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2021 was supposed to be the year the pandemic ended. At least in the United States, anyway, where health officials administered roughly 500 million vaccine doses, more than any other country besides China or India. President Biden declared last spring that by summer, the country would be “closer than ever to declaring our independence from this deadly virus.”

Things didn’t quite go to plan. U.S. health officials are currently reporting well over 238,000 new infections each day. The emergence of the Delta variant last summer, and the omicron variant more recently, threw a wrench into the administration’s grand plans to bring back “normal” life.

As the pandemic stretches into its third year, Biden’s approval rating has slipped. And, more importantly, over 1,000 Americans continue to die from the disease each day, inching closer to the grim milestone of 1 million.

In short, the White House has its work cut out for it, a year after assuming control of the U.S. coronavirus response. Below, STAT lays out the three biggest questions about the Biden administration’s COVID-19 strategy, and whether 2022 can finally be the year the pandemic fades into the background.

Even before there were COVID-19 vaccines, there were commonsense tools used to prevent the disease from spreading: Wearing masks, and avoiding indoor gatherings with large numbers of other people.

But two years into the pandemic, the U.S. is still laser-focused on vaccines, and has largely ignored other factors. In particular, federal regulators haven’t done much to incentivize Americans to wear higher-quality face coverings, or to maintain better filtration and cleaner air in indoor spaces.

In fact, many of the masks that are still worn today aren’t really masks at all, but cloth face coverings that were used as makeshift protection back in early 2020. Still, experts have always known that masks used in medical or industrial settings, like a surgical mask or N95 respirator, are far superior at filtering out infectious particles. Nonetheless, there’s no mask requirement to board a train or plane, or to enter a government building. Instead, any face covering will do.

READ MORE: Changing the definition of ‘fully vaccinated’ is more than just semantics, experts argue

Meanwhile, the federal government hasn’t done much to improve the quality of air filtration in buildings. The Occupational Safety and Health Administration has issued numerous emergency standards requiring employees to be vaccinated, but so far has ignored calls to issue a firm standard for air quality. (Instead, OSHA has issued a number of vague encouragements to filter air to the maximum extent possible.)

We’ve seen the consequences already, like in a recent outbreak among New York City children whose schools relied on portable air purifiers and open windows as opposed to upgraded air filtration systems.

Ideally, if someone suspects they have COVID-19, they’d have access to testing and treatments as soon as possible.

Practically, though, both are tough to come by. Rapid tests remain in short supply, and they’re pricey, too. Bizarrely, the Biden administration initially scoffed at the idea of making them available for free. Instead, the White House announced a complicated scheme to let people with health insurance pay upfront for tests, then ask their health plan to pay them back later. Eventually, though, the administration announced a plan to buy 500 million COVID-19 rapid tests and mail them for free to anybody who requests the kits via a new government website. The first deliveries, however, won’t begin until sometime in January, and it’s not clear how many tests will be available immediately.

Even if people who feel sick do access a rapid test, and it comes back positive, they have limited options besides monoclonal antibody treatments, many of which appear to be less effective against cases of the omicron variant.

The same is true for COVID-19 antiviral treatments under development by a number of companies including Pfizer and Merck. Those two manufacturers’ drugs finally received emergency use authorizations from the FDA in late December.

Still, experts have warned that Americans could face a host of problems when trying to access the drugs: Failure to recognize COVID symptoms, lack of access to testing, lack of access to a doctor who can prescribe the drug, and the inability to get to a pharmacy, health clinic, or hospital.

The Biden administration’s late-2021 COVID response was marred by the back-and-forth debate over booster shots — whether they were necessary for everybody, and whether the White House interfered with the scientific process of getting them approved.

That ship has sailed. Especially with the emergence of the omicron variant, a broad consensus has emerged that adults should be boosted. Now, there’s a new, looming question: Will Americans need a fourth dose, or even additional doses beyond that?

READ MORE: Beyond case counts: What omicron is teaching us

Signs point to yes. Peter Hotez, a leading U.S. vaccine researcher, has acknowledged the possible need for a fourth dose on a more widespread basis. Scott Gottlieb, the former Food and Drug Administration commissioner and current Pfizer board member, also said recently that he expects COVID-19 vaccinations to become an annual ritual akin to flu shots, at least for a while.

Some governments made the same acknowledgment. In Israel, one of the first countries to attain a high vaccination rate and one of the first countries to administer booster shots, an expert panel has recommended a fourth dose for some medically vulnerable individuals. The Centers for Disease Control and Prevention has already announced that immunocompromised Americans will be eligible for a fourth dose at some point in 2022.

But administering more booster shots, to say nothing of fourth doses, could impede the effort to vaccinate the rest of the world currently last in line for vaccines, namely large regions of Africa, Southeast Asia, and the Middle East. It could also complicate vaccine messaging and further strain the U.S. health infrastructure.

This article is reproduced with permission from STAT. It was first published on Dec. 29, 2021. Find the original story here.

Left: President Joe Biden and Vice President Kamala Harris meet with members of the White House COVID-19 Response Team on developments related to the omicron variant at the White House in Washington, U.S., Dec. 9, 2021. Photo by Leah Millis/Reuters.

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