Ending a pandemic costs money. Congress isn’t willing to pay.

Key parts of the U.S. pandemic response will begin winding down in a matter of weeks as funding runs out, leaving the country far less prepared to fight a virus that shows no signs of quitting.

The rollback will fall hardest on the country’s most vulnerable, including people with weakened immune systems, those who don’t have insurance and the poor. And it comes as new cases and hospitalizations are starting to tick up in Europe, raising fears that the sharp downturn in U.S. cases may be short-lived. Even now, virus levels are ticking up in wastewater at 39 percent of U.S. collection sites.

In short, the country’s rush to declare the covid crisis is over could end up prolonging it by ending easy access to vaccines, drugs and tests the U.S. spent billions to help develop.

“Ending a pandemic costs money, just as preventing the next pandemic costs money,” said Arriana Planey, a medical geographer at the University of North Carolina. “I think that this will exacerbate inequities in access to vaccination, testing and antiviral treatments for covid.”

The cash shortfall stems from Congress’s decision last week to ax roughly $15 billion in pandemic relief funding from a broader federal spending bill. And that figure was already a compromise: President Joe Biden’s recently released plan for navigating the next phase of the pandemic came with an estimated $22.5 billion price tag.

There are no signs of movement on the issue in congress. Without another influx of covid funding, the Biden administration cannot complete a planned March 25 purchase of monoclonal antibody treatments; the country could run out of the drugs by late May. The federal program that reimburses healthcare providers for testing or treating the roughly 28 million Americans without health insurance will stop taking claims March 22. And by early April, vaccinations will no longer be covered either, the White House said.

“It’s basically taking away one of the most important outreach tools we have to get people vaccinated, treated and tested,” said Michael Osterholm, an epidemiologist at the University of Minnesota.

Research into developing more effective drugs and vaccines also will sputter. The National Institutes of Health has begun discussions about how to simplify or shut down clinical trials in response to the funding crunch, Politico reported last week; some studies could run out of money as early as this month.

“We’ve seen this story before. We get a health threat, we throw a lot of money at it, and then we really don’t finish the job,” said Georges Benjamin, executive director of the American Public Health Association. For example, bioterror worries after 9/11 spawned a flurry of initiatives that withered as the national focus moved on.

“Once we start taking these systems apart, it’s like starting from scratch,” Benjamin said.

Pandemic haves — and have-nots

Covid has magnified existing inequalities in the United States, despite federal and state programs to make prevention and treatment available to people regardless of income or insurance status. That approach is now in jeopardy. “The success of the vaccine rollout was contingent upon the removal of barriers to uptake,” including cost, Planey said.

Reimposing barriers “will likely make it harder for people who are still unvaccinated to get the vaccine,” she said, including “working-age adults who have lower uptake, despite having greater exposures in the workplace. This is especially true for Black and Latinx workers who are less likely to work in jobs that can be done remotely.”

Then there are the 28 million people without health insurance. Ending the federal government’s ability to pay for their covid-related care is likely to shift the financial burden onto individuals and hospitals.

“If uninsured patients don’t eat that cost, health systems will,” Planey said.

And lifesaving treatments could become scarce, just as most states have dropped mask requirements and other pandemic restrictions — increasing the everyday risk for the roughly 7 million Americans who are immunocompromised.

The Biden administration has pledged to order 20 million treatment courses of Pfizer’s antiviral drug, Paxlovid, which cuts the risk of hospitalization and death by 88 percent if taken in the early stages of infection. But the government doesn’t have enough money to pay for the full order, Stat reported this month.

The White House said this week that it will also have to scale back further purchases of Evusheld, a monoclonal antibody cocktail that reduces a person’s risk of infection by 77 percent. It can help protect people whose immune systems are too weak to benefit from vaccination.

Echoes of past failures

The funding fallout also threatens to undermine attempts to learn from past failures and be prepared for the next surge in cases, which will likely come.

The U.S. struggled to meet demand for testing during the delta and omicron surges last year because it had not prepared for such scenarios. The Biden administration ultimately moved to purchase hundreds of millions of dollars in at-home tests to create a guaranteed market and enable the country to respond more nimbly to future surges.

Without continued investment, “we could be back to where we were last summer,” said Mara Aspinall, a professor of practice and biomedical diagnostics at Arizona State University. Other efforts to bolster preparedness will wither too. Burgeoning genomic surveillance programs, crucial for identifying and monitoring new variants, will have to be scaled back without funds. Plans to scale up wastewater testing, a key early-warning system, could be hampered as well.

“Countries that did well in the pandemic, like South Korea, Taiwan, Singapore and Japan, learned from the 2003 SARS outbreak,” said Ezekiel Emanuel, a bioethicist at the University of Pennsylvania who has advised the Biden administration on its pandemic response. Afterward, those countries bolstered their disease surveillance, improved data systems and hired a public health workforce, he said: “They took it seriously, and they did much better.”

The U.S. has made some progress in these areas, but it needs to be sustained to make a difference, Emanuel said. “We’ve seen the impact of inconsistent funding, of stopping, starting, stopping and starting,” he said. “We seem to be too willing to move on too fast and not spend a little investing in important insurance measures.” He and more than 20 other public health experts recently estimated that preparing for the next public health threat while fighting covid would require an initial outlay of about $100 billion — far more than the $15 billion plan Congress just rejected.

“This is an investment in the public health of the future,” Emanuel said. “We don’t know where the next biosecurity threat is going to come from, but we know that there will be one.”