President Joe Biden has asked Americans to start putting covid behind them and get back to their normal lives. But his proposed budget tells a different story.
Biden’s proposal, released Monday, suggests that the country should prepare for covid to be around for the long haul — and for the possibility of future pandemics.
Congress’ response to covid has been to fund the national response through emergency means, passing spending bills on the fly to fund immediate needs such as purchasing and administering vaccines and reimbursing doctors and hospitals for care. The president’s budget request, which is essentially a wish list, urges a shift to funding these needs over the long term, which would allow agencies to plan ahead and set priorities.
The idea is to “get public health out of this boom and bust cycle of funding during an emergency and then stagnating [afterward],” said Jeffrey Ekoma, director of government affairs for the Association of State and Territorial Health Officials.
The budget calls for $81.7 billion in spending spread over the next five years to streamline vaccine, therapeutics and diagnostics development; bolster public health infrastructure to improve disease surveillance and expand the workforce; and create a new program to provide free vaccines to uninsured adults.
“It’s a move in the right direction,” Ekoma said. “Our fear is that the promise of the budget proposal will not become a reality because it’s hard to push funding through Congress in an election year.”
Covid funding is winding down
Biden’s proposal is aspirational. Presidential budget requests lay out what an administration would like to see Congress do, but rarely do the contours become law.
In the case of covid, the Biden plan and Congress’ desires conflict. Earlier this month, lawmakers rejected the White House’s request for $22.5 billion in emergency funding to continue the country’s covid response. The consequences are already starkly apparent.
Last week, the federal government program that paid for covid tests and treatments for the uninsured ran out of money and stopped accepting claims for reimbursement; now, some of the most vulnerable people in the country will have to foot the bill for covid care if they become sick.
The government last week also cut by 35 percent shipments to states of monoclonal antibody treatments, Surgeon General Vivek Murthy and David Kessler, chief science officer for the White House Covid-19 Response Team, wrote Tuesday in the New York Times. “We will not be able to continue making home tests available, and the critical surveillance efforts that help us anticipate new waves and variants will be compromised,” the pair said.
And next week, the program that allows uninsured people to receive free covid vaccines will stop taking claims, which could stall progress in vaccinating the most vulnerable.
“What we need to continue to finish the job on covid we need immediately,” Health and Human Services Secretary Xavier Becerra said Tuesday of the emergency-funding lapse. “What we’re asking for in this budget for long-term preparedness is very separate, [though] it will take on many of the same tasks.”
What Biden wants
Parts of the proposed budget aim to avoid this kind of last-minute scramble for funding by creating more permanent programs. One, dubbed “Vaccines for Adults,” would provide uninsured adults free access to any vaccines recommended by the Centers for Disease Control and Prevention’s vaccine advisory committee — for covid or any other preventable diseases.
“Making this part of a regular proposal, rather than an emergency that’s going to be covered for the next 90 days or year, is essential,” said Ezekiel Emanuel, a bioethicist at the University of Pennsylvania who has advised the Biden administration on its pandemic response. “We ought to make this a permanent program.”
The Biden budget proposes to boost CDC funding by 171 percent from 2021, including $28 billion toward pandemic preparedness. “We’re excited to see an overall increase in CDC funding,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials (NACCHO). “But overall, it’s a mixed bag.”
The budget calls for $600 million to revitalize public health infrastructure and make it more responsive during surges of disease, $200 million for modernizing data collection, analytics and reporting, and $50 million to bolster the public health workforce. Such broad investments are welcome, Casalotti said, since CDC funding is often disease-specific, which can neglect tools that are more responsive to new threats.
But funding is lacking in some areas, she said. For example, the Public Health Emergency Preparedness program, which is the backbone to early emergency response, would receive only $695 million in the president’s plan; NACCHO suggests $1 billion is needed to fully restore the program after decades of disinvestment.
Cutting-edge research also gets a boost from the budget: $5 billion toward the Advanced Research Projects Agency for Health (ARPA-H), a 400 percent increase above the new agency’s seed funding. Modeled after the Defense Advanced Research Projects Agency (DARPA), ARPA-H would fund high-risk, high-reward projects and initially focus on cancer, diabetes and dementia. Details of how the agency would work, including where in the government it will sit, still must be hammered out.
“The idea of having an advanced program like this is really important,” Emanuel said. But to be truly innovative, the agency will have to be able to take gambles that may not pan out, he said. “A lot of government agencies are unwilling to take gambles because of criticism they could face if they fail,” he said. To give ARPA-H the chance of developing tools that could fight the next pandemic threat, the agency will have to break that mold.
The total price tag — $87 billion over five years — may seem like a very large number, said Howard Forman, a radiologist and health policy expert at Yale University. But if you break it down, it’s about $50 per person, per year, to try to prevent the next pandemic from overwhelming us like this one has, he said.
“That’s a very modest figure in my mind when you’re dealing with a million lives that have been lost and tens of millions that have been harmed,” he said. “It’s just such a small amount when you’re dealing with the public’s health.”
Thanks to Lillian Barkley for copy editing this article.