(NEW YORK) — While COVID-19 ebbs — and many of the pandemic-era policies on surveillance data and funding wind down with it — the nation’s public health leaders warned senators on Thursday that a return to “normal” should not mean forgetting the hard lessons learned over the last three years.

When the federal government’s public health emergency expires next week, COVID-19 data collection tools will also end. Those tools have been described as vital to staying vigilant and preparing for emerging health threats.

“Infectious disease threats have been emerging at an increased pace and are increasingly complex,” Centers for Disease Control and Prevention Director Rochelle Walensky told the Senate Health, Education, Labor, and Pensions (HELP) Committee. “These diseases don’t respect national or state borders, and the increased frequency of outbreaks means that we should not be asking if we will face another serious public health threat — but when.”

Though “for many life has turned to normal after three years of COVID-19,” Walensky said it’s the mission of public health to “remain response-ready to protect Americans from any resolving or emerging health threat,” which can only be done by “actively supporting the core capabilities of public health.”

Thursday’s hearing was part of the process to reauthorize the Pandemic and All-Hazards Preparedness Act, which was first signed into law in 2006 and has been regularly reauthorized since then.

“The approaching end of the public health emergency once again reminds us that policy changes and funding are essential to the readiness of future bio-threats. The CDC will continue to closely monitor COVID-19 and provide the information to which we have access,” Walensky said.

She and other panelists emphasized that caveat: The limited access to data that comes along with a return to “normal” threatens to kneecap future surveillance efforts.

“We will adapt to limitations and utilize tried-and-true systems to monitor other respiratory diseases, to keep our eye on COVID-19,” Walensky said, “but there are data we will no longer have available because they will no longer be submitted to us. For example, certain data for a national picture of health disparities both for race and ethnicity and along urban and rural lines.”

“We will make do,” the CDC director said. “However this should worry us all, primarily because of what it says about the visibility we will have into the next outbreak. We will be back to square one — having to build and negotiate surveillance capacity while we fight a pathogen.”

Dawn O’Connell, the U.S. Department of Health and Human Services’ assistant secretary for preparedness and response, said that the U.S. actually was more prepared for COVID-19 than it would’ve been for other types of pandemics because of two prior respiratory outbreaks.

Neglecting to further that work would put the country at a big risk, O’Connell said.

“This is one of my biggest worries, is that we are losing time in preparing for the next pandemic,” she said. “I know it doesn’t feel like it, but the one place we were lucky when it came to the coronavirus is we had already done a lot of the early work on that because of SARS and MERS. We need to get the same head start.”

That’s something some senators looked to explicate in their line of questioning, with Sen. Bernie Sanders, I-Vt., interjecting: “Are you telling us that we have not done the kind of work you would like to see done in preparation for what might be coming?”

“Correct,” O’Connell said.

Another tragedy briefly cast a shadow over Thursday’s hearing, as Walensky opened her remarks by noting that one of the CDC’s employees was killed Wednesday in a mass shooting in Atlanta.

Amy St. Pierre “was a valued member of our team at the Division of Reproductive Health where she worked every day to save the lives of mothers and infants,” Walensky said.

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(WASHINGTON) — Angela Maske was a college freshman in Washington, D.C., when she first had trouble getting a prescription for birth control pills.

Her Catholic-affiliated university wouldn’t prescribe the medication to students as a sexual contraceptive, so Maske spent three months looking for another doctor’s appointment.

More recently, her telehealth provider stopped servicing her area, sending Maske scrambling to find another provider and a new prescription on short notice while juggling a full-time job.

Maske now works with Free the Pill, a coalition of advocates that’s spent years dedicated entirely to increasing public access to contraception — a goal they say is critical to people already struggling to access health care, find time off work or arrange for child care to make a doctor’s appointment.

“It’s just frustrating because (getting a prescription) feels like yet another barrier that people have to go through to access essential care to control their reproductive and sexual autonomy,” said Maske.

The Food and Drug Administration is on the cusp of deciding whether at least one type of hormonal birth control — a progestin-only drug called “Opill” by French drugmaker HRA Pharma — is safe enough to be sold over the counter without a prescription and without age restrictions.

First approved by the FDA in 1973, Opill is type of hormonal birth control pill known as the “minipill,” which poses fewer risks than combination pills that rely on estrogen. Still, buyers would have to screen themselves for any health risk factors, much as they would other over-the-counter medications.

FDA’s panel of scientific advisers are expected to meet next week to discuss the application, and if the agency signs off the drug in coming weeks, the product could be on shelves this summer.

“It is just super exciting that we’ve gotten here at this moment. It’s really historic,” said Kelly Blanchard, president of Ibis Reproductive Health, an advocacy organization that has long called for over-the-counter birth control pills.

Blanchard said she hopes other types of birth control pills will follow suit and that states embrace laws requiring insurance companies to cover the costs. Currently, federal law requires free contraception “as prescribed” by a health care provider, although some states have pushed their own mandates for insurance to cover over-the-counter options as well.

The question over increased access to birth control comes amid a heated national debate on women’s reproductive rights with the overruling of Roe vs. Wade, which guaranteed a constitutional right to abortion. At least 15 states have barred nearly all abortions so far.

This week, New York Democratic Gov. Kathy Hochul signed a law that authorizes pharmacists to dispense hormonal birth control. Patients there can now rely on a single long-standing order from a doctor, rather than having to return for an updated prescription; if the person does not have a health care provider, the pharmacist could dispense the drug anyway with instructions to consult a doctor.

The vast majority of Americans back widespread access to birth control. Two-thirds of adult women under 50 say they are using some form of contraception, with a third of those relying on birth control pills, according to a 2022 KFF (Kaiser Family Foundation) survey.

Most patients also believe they can screen themselves for risk factors when it comes to hormonal birth control. According to KFF, an estimated 77% of women under 50 say they want birth control pills available without a doctor’s prescription if research shows it’s safe and effective.

One concern is that patients will forgo routine examinations if doctors can be cut out of the process. Still, HRA Pharma’s federal application for Opill solicited significant support from the medical community, anti-poverty organizations and reproductive-rights advocates that say increasing access to family planning will benefit millions of people, particularly those in rural areas and people of color who struggle to access any health care.

The American Medical Association, for example, told the FDA that decades of data shows the benefits of “widespread, nonprescription availability far outweigh the limited risk associated with their use.”

In a separate filing, the American College of Obstetricians and Gynecologists said a patient doesn’t need to be examined or tested before taking the drug and that the birth control pill was overwhelmingly safe for most people to take on their own. And while routine exams are critical to a person’s overall health, the group says that shouldn’t be a reason to make birth control harder to access.

Opponents of the move cited medical risk and teen access as a reason to limit access.

“Even if they read the package insert, evidence documents that teenagers take risks disproportionate to their own safety needs. When this is compounded by the lack of parental notification or health provider supervision, the results could be catastrophic,” wrote an objection signed by several Catholic groups, including the US Conference of Catholic Bishops.

Maia Lopez, a 17-year-old high school junior living outside Dallas, Texas, who now works with Free the Pill as a youth advocate, said teens will have sex anyway.

Easier access to contraception and quality education about reproductive health would go farther to protect young people, she said.

“I think they underestimate teens,” Lopez said.

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