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Congress’s epic pandemic funding failure

The PREVENT Pandemics Act is a good bill. It isn’t enough to prevent pandemics.

A masked demonstration for voting rights outside Congress this past January. Insufficient prevention funding by Congress could mean a lot more years of maskings in the future.
Tom Williams/CQ-Roll Call, Inc via Getty Images
Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

As I write this, the White House is warning that it will soon run out of funding to address the Covid-19 pandemic.

Without additional money, uninsured Americans will stop being able to get free tests and treatments for Covid-19 after March 22, and won’t be able to get free vaccinations through the federal Uninsured Program after April 5. The White House says it won’t be able to buy additional antiviral pills or new monoclonal antibody treatments for people with Covid, or to fund surveillance that could catch future waves of the virus.

The administration wants $22 billion; House Speaker Nancy Pelosi has tried to pass $15 billion only to face a rebellion from both Republicans and Democrats angry that the money would come out of the Biden stimulus plan’s funds for state governments. If this stalemate holds, the federal effort to halt the virus could effectively be over, even though the pandemic itself clearly isn’t.

That would be a disaster. Equally disastrous, though, is that Congress is simultaneously refusing to invest heavily in preventing the next pandemic.

The failures that made Covid-19 such a catastrophe — and kept the federal government and international community from squelching it when it was still a minor outbreak — still exist. We still lack the ability to adequately monitor new infectious diseases, and we still don’t invest sufficiently in preparing treatments and vaccines for viruses that could cause a pandemic if unchecked.

To be fair, Congress hasn’t done zero. There’s bipartisan support for a bill including some legal changes that could improve pandemic preparedness. Called the PREVENT Pandemics Act, it’s the culmination of a year-long effort by Senate Health, Education, Labor, and Pensions (HELP) committee chair Patty Murray (D-WA) and ranking member Richard Burr (R-NC), and it passed the committee by an overwhelming 20-2 margin on March 15.

The bill authorizes a 9/11 Commission-style investigation into the government’s failure to contain Covid-19, establishes a White House office for pandemic preparedness, and demands more information sharing between the CDC, state and local health departments, and other public health agencies, among many other provisions. If the bipartisan committee vote is any indication, the measure has strong odds of passing the Senate and House and making it to Joe Biden’s desk.

But the act only includes about $2 billion in new spending to prevent future pandemics. For comparison, a bipartisan group of former government officials (including noted conservatives like former Homeland Security Secretary Tom Ridge) has called for a $10 billion annual investment in biodefense over the next decade, adding up to $100 billion over the next 10 years. Biden’s own pandemic preparedness plan calls for $65.3 billion in funding over the next seven to 10 years; over $24 billion would go to developing and manufacturing vaccines alone.

The PREVENT Pandemics Act, in other words, leaves out about 97 percent of the funding that bipartisan experts, and the White House, think is necessary to prevent pandemics.

“Time after time, throughout the past two years we have seen how our response to this pandemic could have, and should have, been better — how public health data was slow and incomplete, how development and review of tests and treatments could have been faster, and so much more,” Murray told Vox in a statement. “The PREVENT Pandemics Act is a set of bipartisan solutions that will help address these policy breakdowns and help us better respond to future public health threats.

“But getting the PREVENT Pandemics Act across the finish line is just one part of the equation: we also need to pass the COVID-19 emergency supplemental funding so that our response right now doesn’t falter, and we absolutely need sustained, annual funding for public health so that preparedness remains a priority into the future, as I’ve proposed in my Public Health Infrastructure Saves Lives Act.”

I hope Sen. Murray is successful — but I worry that this bill might have been an optimal place to put that funding.

The current American policy toward pandemics is, frankly, nuts. The federal government is slashing funding for combating a pandemic still killing hundreds of people a day, and not investing much of anything toward preventing another pathogen from unleashing similar or worse damage. Prevention funding would easily pay for itself if it even slightly lowers the odds of a future pandemic. So why isn’t Congress ponying up?

What Congress is spending versus what it needs to spend

The PREVENT Act is, at least, a start. But it’s much more a set of rules changes than a funding bill. The difference becomes clear when you compare it to the White House’s much more comprehensive pandemic prevention proposal.

Nikki Teran, the senior biosecurity fellow at the Institute for Progress and a PhD geneticist, has been tracking the PREVENT Pandemics bill closely and helpfully put together a chart comparing spending levels in the bill to those in Biden’s pandemic prevention plan.

Comparing the pandemic prevention budget in Biden’s plan and the PREVENT Pandemics Act Institute for Progress / Nikki Teran

The chart tallies the amounts on each area of pandemic prevention that the American Pandemic Preparedness Plan, the White House proposal to boost preparedness, and how they compare to the funding amounts authorized in the PREVENT Pandemics Act.

The White House proposal includes, among other things, $24.2 billion in spending on vaccine preparedness (for instance, improving manufacturing capacity and developing candidate vaccines for common types of viruses), $11.8 billion to prepare antiviral and other therapies against likely pandemic pathogens, and $5 billion on research and manufacturing for testing, as well as funding for personal protective equipment (PPE) and improving building design (for instance through better ventilation). It’s worth reviewing the spending plan in full just to get a sense of how sprawling and comprehensive it is.

Public health experts, like those authoring the White House plan, have a decent idea of where the money ought to go. What they don’t have is the actual money from Congress.

They won’t necessarily get the money, even if PREVENT passes. Note that the PREVENT Act does not actually appropriate any money. The HELP committee where the act originated does not have the ability to allocate spending; in this case that’s the province of the appropriations committee. Authorizing funding merely creates a pathway for the funding to be appropriated in the next congressional spending bill.

Even if the act passed, in other words, it would need additional action from Congress to get the measly $2 billion it authorizes spent. With a 50-50 Senate and Republicans likely to retake Congress this fall, the odds of even that happening aren’t too high.

What it does authorize isn’t bad. It includes, for instance, $175 million for the CDC to distribute for genomic sequencing. That’s encouraging, because even a small system of linked sequencing machines at major hospitals, combined with routine sequencing of blood samples from ER patients, would enable the CDC to catch viruses with novel DNA before they’ve spread widely. The US has been a laggard when it comes to this technology; Australia, the UK, and South Africa have been much more aggressive at using genomic surveillance to detect new Covid-19 variants.

That’s not nearly enough for the kind of system we need, however. “The cost to set up and run a surveillance architecture in 200 urban hospitals in the US would be well under $1 billion, and it could be done within a year,” scientist David Ecker wrote in Scientific American last year.

More troublingly, the money comes with some odd strings. Teran notes that the funding is required to go to government agencies, like local health offices, or academic institutions/national labs. It can’t go to, say, nonprofit hospitals, except perhaps through affiliated medical schools. That might make deployment to the high-volume ERs where this sequencing is needed more challenging: most large hospitals are nonprofits, and they can’t directly acquire genomic sequencers through this funding, creating possible gaps in how many Americans the ER surveillance system covers.

“I do think it will likely go to the right spots,” Teran said about the funding, but added that this restriction is “a bit limiting.”

The next largest bucket of money, $161.8 million, goes to the CDC directly to improve its data sharing. The agency was long considered the world leader in infectious disease control, but it hasn’t exactly covered itself in glory during this pandemic. In his book on the Covid-19 emergency, former FDA Director Scott Gottlieb reports that the agency delayed test availability because its scientists patented the rights to the first tests and sharply limited commercial manufacturers’ access to samples of the virus, which they needed to make their own tests.

“Anyone who wanted to make a lab test for COVID had to follow the CDC’s test design, Gottlieb notes, “but to use that blueprint, they had to first secure a license to the agency’s intellectual property.”

Making matters worse, the first test that became available from the CDC turned out to be wholly ineffective, because of an appalling, preventable lab screw-up by CDC scientists.

Some might wonder — I, in fact, wonder — whether it’s prudent to give an agency that’s behaved so poorly additional funding without very substantial reforms. Increased funding can, for sure, help dysfunctional agencies whose main problem is a shortage of funding, and many experts have identified a lack of funding (especially for data sharing) as one of the CDC’s big problems.

But there are other problems too. Gottlieb reports in his book that Deborah Birx, who coordinated Covid-19 response under President Trump, secured funding to send to the CDC “to modernize its reporting of the COVID hospital data.” The modernization was incredibly mild; the Atlantic’s Alexis Madrigal reports that it amounted to a single spreadsheet column, showing how many doses of the antiviral remdesivir hospitals had.

The CDC insisted that adding this single spreadsheet column would take three weeks — in July 2020, as severe cases were piling up and accurately targeting remdesivir to the hospitals that needed it most was essential. Birx wound up having to set up a parallel system collating hospital data because of the CDC’s inability to get the job done.

If the CDC wasn’t able to rapidly improve data-sharing when given money at the height of the pandemic, why would they be inclined to do so now?

The PREVENT Act does offer some reforms apart from the new CDC funding. It makes the CDC director Senate-confirmable, requires annual testimony by them, and directs the agency to improve data sharing (which is what the bulk of the funding is for). But it doesn’t remove the CDC’s ability to patent diagnostic tests and strictly ration access to viral samples. Simply directing the agency to get better at data sharing and offering money for the project might not be enough.

We need real pandemic prevention investment

My point here is not to beat up on the PREVENT Act. Given an all-or-nothing choice between passing it and not passing it, we should pass it. A real investigation into the government’s response to Covid-19 would reveal more important failures like those limned above, and could spur congressional action toward more reforms and investment in preventing the next pandemic. Having a standing office for pandemic prevention in the White House will help keep the issue on decision-makers’ minds.

But it’s crucial that the federal government not stop there. It would be valuable for the Senate’s counterparts in the House to add additional funding authorizations for whole categories of interventions not included in the Senate bill, if feasible on a bipartisan basis: more funding for better tests, vaccine and treatment candidates against potential pandemic pathogens, new manufacturing facilities so we can surge production of countermeasures in an emergency, etc.

And if this bill does not wind up being the occasion for that sort of investment, Congress should be sure to find another occasion. $2 billion in spending authorizations simply is not enough to prevent pandemics going forward. We know what to do, and what it costs. We simply have to do it.

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