The arguments for and against free Covid-19 testing

Free Covid-19 testing could end for millions of people as early as next month amid falling case numbers and deaths.

“Healthy adults” would no longer be able to receive free lateral flow tests on the NHS under new government plans, The Times reported, while PCR testing could also be “scaled back” in an effort to “cut the ongoing costs of the pandemic”.

After “months of speculation” over when free Covid testing might end, the changes are likely to be announced as part of the government’s “Living Safely with Covid” strategy, which is due to be published next week and thought to be scheduled to come into force “as soon as next month”, said the paper.

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The Treasury is thought to be behind a push to end most PCR testing for people with Covid symptoms by the end of March, excluding those in hospitals, high-risk settings or the clinically vulnerable. The Guardian said Rishi Sunak’s department wants the “lowest cost options” of ending “as much testing as possible”.

1. Pro: good proactive measure

When free mass testing through rapid lateral flow tests was introduced in April 2021, the government hailed it as a key instrument in the fight to “prevent outbreaks and reclaim a more normal way of life”.

But in advice published this week, the Scientific Advisory Group for Emergencies said that removing free testing would make it harder to take “precautionary actions” and warned it could “increase anxiety” among those who found access to tests “reassuring after possible exposure”, particularly people who are clinically vulnerable or who live with someone vulnerable.

Scientists are also concerned that the removal of free testing may be taken as a “signal” that people could attend work and social gatherings even if they have symptoms of Covid-19, as the symptoms can be “conflated” with illnesses such as flu.

2. Con: real value is unclear

A government paper on mass testing published in January 2021 said that there were “mixed views” about the “value of screening for SARS-CoV-2 using mass testing”.

The paper continuned that while some scientific researchers thought mass testing to be a “useful additional tool” with which to monitor transmission and identify areas of high prevalence, the value of the tests could depend greatly on their “context and the intended purpose”.

The research found that at the time of publication, the impact of mass testing on the transmission of the illness was “unclear” and that “current trial data did not demonstrate that mass testing was stopping transmission chains”.

There have also been persistent concerns over lateral flow tests returning false positives forcing people to self-isolate “unnecessarily”.

Critics of mass testing have said that when virus transmission is at low levels it can be “hard to distinguish between actual infections and so-called ‘false positives’”, reported the BBC in April last year.

“Mass testing is a scandalous waste of money,” said Allyson Pollock, professor of public health at Newcastle University .“When the prevalence rate of coronavirus falls as low as it is at the moment then an increasing proportion of cases are likely to be false positives meaning that cases and contacts will self isolate unnecessarily.”

3. Pro: spotting new variants

PCR testing has been integral in helping scientists to identify new variants and has allowed the UK to create “one of the most sophisticated monitoring systems in the world”, said The Times. If the use of PCR tests is scaled back, it will be far more difficult to identify harmful new variants.

There are also fears over possible plans to scrap the Office for National Statistics (ONS) weekly infection survey, considered the “gold standard” in measuring the levels of Covid-19 in the community, reported the i news site.

It means scientists who are searching for “the next Omicron”, who use laboratory genome sequences from thousands of positive results a day from mass testing to detect new variants, “will have a drastically reduced pool of samples to work with”, said the paper.

And while new, potentially dangerous variants will still be detected, “it will take longer to assess whether it is more severe or reduces vaccine effectiveness”.

4. Con: the very high cost

It is thought that more than £6bn of public money has been spent on lateral flow test contracts, a considerable cost – although just a fraction of the £37bn budget of the government’s test and trace system.

Sunak is thought to be keen to cut down on the spiralling costs of testing by scrapping most free PCR testing for people with symptoms of Covid-19, except for those who are clinically vulnerable or in high-risk settings.

Lateral flow and PCR tests are not free in many countries. Rapid tests in Europe usually cost the equivalent of around “£5 to £10” while PCR tests can cost £30 or more, with the price in the US rising to almost double that, said The Guardian.

5. Pro: accessible testing

The US market for tests has become a “Wild West” as labs and testing facilities “have been free to charge whatever consumers can be made to bear for tests that we take for granted, fuelling a multi-billion-dollar industry”, said Ivor Campbell, a medical technology consultant, in The Scotsman.

US customers have been left facing “staggering prices”. As the US website Consumer Reports warned: “The next time you get tested might cost $130, $385, or no money at all.”

And just when the UK government appears to be considering ending free testing, the Biden administration is now “belatedly changing tack” as the poorest Americans have free tests delivered to their homes.

6. Con: many unused tests

As of October last year, only 14% of lateral flow tests distributed by the hugely expensive NHS Trace and Trace service had been registered, meaning only a fraction of the tests may ever have been used, according to a report by the Public Accounts Committee (PAC).

Only 96 million of 691 million lateral flow tests were registered online, which allows results to be tracked. “It is not clear what benefit the remaining 595 million tests have secured”, said the PAC report.

Meg Hillier MP, chair of the PAC, said: “The national Test and Trace programme was allocated eye-watering sums of taxpayers’ money in the midst of a global health and economic crisis.

“It set out bold ambitions but has failed to achieve them despite the vast sums thrown at it. Only 14% of 691 million lateral flow tests sent out had results reported, and who knows how many took the necessary action based on the results they got, or how many were never used.

“The continued reliance on the over-priced consultants who ‘delivered’ this state of affairs will by itself cost the taxpayer hundreds of millions of pounds.”