All but three US states have very high or high levels of Covid-19 in their sewage right now, according to the CDC. Due to a drop in efforts to count individual cases, that data is the most accurate way to paint a picture of the current extent of Covid cases—and it’s bad.

In addition to wearing respirators, getting the updated Covid vaccine (mRNA shots were approved last week, and the Novavax vaccine this week) is an important way to reduce one’s chance of getting the infectious disease. Even if a person contracts it, the shot will reduce their risk of death and developing Long Covid.

But for uninsured and underinsured Americans, the vaccine has just gotten significantly more costly. On August 22, the CDC sunsetted its Bridge Access Program, which provided free Covid vaccines to 1.5 million Americans over the past year. A CDC spokesperson told Mother Jones that the sunsetting was a consequence of the new 2024-2025 vaccines being approved—which meant the 2023-2024 vaccines could no longer be administered. But many people did not know that the program would only cover the vaccine approved last year—just that it would end in August, potentially after the new shots became available. The CDC’s page on the program, which was live until some point Friday, did not clarify any of this information.

“For every step that you add in the process of trying to get a vaccine, you’re going to lose people.”

A rhetorical staple of the Biden administration is that it’s ensured people have the tools to fight Covid—but that is not the case for people unable to afford the updated vaccine out-of-pocket, which typically costs around $200.

Elizabeth Jacobs, an epidemiologist and professor emeritus at the University of Arizona, has studied the reasons why people do not get Covid-19 boosters. One reason, Jacobs says, is the logistics and challenges of getting the vaccines. 

“For every step that you add in the process of trying to get a vaccine, you’re going to lose people,” Jacobs said.

Even before the end of the Bridge Access Program, getting vaccines has not always been easy. One person who spoke to Mother Jones said that he had to explain how the Bridge Program worked to pharmacists before he could get vaccinated for free.

The CDC, however, did announce that it has allocated $62 million for state and local health departments to buy vaccines for uninsured and underinsured people. However, the current surge and delays in implementation means people may fall by the wayside. 

“I do have faith that $62 million will be used well to provide vaccines,” says Emory University epidemiology professor Jodie Guest. “Unfortunately, we just don’t have the details for how that will be done yet.” 

Guest also notes that the up-front cost of subsidized vaccines is less of a burden on the healthcare system than a spike in the number of people severely ill with Covid. It is hard to know just how many people are currently hospitalized with Covid complications, as hospitals have not been required to report cases to the federal government since May. But the requirement to report respiratory viruses in hospitals will resume on November 1. 

Since early in the pandemic, research has highlighted the risks of severe illness that low-income people, who are more likely to have chronic health conditions, face with Covid. These risks remain, and while it’s important that people with Medicare and Medicaid will be able to get updated vaccines, so should low-income people without health insurance.

“Vaccines are only as good as how vaccinated our immediate communities are.”

Children whose guardians are uninsured and underinsured will still be able to get vaccinated for free through the Vaccines for Children program, initially established by Congress in 1993 to make sure more kids were being vaccinated against measles. Chrissie Juliano, the executive director of the Big Cities Health Coalition, says that the ending of the Bridge Access Program underscores the “need for a permanent Vaccines for Adults program.” The Biden administration has proposed funding a Vaccines for Adults program in its proposed budget for the next fiscal year, but Congress could still reject it. In the meantime, Guest also recommends that people search for coupons at pharmacies that could bring down out-of-pocket costs. 

“Vaccines are only as good as how vaccinated our immediate communities are,” Juliano said. “Vaccines protect us when we individually get it, but we really depend on our neighbors, our family, our friends [and] our classmates to also be fully vaccinated.”

While Covid-19 vaccines can reduce transmission, they are not perfect yet, which highlights the importance of wearing N95 and KN95 masks during surges, especially in medical settings, while traveling, and in other crowded indoor settings.

Jacobs finds it frustrating that masking is no longer promoted by public health agencies as it has become further politicized. “It is an established fact that respirators or high-quality masks reduce your risk significantly of becoming infected,” Jacobs said.