America begins rationing COVID resources

• "These trade-offs we are being forced to make because of Congress will have serious consequences," a White House official told Axios, ticking off therapeutics and diagnostics, domestic vaccine production capacity, stockpiling of PPE and tests and testing supplies for community health centers as examples of what could go wanting.

By the numbers: The Biden administration is redirecting $5 billion to purchase doses of updated versions of the vaccine for the fall.

• Another $4.9 billion will be redirected to buy 10 million courses of Pfizer's Paxlovid oral antiviral treatment, while $300 million will be reallocated for more monoclonal antibody treatments, the official said.

On one hand: "Our best arrow in the quiver of prevention is definitely vaccination. So if we have to prioritize that's definitely the right way to go," said Linda Dickey, president for the Association for Professionals in Infection Control and Epidemiology.

On the other hand: "This is a really unfortunate situation in which you're just taking money from one important account for another and you need both," Jennifer Nuzzo, an epidemiologist at Brown University School of Public Health told Axios.

The fallout: Blindspots in the nation's disease surveillance is one of the key concerns for epidemiologists like Nuzzo, who feared the country was shifting away from testing to more vaccine development as early as the spring of 2021.

• "We're going to lose our ability to track variants," she said.
• Experts say they fear it will be difficult to build back testing capacity if there is a spike in cases in the fall. Private companies may not make enough tests or keep staffing levels without a strong commitment from the federal government, experts say.
• Beyond tests, other areas that may go without include critical supplies like PPE or ventilators, as well as research on new vaccines including candidates for a universal coronavirus vaccine, officials said.
• So far, Dickey said there appears to be enough protective gear to go around. "We're hoping that sustains because that was obviously very scary for everybody and I'd hate to have that have to bubble up to the surface for something last minute because that's obviously something you have to have a runway to keep the pipeline going," Dickey said.

Between the lines: Beyond supplies and research, there's also concern about how reallocating COVID dollars could widen health disparities. The government in March started making austerity moves by idling the federal program that pays for testing and treatment of the uninsured.

• That's limited the ability to track the virus in some of the most vulnerable populations who are at greater risk of getting sick and spreading the disease.
• A lack of new funding hits federally qualified health centers like Cherokee Health Systems, a group of clinics in primarily rural eastern Tennessee, where nearly a third of the patients are uninsured.
• The clinics are using the HRSA COVID grant dollars to cover their expenses to cover the cost of continuing to treat, test and vaccinate those patients but the money will be gone before the end of the year, Parinda Khatri, CEO of Cherokee Health Systems told Axios.

• "I don't know what we will do," Khatri said. "We will just have to find a way to absorb those costs."

What they're saying: "Because we can't get our act together to pass the funding, it's like trying to decide between which of your children you're going to save," Nuzzo said. "My worry is this is not only compounding the stark toll of the virus, but compounding the disparities."

The other side: Some congressional Republicans who've been at loggerheads with the administration over new spending maintain COVID vaccines are being wasted and are raising broader questions about the pandemic response. GOP lawmakers also want to prioritize buying therapeutics, given the vaccines' waning effectiveness and the evolution of the virus.

What to watch: The outlook for the fall.

• It could be complicated by a potentially bad flu season and a convergence of disease spread that could again swamp health systems, Nuzzo and Dickey said.
• "If we have that, it would be really nice to say 'You have this or that, here's what you can take,'" Nuzzo said. 

The bottom line: "It seems that Congress has not learned the most critical lesson from the last two-plus years that preparedness is key to public health response," Leana Wen, an emergency physician and a professor at George Washington University told Axios in an email.

• "It's particularly frustrating because we have the tools to prevent more suffering and death — vaccines, boosters, treatments, testing, etc. What a tragedy it would be if these tools can't be deployed because of lack of funding."

Axios' Arielle Dreher contributed to this report.