1 big thing: Drug pricing law a GOP target 

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Deal reached to renew funding for key FDA programs

2. Deal reached to renew FDA user fees

White House unloads on Lindsey Graham's abortion ban

3. White House unloads on Graham's abortion ban

Drug treatment center admissions fell 23% during COVID

4. Data du jour: Drug treatment amid COVID-19

5. Catch up quick

We made it to Friday, Vitals gang. I'll be filling in for Tina for the next few days. Today's newsletter is 751 words or a 3-minute read.

Situational awareness: The Biden administration today is awarding nearly $1.5 billion in grants to states and territories for treatments and recovery services to address the opioid crisis. 

A big thank you, as always, to Bryan McBournie for copy editing the newsletter.

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Keep up with health care politics, policy and business

Axios Vitals

1 big thing: Dem drug bill targets old blockbusters

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2. Updated COVID boosters could be fast-tracked

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3. Wuhan market pinpointed as COVID Ground Zero

4. Challenge to ACA puts cloud over HIV coverage 

We're halfway to the weekend, Vitals fans. Today's newsletter is 897 words, or a 3-minute read.

Join me and Axios’ Caitlin Owens today at 12:30pm ET for a virtual event examining the path forward for health care in a post-pandemic world. Guests include Centers for Medicare and Medicaid Services administrator Chiquita Brooks-LaSure and Rep. Fred Upton (R-Mich.). Register here.

1 big thing: Contraception anxiety peaks

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2. Democrats' insulin dilemma

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3. Travel nurse demand cools off

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4. More LGBTQ youth with trauma tried suicide

Happy Thursday, Vitals readers. Today's newsletter is 921 words, or a 3-minute read.

1 big thing: Dems poised to fulfill drug price promise

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2. Monkeypox vaccine well could run dry 

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3. 1 in 5 OK with threatening health officials

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4. United-Change trial begins

5. While you were weekending

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Rise and shine, Vitals gang, we have a big week ahead. Today's newsletter is 916 words, or a 3-minute read.

Plus: 1 in 5 OK with threatening health officials

1 big thing: Flooding the zone

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2. 20% of public fear getting monkeypox

3. Workers on the hook for more medical costs

4. Study links head trauma to CTE

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Situational awareness: The Biden administration will begin offering updated COVID-19 boosters in September that are expected to offer stronger protection against the BA.5 subvariant. That means federal officials will not expand eligibility for second booster shots of existing vaccines.

Today's newsletter is 900 words, or a 3-minute read.

Data: Axios/Ipsos poll; Chart:Simran Parwani/Axios

Two and a half years into the pandemic, Americans say they’re doing well in most aspects of their lives — except possibly their personal finances, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Why it matters: Many of us appear ready to roll the credits on the pandemic, despite lingering political divisions over the response and some residual distrust of government and some health institutions.

The public’s perception of personal risk also is at a low point, and people are starting to pick and choose more where they deem it necessary to take precautions like masking. 

Between the lines: While there haven’t been significant behavioral shifts since last spring, there’s been an across-the-board improvement in the public’s mood. 

Overwhelming majorities say they had very or somewhat good physical health (83%), mental health (85%), emotional well-being (84%) and home life (90%). 

But only 78% reported having very or somewhat good personal finances. 

The results may bode well for Democrats who are wary of discussing COVID or reminding people there’s still a health threat in the run-up to the midterms.

But it could also make it difficult for the Biden administration to spark interest in getting reformulated booster shots. 

What they’re saying: “Most Americans have turned the page on the COVID pandemic, even as most acknowledge the virus is likely to be with us for the long term," said Cliff Young, president of Ipsos U.S. Public Affairs.

"While interest in easy preventatives, like the new Omicron-specific booster, remains high, most people are taking COVID risks in stride." 

That doesn't mean most Americans think we're done with the pandemic: 65% disagreed that it's over, while just 33% agreed.

The poll found that 60% plan to get the new booster by the end of the year and another 7% say they'll get it next year, with 32% not sure.

The intrigue: While the majority of Americans may not be focused on the course of the pandemic, they've increasingly developed a hierarchy of when it's appropriate to wear a mask. 

48% say they always or sometimes mask up on airplanes, and 39% do on trains, buses, taxis or in rideshares.

Only about a quarter will when outdoors in crowded spaces, in small indoor gatherings or walking into a restaurant to dine indoors.

The public also continues to grapple with what the pandemic has meant on an individual and broader societal level. 

73% strongly or somewhat agree with the statement that pandemic-related shutdowns were needed to save lives, but 51% say they also caused unnecessary damage to the economy.

88% say COVID has changed Americans' lives forever, though 82% say we're in a better place today than a year ago. 

The big picture: While the COVID response isn't the political lightning rod it was even a year ago, some institutions have emerged with diminished public trust.

For example, 62% say they have a great deal or a fair amount of trust in the Centers for Disease Control to provide accurate information, compared to 84% when Axios and Ipsos began polling on the crisis in March 2020.

And though President Biden's trust numbers have inched up in recent months, 53% say they still don't trust him at all or very much to provide accurate information about COVID-19.

Methodology: This Axios/Ipsos Poll was conducted Sept. 9-12 by Ipsos' KnowledgePanel®. This poll is based on a nationally representative probability sample of 1,158 adults age 18 or older.

The margin of sampling error is ±3.1 percentage points at the 95% confidence level, for results based on the entire sample of adults. 

Axios-Ipsos poll: Roll credits on the pandemic

They don't think it's over, but their perception of risk is at a low point.

Public health

Coronavirus

<div><figure><iframe frameborder="0" height="304" id="datawrapper-chart-A7UzK" scrolling="no" src="https://datawrapper.dwcdn.net/A7UzK/" title="Share of Americans who say their &lt;span style=&quot;border-bottom: 2px solid #000;&quot;&gt;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&amp;nbsp;&lt;/span&gt; is &lt;span style=&quot;background:#663000; padding:3px 5px;color:white;&quot;&gt;very&lt;/span&gt; or &lt;span style=&quot;background:#d96700; padding:3px 5px;color:white;&quot;&gt;somewhat&lt;/span&gt; good right now"></iframe><figcaption>Data: Axios/Ipsos poll; Chart:Simran Parwani/Axios</figcaption></figure></div>Two and a half years into the pandemic, Americans say they’re doing well in most aspects of their lives — except possibly their personal finances, according to the latest installment of the <a class="gtmContentClick" data-vars-link-text="Axios/Ipsos Coronavirus Index" data-vars-click-url="https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index" data-vars-content-id="40364540-d7a4-470e-b3e9-3740b5f0a0a2" data-vars-headline="Axios-Ipsos poll: Roll credits on the pandemic" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index" target="_blank">Axios/Ipsos Coronavirus Index</a>.Why it matters: Many of us appear ready to roll the credits on the pandemic, despite lingering political divisions over the response and some residual distrust of government and some health institutions.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

The first updated COVID-19 boosters are days away from going into the arms of Americans. But the expedited way in which they're being rolled out, and unknowns on how well they'll work, have left many people leery and full of questions.

Why it matters: Experts generally agree COVID vaccinations were in need of an update to target strains like Omicron that now account for the majority of U.S. cases. And the evidence suggests the reformulated Pfizer-BioNTech and Moderna shots should protect those at greatest risk from hospitalization and death.  

With a CDC vaccine advisory panel set to meet today to consider recommending the shots, Axios checked in with leading public health experts to suss out the biggest lingering questions:

Should we get Covid boosters right away? 

It depends. People who haven't been vaccinated should get the original shots first, said Andrew Pekosz, co-director of the Johns Hopkins Center of Excellence for Influenza Research and Surveillance. The boosters were designed to be used as a boost only with a lower dose of mRNA.

The consensus for people who already got a booster or caught COVID this summer is to wait at least 60 days before getting these shots, Megan Ranney, academic dean at the Brown University School of Public Health, wrote on Twitter.

For still others, it's a personal choice partly based on what could lie ahead. Some people could reasonably hold off until closer to October or November, to maximize protection ahead of an expected surge during the holidays. That might also buy a little time to see how well the shots are working.

Why were the new shots authorized without real-world data on how they work in humans? 

The Biden administration is putting speed ahead of having all the data on how the vaccines work in order to target the dominant strain. 

It's largely like the process for making a seasonal flu vaccine, in which an established vaccine technology gets reformulated to target the strain experts believe is likeliest to be circulating. 

"If you know the vaccine platform works, just putting a new variant sequence into it shouldn't necessitate you do a full-blown clinical trial once you have all that data," Pekosz said.

The real-world data gets collected and studied after people start getting these shots, Ranney said. Definitive clinical data will be available from manufacturers in one to two months, per Peter Marks, the FDA's chief vaccine regulator, said on a conference call Wednesday.

There's an argument to be made that pushing these vaccines out as early as possible makes sense as kids head back to school and colder temperatures push people to spend more time indoors.

"We have a virus that is rapidly changing and we want to be able to have as much impact in terms of saving lives, preventing severe illness as we can," said Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC.

Emerging data showing more younger patients with "long COVID" also factored in the decision to make the shots available to people age 12 and up. 

Politics may also play a role, some suggest.

"The ideal time for individuals to get boosters would likely be late October to mid-November based on conversations we have had with experts. That is literally right before the election," Chris Meekins, an analyst for Raymond James, wrote in a note to clients.

One line of thought holds the Biden administration in pushing the shots now can prevent a significant uptick in cases before the midterms, Meekins said. That could avoid having a discussion about COVID and the need for boosters in the weeks before people go to the polls. "Both are viewed by Democratic political consultants as harmful to Democratic chances," Meekins wrote. 

Do we really need an Omicron-specific booster? 

The consensus is yes. But there still are questions whether it's worth the effort.

That's because the original mRNA vaccines continue do a good job of preventing severe illness, even though they're increasingly ill-suited to tackle Omicron.

Paul Offit, a vaccine researcher at the Children's Hospital of Philadelphia, told the journal Science that because the time between getting infected and becoming infectious to others is so short with COVID-19, the reformulated shots may not have a big impact. 

He contrasted that with measles or rubella, which have a longer incubation period and give a vaccinated person's immune memory cells time to produce enough antibodies to prevent the disease from being passed on. 

Should I get the same brand of booster as my original shot, or is mixing and matching better?

Pekosz said studies haven't shown significant differences between one combination over another. "Really whatever is available is just fine," Pekosz said.  

How many people will get these new Covid vaccines? 

Uptake will likely be lower in part due to fewer dollars available for outreach, Besser said. And then, there's pandemic fatigue. 

"There are a lot of people who are just done thinking about COVID and taking any measures whatsoever to reduce their chances of getting it. That's concerning given that more than 400 people are still dying every day from COVID," Besser said.

"We believe less than one-third of the fully vaccinated will get this new booster between now and March 1, 2023," Meekins said. "At the high end, we believe 75M booster shots could be administered, though we expect that number to be much lower. We would not be surprised if it fails to crack 50M."

However, Meekins said: "If we start to see a significant wave, we expect vaccination demand to increase."

Editor's note: A quote from Andrew Pekosz, co-director of the Johns Hopkins Center of Excellence for Influenza Research and Surveillance, has been corrected to say: "If you know the vaccine platform works, just putting a new variant sequence into it shouldn't necessitate you do a full-blown clinical trial once you have all that data." It was previously misstated to say "should".

What to know about new COVID boosters

Experts answer some top questions about Omicron-specific COVID boosters.

Illustration of a virus cell surrounded by question marks

COVID-19

The first updated <a class="gtmContentClick" data-vars-link-text="COVID-19 boosters" data-vars-click-url="https://www.axios.com/2022/08/31/fda-retooled-covid-boosters-omicron" data-vars-content-id="4bf1c098-f8e1-474e-807e-5719203f6387" data-vars-headline="What to know about new COVID boosters" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/08/31/fda-retooled-covid-boosters-omicron" target="_self">COVID-19 boosters</a> are days away from going into the arms of Americans. But the expedited way in which they&#x27;re being rolled out, and unknowns on how well they&#x27;ll work, have left many people leery and full of questions.Why it matters: Experts generally agree <a class="gtmContentClick" data-vars-link-text="COVID vaccinations" data-vars-click-url="https://www.axios.com/health/coronavirus" data-vars-content-id="4bf1c098-f8e1-474e-807e-5719203f6387" data-vars-headline="What to know about new COVID boosters" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/health/coronavirus" target="_self">COVID vaccinations</a> were in need of an update to target strains like Omicron that now account for the majority of U.S. cases. And the evidence suggests the reformulated Pfizer-BioNTech and Moderna shots should protect those at greatest risk from hospitalization and death.

Data: Cantor, et. al, 2022, Analysis of Substance Use Disorder Treatment Admissions in the US by Sex and Race and Ethnicity Before and During the COVID-19 Pandemic; Chart: Erin Davis/Axios Visuals

Admissions to drug treatment facilities fell by more than 23% during the pandemic as substance use disorders and overdose deaths rose, a new analysis published in the Journal of the American Medical Association shows.

What they found: Almost every state saw fewer patients seek treatment during 2020 than in previous years.

Native Americans accounted for the largest drop in admissions, and they also had the largest increase in overdose deaths during the pandemic.

The authors noted more work is needed to examine reasons for the differences, including pandemic-driven shelter-in-place policies and bans on elective procedures. 

Almost every state saw fewer patients seek treatment during 2020 than in previous years.

Health care

Admissions to drug treatment facilities fell by more than 23% during the pandemic as substance use disorders and overdose deaths rose, <a class="gtmContentClick" data-vars-link-text="a new analysis" data-vars-click-url="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796619?utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_term=092222" data-vars-item="in_content_link" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796619?utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_term=092222" target="_blank">a new analysis</a> published in the Journal of the American Medical Association shows.What they found: Almost every state saw fewer patients seek treatment during 2020 than in previous years.

A federal court ruling that struck down required coverage of HIV prevention medication may have far more sweeping implications for whether insurers will have to continue offering a range of no-cost preventive health services. 

Driving the news: U.S. District Court Judge Reed O'Connor ruled on Wednesday that an Affordable Care Act requirement that employers cover the HIV prevention medication known as PrEP violates the Religious Freedom Restoration Act.

What he's saying: The government failed to show "a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions," O'Connor wrote.

O'Connor also said the U.S. Preventive Services Task Force violates the Appointments Clause of the Constitution, casting into doubt its recommendations about how primary and preventive care is delivered, along with which services should be paid for by insurance.

PrEP is among the services the task force most highly recommends. Other services include screening for breast, lung, colorectal and cervical cancers, fall prevention for older adults, depression screening and certain prenatal care services and infant screening services.

What they're saying: "This is not just about PrEP. It's much broader," Katie Keith, a health law expert at Georgetown University told Axios. 

"If we l0se the A or B recommendations, then any employer or plan, religious objection or not, could say we're not going to cover that anymore."

Jonathan Adler, a Case Western Reserve University law professor, agrees. The ruling suggests "self-insuring employers could pick and choose what they want to cover based on religious objections to certain types of coverage."

What to watch: There's still some uncertainty about the scope of the ruling, Keith said. O'Connor told both sides to file briefs addressing that by Friday.

If it does apply more broadly, experts say it would strike at the heart of the ACA's preventive services mandate and could put millions of Americans on the hook financially for some of the highest-value services. 

"Adding an additional barrier to so many essential medical services is only going to make things worse and it's going to make things disproportionately worse for the most vulnerable," Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design told Axios.

Court ruling on HIV meds could have sweeping implications for preventive care

"This is not just about PrEP. It's much broader."

Illustration of a caduceus turning into a gavel.

Affordable Care Act

A federal court ruling that struck down required coverage of <a class="gtmContentClick" data-vars-link-text="HIV prevention medication" data-vars-click-url="https://www.axios.com/2022/04/27/hiv-prep-is-supposed-to-be-covered-but-often-isnt" data-vars-content-id="a4fc64bf-1cba-4ea3-af80-f3108d455de8" data-vars-headline="Court ruling on HIV meds could have sweeping implications for preventive care" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/04/27/hiv-prep-is-supposed-to-be-covered-but-often-isnt" target="_self">HIV prevention medication</a> may have far more sweeping implications for whether insurers will have to continue offering a range of no-cost preventive health services. Driving the news: U.S. District Court Judge Reed O&#x27;Connor <a class="gtmContentClick" data-vars-link-text="ruled on Wednesday" data-vars-click-url="https://www.axios.com/2022/09/07/court-hiv-prep-requirement-aca-truvada" data-vars-content-id="a4fc64bf-1cba-4ea3-af80-f3108d455de8" data-vars-headline="Court ruling on HIV meds could have sweeping implications for preventive care" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/09/07/court-hiv-prep-requirement-aca-truvada" target="_self">ruled on Wednesday</a> that an Affordable Care Act requirement that employers cover the HIV prevention medication known as PrEP violates the Religious Freedom Restoration Act.

The public has quickly become familiar with monkeypox and how it spreads, but more than a quarter of Americans say they’re not likely to get vaccinated if exposed to the virus, according to a new Annenberg Public Policy Center survey.

Why it matters: At a time when polls suggest crisis-weary Americans are tuning out public health messaging, the findings suggest the public is still able to lock in on information about a new health threat, said the center's director, Kathleen Hall Jamieson.

Findings: 61% of those surveyed know that a monkeypox vaccine exists, up from 34% in July. And the vast majority are aware monkeypox usually spreads through close contact with an infected person.

Nearly two-thirds (63%) know that men who have sex with men are at a higher risk of infection, up from 33% in July.

1 in 5 Americans worry about getting monkeypox over the next three months, which is roughly the same as in July.

Only 41% know that monkeypox is less contagious than COVID-19.

The survey of 1,621 U.S. adults surveyed was conducted Aug. 16–22 and has a margin of error of ± 3.3 percentage points at the 95% confidence level.

Monkeypox awareness surged over the summer

Illustration of a US map with scattered dots.

The public has quickly become familiar with monkeypox and how it spreads, but more than a quarter of Americans say they’re not likely to get vaccinated if exposed to the virus, according to a new <a class="gtmContentClick" data-vars-link-text="Annenberg Public Policy Center" data-vars-click-url="https://www.annenbergpublicpolicycenter.org/public-knowledge-of-monkeypox-increases-but-over-1-in-4-unlikely-to-get-vaccinated-if-exposed/" data-vars-content-id="d3a02735-f602-48b3-a420-c07e4170de03" data-vars-headline="Monkeypox awareness surged over the summer" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.annenbergpublicpolicycenter.org/public-knowledge-of-monkeypox-increases-but-over-1-in-4-unlikely-to-get-vaccinated-if-exposed/" target="_blank">Annenberg Public Policy Center</a> survey.Why it matters: At a time when polls suggest crisis-weary Americans are tuning out public health messaging, the findings suggest the public is still able to lock in on information about a new health threat, said the center&#x27;s director, Kathleen Hall Jamieson.

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Stories

Drug treatment center admissions fell 23% during COVID

Monkeypox awareness surged over the summer

Axios-Ipsos poll: Roll credits on the pandemic

Court ruling on HIV meds could have sweeping implications for preventive care

What to know about new COVID boosters

Newsletter editions

Axios Vitals: Target on drug price law

Axios Vitals: Delivering a decades-long promise

Axios Vitals: Monkeypox vaccines

Axios Vitals: Contraception anxiety peaks

Axios Vitals: Dem drug bill's bite