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Congress is cutting corners on Covid-19 funding. We may pay for it later.

The global vaccination campaign got cut out of Congress’s new Covid-19 funding bill. That’s a mistake.

Illustration of George Washington on the United States dollar bill wearing a disposable mask.
Congress has brokered a $10 billion deal for a new round of Covid-19 response funding. The Biden administration had originally asked Congress for more than $22 billion
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Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Another surge of Covid-19 seems nearly inevitable — whether sooner, from the BA.2 omicron variant, or later, when the next winter with its widely expected cold-weather wave arrives. Yet the US government’s willingness to fund the response to the Covid-19 pandemic here and around the world is dwindling, suggesting the US is once again missing an opportunity to get ahead of the virus.

Congress has brokered a whittled-down $10 billion deal for a new round of Covid-19 response funding. The agreement between Senate Democrats and Republicans comes nearly a month after a slightly larger proposal for emergency funding was pulled from the government spending bill.

Already, as the original funding ran out, the Biden administration canceled new orders for antiviral medications and stopped accepting claims to reimburse testing and treatment bills for uninsured Americans.

The Biden administration had originally asked Congress for more than $22 billion in new funding. The emerging deal would allocate less than half of that amount; senators nixed funding for the global vaccination campaign because they couldn’t agree on how to pay for those provisions. But even the portion of the new funding being spent on vaccines for Americans, capped at $4.25 billion under the bill as written, may ultimately be insufficient. The Biden administration recently expanded eligibility for a fourth dose of the Covid-19 vaccines for some Americans. There isn’t enough money in the bill to pay for a fourth dose for every American if that turns out to be medically necessary.

The shortfall threatens the pandemic response across the world and in the US.

Already, there is an enormous disparity in vaccination rates between the US and other wealthy countries and their less affluent counterparts. In high-income and upper-middle-income countries, about 75 percent of the population is vaccinated. But there is much less protection in lower-middle-income (roughly 50 percent) and low-income (a little more than 10 percent) nations.

The countries with the lowest vaccination rates are in Africa, which has been a focal point of the US government’s global vaccination support program. USAID has been spending money to help those countries’ health systems with transporting, storing, and administering the Covid-19 vaccines.

Our World In Data

But, as Politico reported last week, USAID expects it will have to stop funding those activities in the second half of the year without an infusion of new funding from Congress. The deal announced this week was maybe the last best chance to get the money approved.

That represents a humanitarian failure. Though the official death toll in these countries is generally lower than in many wealthy countries, the statistics may dramatically undercount the actual devastation of the pandemic. A recent analysis from the World Bank suggested that the real number of pandemic deaths in Kenya could be nearly six times higher than the official count.

“Across Africa, the Covid-19 death count may be higher than official counts, pointing to the urgent need to ramp up global vaccine access,” the World Bank researchers wrote, less than two months before Congress would fail to do exactly that.

And cutting those efforts not only puts people’s health in Africa at risk, but Americans’ health as well. Experts have been warning for months that if the virus continues to circulate in other parts of the world, new variants could continue to emerge. The omicron variant, which was first detected in South Africa, killed more than 2,500 Americans every day at its peak.

On top of the risk to global health, outside estimates suggest even the funding in the new legislation dedicated to America’s Covid-19 response may not be sufficient.

The $10 billion authorized in the new legislation will be used to buy more Covid-19 medications, tests, and vaccines. But it’s not clear there will be enough funding available to sustain the vaccination campaign into the future.

Fourth shots are now okayed for every American over 50. According to a Kaiser Family Foundation analysis, the US barely has enough vaccine doses in hand to provide all four shots to 70 percent of the over-50 population. If we wanted to reach 100 percent of that cohort, the country is 225 million doses short.

For now, experts don’t believe a fourth shot is necessary for younger people unless they are immunocompromised. But that could change if a new and more dangerous variant were to become dominant — something that will be more likely if large portions of the world remain unvaccinated. And if the United States were to eventually approve the fourth dose for all ages, the country is roughly 500 million shots short of the necessary number to fully vaccinate everyone.

Acquiring the necessary doses could cost up to $10 billion all on its own, according to the estimates. Out of the $10 billion in new funding negotiated by Congress, at least $5 billion must be spent on therapeutics, according to the bill text, and another $750 million would be earmarked for research on shots targeting new variants. That would leave $4.25 billion for buying more of the current vaccines and for increasing testing capacity.

In a separate analysis, KFF’s researchers warned that future vaccine doses may prove to be harder to come by, too. To date, the US has had a sufficient vaccine supply because it bought the doses ahead of time. Vaccine manufacturers had a guaranteed market for a certain number of doses. But without pre-purchasing agreements, companies may not produce enough doses and the US would be left competing with the rest of the world for whatever supplies are still left.

“Together, this could contribute to shortages of supplies if and when the next Covid-19 wave hits and demand increases,” the researchers wrote.

Rather than make investments now that could pay off when Covid-19 inevitably surges again, Congress is cutting corners. The cost of this myopia could end up being felt all over the world in the months to come.

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