Why home COVID tests remain costly and hard to get in the U.S. : Shots - Health News With a fast-growing winter surge upon us, self-testing kits remain expensive and hard to find. The reasons go back to the approach the U.S. took from the outset in developing tests.

Why rapid COVID tests are in short supply in the U.S.

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In Europe, take-home COVID tests are free or virtually free and widely available. So they get used every day before going to work, say, or a party. Here in the U.S., similar over-the-counter tests cost 7 to $15 apiece, and supply is limited. That frustrates public health experts, who argue that fast, frequent testing is critical, especially as cases surge again. NPR's Yuki Noguchi explains how the U.S. entered up on a different track.

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 is also a fellow at the Brookings Institution.

PATEL: I am sitting here December 2021. We're going to get hit with the 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.

Yuki Noguchi, NPR News, Washington.

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