‘Haven’t we learned anything?’: Experts warn of disastrous consequences if pandemic funding dries up

WASHINGTON — The failure of Congress this week to approve additional pandemic response funding could have potentially devastating consequences, prominent Covid-19 experts are warning, leaving the federal government unable to invest in more therapeutics, vaccines, testing, and other initiatives.

Congress may yet approve more funding. But a deal to provide $15 billion to continue Covid-19 response activities imploded on Wednesday, and the measure was abruptly dropped from a government funding package.

The impasse has left several prominent experts distressed that political posturing could leave the United States stuck yet again in a cycle of under-preparedness. Several experts who spoke with STAT said it’s not entirely certain a new variant could be coming, or when it could emerge, or how severe it could be, but if lawmakers wait to find out, it’s going to be too late.

“It would be going out and purchasing fire trucks the moment the 911 calls come in to the station,” said Michael Osterholm, a prominent epidemiologist at the University of Minnesota and former Covid-19 adviser to President Biden.

The Biden administration just last week announced a forward-looking playbook to address the next phase of the pandemic, and a high-profile plan to expand access to oral antivirals. But a lack of funds would undercut those proposals, said Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania and a former Obama White House health policy budget adviser.

White House press secretary Jen Psaki said in recent days that without additional funds, testing capacity could decrease in March; a program that pays for free testing and treatments for people without insurance could expire in April; supplies of monoclonal antibody treatments will dry up in May; and supplies of oral antivirals will run out in September. There’s also a looming possibility of another round of booster shots that could strain vaccine supply in the future.

The White House is currently evaluating the impact that a lack of funds will have on its pandemic response, including where programs may need to abruptly end or be pared back, a White House official said.

“To not fully fund these programs, you are playing with an infectious disease fire, and it will burn you. In the process, unfortunately, people will unnecessarily have to die,” Osterholm said.

Congress had planned to give the Biden administration $15 billion to buy needed supplies, which was less than half of the $30 billion the Department of Health and Human Services told lawmakers it needed in mid-February. Roughly one-third of the $15 billion would have been directed to global efforts to fight the pandemic.

Those asks are far below the estimates made by a group of nearly two dozen experts who released a report Monday. That group said putting the country on track to the “next normal” — defined as living with the SARS-CoV-2 virus as a continuing threat that needs to be managed — could take closer to $100 billion for new data surveillance programs, next-generation vaccines and therapeutics, and air quality improvements in buildings.

The decline in case rates due to ebbing of the Omicron variant could be an opportunity to finally get ahead of the next surge. But Eric Topol, the founder and director of the Scripps Research Translational Institute, said there’s also a danger officials will become complacent.

“These legislators are lulled in some type of trance, thinking the pandemic is over. That couldn’t be further from the truth,” Topol said. “Haven’t we learned anything in two years? I’m dismayed and disquieted about this, and I’m hoping that there is going to be some remedy.”

There’s immediate need for additional funds, the White House argues.

The federal government promised to buy 20 million courses of Pfizer’s antiviral drug, but has only actually contracted for 10.8 million of those courses. Available supply could wane as other countries place orders, a Biden administration official said. The federal supply of monoclonal antibody treatments, which are a favorite tool of some Republican governors, could run out in early May without further funding.

Testing capacity could potentially decline by 50% without further federal investment, an administration official said, as testing demand is declining as the Omicron surge subsides. Ramping back up to current levels could take six months, and turnaround times would be longer.

Even though vaccine supply is ample right now, it’s possible purchases will need to be made this spring to prepare for a future authorization of vaccines for children younger than age 5, which would be administered in a specialized dosage and delivered to thousands of providers. The looming possibility of additional booster shots for immunocompromised patients could further strain the existing supply. Only 65% of the U.S. population is fully vaccinated, according to data from the Centers for Disease Control and Prevention, and of the fully vaccinated, only 44% have received a booster.

A program that pays hospitals and clinics for testing and Covid-19 treatment for people without insurance will run out of funds soon. It’s unclear how much of those costs would be transferred to patients if providers don’t have the option to bill the federal government for those expenses.

There’s plenty of blame to go around for the disintegration of a precarious deal on Covid-19 relief funds.

The White House didn’t publicly, formally sound the alarm about the urgency of new funding until roughly a week before a government funding deadline in March, even though officials started skimping on therapeutics contracts due to budget constraints in early January. House Democratic leadership miscalculated that their caucus wouldn’t tolerate using unspent relief for state and local governments as an offset, according to a Democratic congressional aide. And Republicans are demanding that Covid-19 response dollars be offset with other funds, even though they didn’t make similar demands for emergency funding to support Ukraine.

Watching the $15 billion deal on pandemic response funds fall apart “was like watching a car crash in slow motion,” the Democratic congressional aide said.

Howard Forman, a professor of public health at Yale University School of Medicine, said he understood the arguments each party was making politically, but said lawmakers ultimately bear responsibility if the stalemate stretches longer than a few weeks and imperils response efforts.

“If they allow this to get where money actually runs out, they will be putting politics above the public’s health,” Forman said.

House Democrats introduced a standalone measure with a significant offset — $8.6 billion, more than the original deal — pulled from other leftover funding sources, including from the Small Business Administration. It’s unclear when that bill could advance in the House, and whether it could achieve the necessary votes in the Senate.

Advocates for more funding are hoping lawmakers can resolve their differences if there’s a common understanding that more funding is ultimately needed.

“The issue is not whether we need to spend this, it’s where is the money coming from,” Emanuel said.

Given the spectacular pandemic response funding meltdown, if a Covid-19 surge comes and the government is behind in planning and purchasing, the American public will hold Congress responsible for the failures, Topol warned.

“Failing means people dying, and getting severely ill unnecessarily, and it’s preventable. I wouldn’t be able to sleep at night if I were responsible for that,” Topol said.