Dec 21, 2022 - Health

Congress' pandemic prep effort receives mixed reviews

Illustration of a scientist at a chalkboard drawing a mask surrounded by equations

Illustration: Sarah Grillo/Axios

The $1.7 trillion omnibus Congress is poised to pass this week has provisions addressing the ability to respond to future pandemics, but some experts say its lack of new spending, including on COVID-19, will leave Americans vulnerable.

Why it matters: The virus has evolved significantly since the beginning of the pandemic, rendering vaccines less effective and some treatments useless. And new health threats could hit at any time.

The big picture: The bipartisan PREVENT Pandemics Act, included in the year-end package, would fortify public health data collection, establish a "mission control" pandemic office in the government, and create a loan repayment pilot program to help recruit infectious disease doctors.

  • What the bill does not do, though, is provide major new funding for pandemic preparedness, or fulfill a $10 billion Biden administration request to fight the current pandemic.
  • The underlying spending bill would deliver funding bumps for needs such as public health infrastructure and data surveillance upgrades and a hospital preparedness program.

What they're saying: "I'm delighted that there's a bipartisan action, but there's a whole lot more that needs to get done," said Tom Frieden, a former CDC director now president of the group Resolve to Save Lives. "I wouldn't want people to think, 'Well, Congress's kind of checked that box. It's legislated on pandemics. We're done until the next one.'"

  • Others were more critical: "This is just preparing the country to have a really bad response the next time something breaks out," said Zeke Emanuel, vice provost of global initiatives at the University of Pennsylvania, who co-authored a pandemic roadmap for safely resuming normal activities this year.
  • "We are not fixing the things that led to a bad response over COVID, and we're facing a serious possibility that new variants of concern could arise in China," he added, referring to the rapid spread of the virus in that country following the country's recent shift in strategy.

The Biden administration has been asking for more COVID funding for months, but Republicans haven't budged, countering that additional money is not needed because billions have already been provided in earlier pandemic bills.

  • The White House says the new money could have gone in part towards boosting development of next-generation vaccines that can better fight multiple virus variants.
  • "The truth is that for the long-run management of this virus, we need variant-resistant vaccines, we need vaccines that prevent transmission," White House COVID coordinator Ashish Jha told reporters last month. "A major part of our request is for funding for public-private partnerships to move those kinds of technologies forward, to move the next generation of treatments forward."
  • "These are not perfect drugs and perfect vaccines. COVID's not going away, and you need a next generation of vaccines and therapeutics," a senior Biden administration official told Axios. "It will take a lot more time if there isn't government involvement than if there are government resources."

State of play: The virus has evolved to the point where none of the monoclonal antibody therapeutics developed to treat infected patients are effective anymore, and Evusheld — a preventative therapy used by immunocompromised people —  is less effective against new variants.

  • Three antivirals — Paxlovid, remdesivir and Merck's molnupiravir — remain effective against the virus, per the NIH.
  • Two studies released by the CDC last week painted a mixed picture of the updated bivalent vaccines’ effectiveness. One found that the bivalent booster was 57% effective against hospitalizations compared with no vaccination. The second found that among adults 65 and older, the updated booster was 84% effective against hospitalization compared with no vaccination.

Zoom out: Experts have been calling for some kind of Operation Warp Speed 2.0 for a year, to no avail.

  • Frieden said more funding could both spur vaccine development for future pandemics and boost public health infrastructure more broadly. "When there's not a market for a vaccine, it doesn't get made, unless the government pushes it," he said. "So there's no market for a vaccine for a disease that is not yet causing illness."
  • Sen. Patty Murray (D-Wash.), who led the PREVENT Pandemics Act with Sen. Richard Burr (R-N.C.), has separate legislation to provide $4.5 billion per year for public health infrastructure. But that bill only has Democratic cosponsors.
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