By Dr. LEANA S. WEN
The White House
Two years into the pandemic, Congress is poised to repeat what will almost certainly be a deadly mistake: waiting until it’s too late before investing in prevention.
The United States is experiencing a relative lull in COVID-19 infections. This is the ideal time to prepare for the next surge, which is what the Biden administration is trying to do. It has asked Congress for a reasonable $22.5 billion to purchase treatments, secure boosters and ensure that there is sufficient testing in case of new variants. This is a tiny fraction of the nearly $6 trillion allocated thus far on pandemic relief and will surely pay for itself many times over.
The White House’s request was negotiated down to $15.6 billion in Congress, but even that compromise amount was stripped from the omnibus spending package last week after objections from both Republicans and Democrats. A standalone bill for supplemental funding has been introduced in the House, but it currently lacks the support to pass the Senate.
This is a devastating turn of events with immediate consequences. The most directly impacted are the 7 million Americans who are moderately or severely immunocompromised and millions more who are elderly with underlying medical conditions. The pathway out of the pandemic for these individuals is prompt diagnosis and early treatment, so that contracting the coronavirus no longer needs to be a potential death sentence.
That’s precisely what’s at risk if Congress does not provide supplemental funding. The White House has said that it cannot purchase additional oral antiviral pills including Paxlovid, the promising treatment from Pfizer that reduces the rate of hospitalization and death by about 90%. Monoclonal antibodies are another effective COVID-19 treatment, but the administration’s own fact sheet states starkly that “the federal government has no more funding for additional monoclonals, including a planned order for March 25.” Beginning next week, it will have to ration the already limited supply and cut state allocations by more than 30%.
Immunocompromised patients have another lifeline, AstraZeneca’s Evusheld, which essentially provides antibodies to people who can’t make enough of their own. In studies of vulnerable individuals, Evusheld reduces the risk of developing COVID-19 infection by 77%. Yet the Biden administration has been able to purchase only enough to fully treat 850,000 people. It had plans to move forward with another allotment later this month but won’t be able to do so without the requested funding.
Congressional inaction means that millions of vulnerable citizens will be left to fend for themselves. Many of these individuals have done everything right and, like everyone else, just want to get back to doing the things they love. But it seems lawmakers are willing to relegate them to continued fear and prolonged isolation. What an indictment of our society it would be if our leaders allow those with the greatest need to suffer instead of funding treatments that would dramatically reduce their risk of severe illness and death.
I can’t help but wonder whether Congress would be so slow to approve funding if we were still in midst of the omicron surge. Perhaps legislators are waiting for another crisis before committing resources. That kind of thinking reflects a total misunderstanding of how public health works. By the time a new worrying variant arises, our window for prevention will be closed. A new surge could see us scrambling to reestablish testing sites that shuttered without sustained resources. It takes months to contract with manufacturers and ramp up testing and treatment.
And that doesn’t even begin to address the possibility that we might need more vaccines. Right now, the federal government doesn’t have the funding to purchase fourth doses for all Americans, much less to develop and distribute variant-specific boosters if they are needed.
The next surge might not be too far off. Britain, Germany and some other European countries are seeing a worrisome uptick in cases. The refugee crisis caused by Russia’s invasion of Ukraine could lead to outbreaks in Eastern Europe. China is just beginning its omicron wave and is already recording its highest case counts since the pandemic began. And although reported infections continue to decline in the United States, the early detection system of wastewater surveillance is raising flags with more than a third of sites seeing increases.
I still believe it was the right call to lift mask mandates and allow individuals who can, to enjoy this period of relative calm. But leaders are supposed to use this lull to prepare for what’s next, because we know it’s only a matter of time before the next emergency arrives. And we’ve already seen what happens when we don’t prioritize preparedness and prevention.
Nearly 1 million Americans have already died from COVID-19. How many more must die before Congress heeds the lessons learned?
By Dr. Leana S. Wen is an emergency physician, professor of health policy and management at George Washington University, and a nonresident senior fellow at the Brookings Institution. She can be reached through https://publichealth.gwu.edu.