The fury with which public-health experts greeted Psaki’s comments reflected their longstanding frustration with an administration that, in their view, has put almost all its focus on vaccinating the American public, at the expense of other critical aspects of the response, from getting shots into arms overseas to making high-quality masks widely available. The rapid-test push, in particular, seems to have bumped up against the peculiar challenges of fighting COVID-19 in the 21st-century United States. Difficulties include a regulatory gauntlet intent on vetting devices for exquisite sensitivity, rather than public-health utility; a medical fiefdom in which doctors tend to view patient test results as theirs alone to convey; and a policy suspicion, however inchoate, that too many rapid tests might somehow signal to wary Americans that they could test their way through the pandemic and skip vaccinations altogether. “It’s undeniable that [the administration] took a vaccine-only approach,” said Dr. Michael Mina, a vocal advocate for rapid testing who attended the October White House meeting. The U.S. government “didn’t support the notion of testing as a proper mitigation tool.”
On Tuesday, faced with a terrifying omicron surge, a stampede of holiday travel, and images of Americans waiting in hours-long testing lines from Brooklyn to Miami, Biden finally announced that his administration would do what many experts had been urging since the earliest days of the COVID-19 pandemic: Give Americans the ability to diagnose themselves. The federal government will launch a website next month where individuals can request free rapid tests that will be mailed to their homes. That plan requires 500 million test kits that the administration has yet to procure.
“The administration has been focused on expanding testing since the very beginning,” Dr. Tom Inglesby, who in January will become senior adviser for testing on the White House COVID-19 response team, told Vanity Fair. “It has always been a major pillar of the approach.” When Biden took office, there were no rapid, at-home COVID tests on the market; there are now 13. And the monthly supply has almost quadrupled since late summer. The administration has invested more than $23 billion on expanding testing, surging manufacturing capacity, and improving genomic sequencing, according to Mara Aspinall, cofounder of the biomedical diagnostics program at Arizona State University.
But the president’s announcement on Tuesday struck many experts as “an exemplar of too little, too late,” as Dr. Eric Topol, director and founder of the Scripps Research Translational Institute in La Jolla, California, put it in a Substack post on Tuesday. Topol called the plan to make 500 million free rapid tests available sometime next year “totally inadequate,” writing, “We need several billion of these, and have needed them for over a year to help prevent spread, as validated and relied upon in many countries throughout the world.”
Critics say the Biden administration has been slow to act on testing, in part because it saw vaccination as the best pathway out of the pandemic. The Centers for Disease Control and Prevention assured Americans early this summer that, once vaccinated, they could shed their masks and forgo testing. Those declarations quickly proved untrue as breakthrough infections have risen. “We put all our eggs in the vaccine basket and it’s not enough,” Dr. Jay Wohlgemuth, chief medical officer at Quest Diagnostics, told Vanity Fair.
Three experts who interacted with the White House came to believe that the Biden administration had deprioritized rapid testing, partly out of concern that people would opt for that instead of getting vaccinated. As one expert put it, “It was clear they felt that people who didn’t want to get vaccinated might like no-strings-attached rapid testing.” The White House’s Tom Inglesby said the administration was always committed to both: “In our analysis, they are not competing with each other. They are not zero sum.”
It has fallen to a small but determined group of advocates to argue that rapid testing is an essential strategic tool, and should be pursued as aggressively as vaccinations. Chief among them is Dr. Michael Mina, who until recently worked as an assistant professor of epidemiology and immunology and infectious diseases at the Harvard T. H. Chan School of Public Health, and as an associate medical director of molecular virology diagnostics at the Brigham and Women’s Hospital. He is now chief science officer at a Miami-based diagnostic company, eMed.
His journey began as early as January 2020, when he saw clearly that Boston was going to need COVID tests it didn’t have. He sought funding from Brigham and Women’s Hospital to build a test. “They thought it was a joke,” he said of some of the hospital’s pathology officials.
So he went to the Broad Institute, got approval to use its sequencing platform, and helped establish what became a prodigious testing laboratory there. From the Broad, he went back to top Boston hospitals, including Brigham and Women’s, Tufts Medical Center, and Beth Israel Deaconess Medical Center, to offer the Broad’s new testing capacity as an additional resource. “The pushback I got was amazing and swift,” he said. There were “pissing contests everywhere,” as the physicians worked to protect their turf running hospital-based tests.