Federal funding for Covid-19 response measures like tests, treatments, and vaccines is drying up just as cases are poised to rise again, raising another barrier for some of the most vulnerable Americans.

Several key factors are different in this go-around, however: The vast majority of people in the US have already been infected or vaccinated, so most have at least some protection from the disease. There are also several effective treatment options, like the antiviral drug Paxlovid, so even those who do get sick have a way to get better.

But most public health measures to limit infections in the first place like wearing face masks and social distancing are gone as well. Tracking the pandemic is getting harder too, with most Covid-19 tests now occurring at home and going unreported. Last month, the Centers for Disease Control and Prevention announced it was shifting from daily to weekly reports of cases and deaths. Currently, more than 2,600 people in the US are dying per week from Covid-19.

Now the government is turning over some of the Covid-19 response to the private sector. Throughout the pandemic, the federal government spent billions of dollars on these measures and provided them for free to the public under its public health emergency powers. The emergency declaration has to be renewed every 90 days, and the current round expires in 2023. If the government doesn’t renew the emergency declaration at that time, Americans may end up paying out of pocket for some or all of the tools needed to cope with the pandemic.

This funding rollback will likely play out differently depending on the measure. With vaccines, manufacturers are preparing to raise prices. Pfizer announced last month that it’s planning to raise the price of its Covid-19 vaccine next year, from the roughly $30 per dose it charges the US government now to at least $110 per dose.

However, the US government has a stockpile of Covid-19 vaccines, including new bivalent boosters that target more recent variants of the virus that causes Covid-19. With booster rates still in the single digits, the US isn’t running out of Covid-19 vaccines anytime soon. When prices do go up, health insurers will be required to offer them to their customers for free under most plans.

“Almost everybody will still be getting free vaccines,” said Jennifer Kates, senior vice president at the Kaiser Family Foundation, a health policy think tank. “The only group that’s out of luck there are uninsured adults.”

Tests are a different story. The government’s free at-home test program ended in September because Congress didn’t appropriate more money to order more kits. Insurers are still require to reimburse part or all of the cost of home Covid-19 test kits as well as more robust PCR tests, but when the public health emergency ends, policyholders will likely end up paying more out of pocket. And again, people without health insurance will likely end up paying the most.

Americans may also end up paying more for Covid-19 treatments like antiviral drugs and monoclonal antibodies. These therapies have been crucial in reducing the death rate from the disease, and the government has them stockpiled. But as the emergency ends and supplies run out, people on private health plans and on Medicare will likely have to share more of the costs.

What effect will these funding rollbacks have? Are they premature?

“The data doesn’t tell me that it’s time for us to pull back, but it’s kind of where we are,” said Thomas LaVeist, dean of the school of public health at Tulane University.

On one hand, Covid-19 cases, hospitalizations, and deaths are far below their peak, many people have largely checked out from taking precautions, and there are still supplies left. The people who are at greatest risk of severe illness and death from Covid-19 even now are those who are unvaccinated, but the overall vaccination rate is unlikely to budge now.

“At this point, it’s not clear to me that we’re going to get many more people vaccinated who are unvaccinated,” said LaVeist.

At the same time, Covid-19 cases are projected to rise again this winter, along with other infections like RSV and influenza, again stressing the health care system. Any increases in costs will push already low vaccine, testing, and treatment rates even lower, adding more strain to already exhausted health workers and hospitals.

Eventually, funding for some of these pandemic measures does have to taper off, but the looming rollbacks are more abrupt than some policymakers wanted. “Waiting to provide funding once we’re in a surge will be too late,” according to a March 15 statement from the White House warning Congress about the dangers of a sudden loss of Covid-19 funding.

“The hope is that this transition is done as a smooth, balanced one and not a cliff,” Kates said.

But with an upcoming election and Republicans poised to gain seats in the House, it will likely be harder to get any more money for tests, treatments, and vaccines. “There is a political aspect to this as well: Because people are fatigued, policymakers don’t want to continue these measures because they’re being pressured not to,” LaVeist said.

Nonetheless, the worst effects of Covid-19 can still be contained. Wearing face masks and improving ventilation can reduce infections in the first place, vaccine boosters can lessen the chances of falling severely ill, and treatments can still save lives. Preventing another spike in deaths is a matter of availing these tools, especially while they’re still free.