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Stall of Covid-19 aid in Congress stokes fears on pandemic preparedness

Vaccine & treatment programs are in precarious spot after Senate failed to agree to a whittled-down pandemic aid package last week

One week after Congress failed to pass more funding of federal pandemic programs, several lawmakers spent the start of Easter recess in quarantine amid a rise of COVID-19 cases in the nation’s capital.

As public health experts see it, partisan politicking is endangering the fight against the ever-evolving virus.

“It’s frustrating because we are now in a position two years later where more systems are in place,” Alyssa Llamas, director of the Wynne Health Group, said in an interview. ”But what needs to happen is that they’re sustained.”

Congress’ two-week break over the Easter holiday came late last week just as several lawmakers, members of the press and cabinet members, including Speaker of the House Nancy Pelosi and Attorney General Merrick Garland, tested positive for the respiratory illness caused by the novel coronavirus. The string of positive cases on the Hill coincided with Congress’ failure to infuse the existing pandemic-response initiatives with more federal funding.

The burden of paying for vaccine procurement, virus research and treatment has become an increasingly fraught one for Congress in recent months as low case counts nationwide and the dissolution of mask mandates have pushed the pandemic to policymakers’ back burner.

But cases are on the rise across the country and in Washington, D.C., where average daily reported infections are more than double what they were two weeks ago and transmission rates in the district are at a level not seen since February.

The White House has urged Congress to continue funding COVID-19 vaccine, treatment and research efforts, warning that cutting off the flow of cash to such programs could leave the U.S. unprepared for the next variant and derail pandemic progress.

The Biden administration initially requested lawmakers pass $30 billion in aid, an ask that later dropped to $22 billion. Last week, Senate leaders reached a bipartisan deal to allocate $10 billion in COVID-19 relief. But that agreement fell apart over demands from Senate Republicans that a vote on pandemic aid also include a vote on an amendment to sustain Title 42 immigration restrictions, which the Centers for Disease Control and Prevention issued in the early days of the pandemic.

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“The poison pill is what we call that kind of amendment,” said Todd Belt, professor and director of the political management program at George Washington University, in an interview.

The proposed amendment doomed a swift vote on pandemic aid because several moderate Democrats also support keeping Title 42 in place. The CDC is set in late May to lift the emergency health policy, which allows border officials to turn away immigrants and asylum seekers on the basis of public health precautions.

Belt said the whittled-down $10 billion package and last-minute amendment are indicative of how pandemic policy discussions have morphed into a tool for political battle, rather than a matter merely about public health.

“This is a lot of posturing in advance of the elections, and both sides trying to set up the other party to look bad in the eyes of voters,” Belt said.

Democrats want to be seen as cautious and prepared for the future of the pandemic while Republicans want to get Democrats on the record about immigration policy as a precursor to the November 2022 midterms.

“This is a way for for Republicans, primarily, to really sort of fracture the Democratic Party,” Belt said.

Dr. Anand Parekh, chief medical adviser at the Bipartisan Policy Center, said the CDC decision to lift Title 42’s restrictions on immigration is based on the state of the pandemic, but in Congress, it’s shrouded in politics.

“There’s not really much public health rationale to continue with Title 42, particularly if there are COVID mitigation measures at the border. You know, I am concerned that this is a public health measure, and it’s essentially sort of being seen and used as an immigration tool,” Parekh said in an interview.

Public health experts warn that this partisan approach to pandemic policies puts the fight against COVID-19 in a precarious, and even dangerous, place.

Congress’ failure to pass the $10 billion package before the Easter holiday added at least two weeks to the timeline for a vote on aid that includes funds for vaccine research and monoclonal antibodies.

The White House has said there is no federal money to purchase additional monoclonal antibodies, which are used to slow down and treat infection, and the administration had to cancel an order of treatments that was scheduled for March 25.

Current supply of the antibodies is set to run out in late May, according to the White House.

While the current aid package pending in the Senate would procure more treatments, it doesn’t include funding for critical programs that distribute vaccines globally and cover the cost of vaccinations and treatment for people without medical insurance. Those provisions ended up on the cutting-room floor during congressional negotiations.

A Health Resources & Services Administration program that reimbursed providers for the cost of testing and treating uninsured patients stopped accepting claims last month and stopped covering the cost of administering vaccines to people without insurance in early April.

While several COVID-19 treatments, including monoclonal antibodies and antiviral pills, exist to treat infection early on, putting the cost of these treatments, as well as testing, on patients who lack insurance could force the 28 million uninsured people in the U.S. to make difficult choices about their health and finances.

“It creates a great deal of uncertainty of where to go if you get sick,” said Dr. Georges Benjamin, executive director of the American Public Health Association, in an interview.

“If you have an existing relationship with the provider, you know that they’re probably at least likely to take care of you, but the costs are going to be out of pocket,” he explained. “So for lower-income individuals, that’s going to be a problem. People are going to be making a decision between going to the doctor or not at some point. In the next few weeks to months, we’re going to be seeing a higher number of people who are ill and maybe die in a preventable situation.”

Without the federal reimbursement program for vaccines, pharmacies and providers have to swallow the cost of administering vaccines. The shots themselves are paid for by the federal government, but that cost of giving someone a shot is now on vaccine providers themselves to cover.

Claire Hannan, executive director of the Association of Immunization Managers, said the CDC has reminded providers that they have to issue vaccines at no cost to patients.

“This just puts providers in a difficult position and it puts state public health departments in a difficult position to try to enforce that,” Hannan said in an interview. “Uninsured people not getting the vaccine, pharmacies not giving vaccine to people who have no insurance, that is exactly where we don’t want to be. We don’t want to be fueling health equity issues.”

The failure to fund global vaccination efforts is a primary concern for public health experts, who warn that funding domestic programs isn’t enough to fight COVID-19.

“I think we’ve all seen what happens; the virus is only a plane ride away. If we don’t get global vaccination rates up, then we’re still at risk and we will continue to be at risk,” Hannan said.

The onset of the pandemic initially forged some bipartisan support behind funding measures to address the spread of COVID-19. That approach has shifted, however, as the months have dragged into years.

When Congress returns on April 25, they will once again have a chance to take up the $10 billion aid package while public health advocates push for additional legislation addressing global vaccinations and coverage for uninsured people.

Benjamin said this “will they, won’t they?” narrative when it comes to federal funding is not a new story for public health programs.

“Congress always does this; they never finish the job. They get almost there, then they pull the money away. They don’t finish the job. And what will happen is, nobody can be predictive, but if we get a big wave of a variant that is like that omicron wave, we’re going to be spending certainly billions, maybe trillions of dollars, dealing with another big outbreak that was totally preventable,” Benjamin said. “You can be darn sure that the people are going to be expecting the system to perform far after the money goes away. And we’re not going to be ready to do that.”

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