their masks. After all, the U.S. has invested enough money for every American to get a vaccine or three. Why not tests, too?

NIRAV SHAH: Testing never really took on the same talismanic or politically divisive nature that other types of mitigation steps in the pandemic did, be it masking or, more recently, vaccines.

SHAPIRO: Dr. Nirav Shah is director of the Maine Center for Disease Control and Prevention. He's one of many public health officials who've told NPR easier, faster testing is crucial. And he says while rapid at-home tests are not as accurate as PCR tests that come from a lab, they're still useful.

SHAH: They're meant to be used ideally in a serial manner. So if you're not feeling well, you can take them multiple times over the course of the week. And by having a rapid result, again, what you lose a bit in terms of accuracy, you actually gain much more because of the repeated, serial nature of using those tests. Again, for where we are in the pandemic, the central question that folks need to answer is - hey, is it safe for me to go to this birthday party? Is it safe for me to go to this event this weekend? And these rapid at-home tests afford you that.

SHAPIRO: That is, if you can get one. The reasons that's still difficult in the U.S. are complicated. And some of the challenges can be traced back years. NPR's Yuki Noguchi dug into it.

YUKI NOGUCHI, BYLINE: Kavita Patel treats mostly poor patients at a health center in D.C. It's hard enough, she says, convincing them to test for COVID.

KAVITA PATEL: I mean, literally, most of my patients don't want to test because they don't want to know the answer. People don't want to miss work, so you have to kind of go through, like, this is why you have to test because you could actually die.

NOGUCHI: Patel says it would be safer and easier if patients could test at home to quickly assess whether they're infectious. But over-the-counter tests are too expensive and, she says, often hard to find.

PATEL: Shouldn't this be so damn easy that there is very little friction to getting a test? Yes. The answer should be yes.

NOGUCHI: The Biden administration says health insurance will reimburse those with private coverage. It also plans to distribute 50 million free tests through libraries or federally funded clinics like Patel's. But that's too little, too late, says Patel, who's also a fellow at the Brookings Institution.

PATEL: I am sitting here December 2021. We're going to get hit with a surge. It is inevitable. And why am I sitting here, like, trying to figure out when I'm getting tests?

NOGUCHI: The answer goes back to the U.S.' approach at the start of the pandemic. The Trump and Biden administrations didn't develop and pay for universal at-home testing the way it did with vaccines. That was a mistake, says Michael Mina, a well-known testing expert and former Harvard professor. He now works for eMed, an at-home diagnostics firm.

MICHAEL MINA: Every step we've taken in the pandemic has assumed that this is a medical problem.

NOGUCHI: It's more than that. It's also a public health issue. So Mina argues, acquiring and paying for tests should fall to the U.S. government, not individuals. The state of New Hampshire tried that last month. It partnered with the federal government to deliver 800,000 free tests to residents requesting them. Supplies ran out within one day. Mina argues, if the federal government did that across the country, it could negotiate discounts on price and distribute them broadly, as in Europe.

MINA: Why not just make it simple and streamlined? So I don't have a good answer why they're choosing not to.

NOGUCHI: Another issue - the U.S. took longer to authorize the tests than elsewhere. Jack Feng is chief operating officer at iHealth Labs, whose at-home tests were recently authorized by the Food and Drug Administration.

JACK FENG: One reason the price here is a little bit higher because you need to spend more. You need to do more on study and even do more clinical trial.

NOGUCHI: Fluctuating demand is also a challenge for test makers. A year ago, Abbott, one of the country's earliest makers of over-the-counter tests, rushed to set up two U.S. factories in a fraction of the time it would normally take. But by early this summer, demand plummeted, and Abbott shut down its Illinois factory, only to reopen it again in the fall as a new COVID surge fueled demand. Meanwhile, the lack of steady supply makes it hard to include testing in public policy. Elizabeth Stuart is a public health professor at Johns Hopkins. With more tests, she says, schoolchildren exposed to COVID could test daily instead of having to quarantine.

ELIZABETH STUART: And I've been pushing public schools on this. And I will say it's been hard to push on it because of the supply problems. They sort of say, we just can't get enough tests to implement that.

NOGUCHI: Stuart says the highly anticipated antiviral drugs from Pfizer and Merck will make rapid testing even more important.

STUART: Knowing that you're infected with COVID quickly can help make sure you get the right treatment. Some of the new therapies are really most effective if taken early in the course of the disease.

NOGUCHI: Experts say that may prove the most promising use for at-home testing in the U.S.

SHAPIRO: NPR's Yuki Noguchi.



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