As winter approaches, vaccination remains an essential component of stemming a seasonal COVID-19 surge. But public health officials have turned their attention — belatedly, some would say — to an aspect of the COVID-19 battle that has fallen by the wayside since vaccines emerged: testing.

Indeed, it has become clear that vaccination alone won’t be enough. To that end, President Biden recently announced a $2 billion investment in boosting the supply of COVID tests and related infrastructure, which includes discounting at-home tests at major retailers like Walmart and Amazon. Meanwhile, some 280 million rapid tests will be sent to long-term care facilities and community testing sites.

State leaders and health officials welcomed the investment, especially given the surge in demand they anticipate.

“During the summer, state leaders informed us that they did not have enough tests for the demand expected,” said Hemi Tewarson, executive director at the National Academy for State Health Policy (NASHP). “I’m happy to see the federal government step up here and make a monetary investment. That’s what’s needed to signal to manufacturers to make more tests.”

Tewarson noted that, in spring and summer, demand for COVID tests plummeted compared to its level at the start of the pandemic. As the focus shifted to vaccination, states saw demand dip, with fewer people showing up to testing sites.

As a result, states disassembled testing infrastructure and converted many facilities to vaccine clinics.

The country now needs both, Tewarson stressed. “We need to push for vaccination and a continued supply of testing, especially if we’re going to identify any outbreaks among the vaccinated,” he said.

Testing will remain important for several reasons, the first being that progress remains slow in inoculating the unvaccinated population. In addition, the U.S. government’s mandate to employers requires frequent testing of employees who aren’t vaccinated. This will likely further drive up demand for quick, easy and reliable testing.

Even fully vaccinated people will need to be tested occasionally, given the possibility of breakthrough infections.

“People who have symptoms will need to go get tested, especially as they start to go back into the office and schools,” Tewarson said. “We also have more transmission of colds and viruses in the fall and winter, and you might not know if it’s COVID or not.”

The federal plan, which involves distributing rapid and at-home tests to schools, retail pharmacies and local health centers, marks a shift toward convenience. This represents a change from the pandemic’s earliest months, when the country relied on lab-based testing.

Since the Delta variant’s surge, retail pharmacies have seen demand for testing rise once anew, particularly for at-home tests like Abbott’s BinaxNOW. Under Biden’s plan, major retailers will be incentivized to sell at-home rapid tests at a lowered cost – up to a 35% discount – for the next several months.

“People need convenience,” Tewarson said. “They need to feel like at-home tests are effective and accurate, because there have been some questions around that.”

The Food and Drug Administration has its hands full attempting to distinguish between effective and ineffective testing products. In an announcement earlier this month, the agency singled out the Ellume COVID-19 Home Test for issues around false-positives, noting that it will continue to work with the company to monitor manufacturing problems.

It will be critical for the FDA and other public health agencies to maintain clear communication around testing this fall and winter. This could represent a challenge, given bungled communications during the last 20 months around masking and breakthrough infections. Testing, Tewarson stressed again, will be just as important as vaccination until the pandemic ends. That needs to be made clear to the public, manufacturers (so that they boost supply) and states (to get a head start on rebuilding testing infrastructure). “We need to emphasize that the tests are fairly accurate. So far, that messaging has not been completely clear,” Tewarson said. “At the federal, state and local levels we need clear, trusted talking points about the role testing should play and what the public should d