President Joe Biden campaigned as America’s pandemic fighter. So it will be strange, to say the least, if his infrastructure bill fails to significantly increase the country’s pandemic-preparedness budget.
But it could happen. Biden proposed $30 billion to address the issue, which advocates say could permanently mitigate the risks of future outbreaks. The investment would replenish medical stockpiles, proactively develop vaccines for major types of viruses, and ensure that the United States has a permanent production base of face masks and respirators. In effect, it would amount to an Apollo program–like push to guarantee that a global pandemic could never shut down the country again.
Yet those funds have been slashed in the current negotiations over the $3.5 trillion reconciliation package as part of a push to slim it down, according to a source familiar with the situation. (I agreed not to name this person because they were not authorized to speak publicly about the negotiations.) While the exact amount is still in flux, it is significantly less than requested.
In the past week, public-health advocates and nonprofits have mobilized against the reduction, which Tom Frieden, a former CDC director who now runs the nonprofit Resolve to Save Lives, first revealed earlier this month. But as the White House and Democrats in Congress discuss the package’s details, they may be locking in an outdated approach to tackling pandemics, quietly and out of public view.
“Public health has been chronically underfunded. But prevention is always better than treatment, and the fact that, after an event as significant as COVID, we have to fight for this $30 billion defies belief,” Gabriel Bankman-Fried, the executive director of the nonprofit Guarding Against Pandemics, told me. (The White House and Senate Majority Leader Chuck Schumer did not respond to requests for comment.)
Looming over this funding fight is a broader question: What reforms, if any, will the federal government make to its public-health agencies after their significant failures over the past 16 months? After 2,977 people were murdered on September 11, 2001, Congress started a war and revised the country’s approach to policing, surveillance, and national security within six weeks; it opened a new federal agency and commissioned a bipartisan fact-finding panel within 14 months. Although the wisdom of some of those decisions is debatable, COVID-19 has now killed more than 600,000 Americans. The federal government’s failures have been, in some ways, just as stark as 20 years ago: The CDC, for instance, did not know how many people were sick throughout the early months of the pandemic. Yet Congress has demonstrated little haste so far in determining what went wrong and how the country’s public-health institutions can prevent it from happening again.
That was supposedly about to change. In recent weeks, leaders in Congress and the White House had seemingly coalesced around a two-step approach: First, increase funding to pandemic prevention in the current infrastructure package. Then, perhaps as soon as this fall, conduct a more in-depth investigation that could end with the reorganization of major agencies. Senators Patty Murray of Washington and Richard Burr of North Carolina, the highest-ranking Democrat and Republican on the Senate health committee, have discussed beginning such an effort later this year.
The two steps are separate but not entirely disconnected. Murray and Burr’s ability to remedy the failures of the CDC or FDA will be limited, public-health advocates and lobbyists say, if pandemic preparedness receives tens of billions of dollars less than proposed. “Senator Murray believes we need to make as strong of an investment as we can at this critical moment in our nation’s pandemic response,” a spokesperson told me in an email.
The $30 billion is meant to enable a far more aggressive stance toward pandemic prevention than has previously existed in the United States. A large share of the funding would go to “developing, testing, and approving” vaccines and treatments for the viral pathogens with the most pandemic potential, according to a document circulated by Guarding Against Pandemics.
Scientists, for instance, have long sought to develop a vaccine that addresses all known types of betacoronaviruses—that is, not only SARS-CoV-2, the virus that causes COVID-19, but also SARS and MERS. With the $30 billion, the government could develop not only that universal vaccine, but one for all 25 known viral families that infect humans, such as filoviruses, a family of viruses that includes the pathogen that causes Ebola.
This would mark a big change in how the country addresses infectious disease, Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, told me. For years, Congress has apportioned money only to fight specific diseases. If a new pathogen arose or became a public-health threat—as the Zika virus did last decade—then public-health agencies often had to wait for Congress to provide more money before they could attack it in earnest.
Having a vaccine ready to go for every class of pathogen would help America meet the goal—endorsed by Biden and the other Group of Seven leaders last month—of distributing a vaccine for any pathogen that could potentially cause a pandemic within 100 days of its emergence.
Most of the remaining funds would go to similar problems, subjects related to the technical and engineering challenges of countering a virus. The goal is to keep an outbreak from ever again spiraling into a pandemic, Bankman-Fried said. The funding would also allow for R&D into cheap, fast, and more widely available tests for potential pathogens. As I have previously reported, America’s inability to test for the coronavirus during the first months of the outbreak all but ensured that it would swell out of control.
Appropriately enough for the Apollo comparison, the Biomedical Advanced Research and Development Authority, or BARDA, would take home the largest share of the total, about $14 billion, according to the Guarding Against Pandemics document. BARDA is the federal agency in charge of applying basic medical research to treatments and in-the-field technology—medicine’s answer to DARPA, the famous defense R&D agency whose projects spawned GPS, weather satellites, the internet, and personal computing.
The National Institutes of Health, which conducts medical research, would receive $9 billion, the document said. Finally, the CDC would receive $6.5 billion of the proposed $30 billion, and the FDA would get $500 million.
But that injection of funds is now in question as negotiators have been trying to shrink the reconciliation package from its original size of $3.5 trillion to satisfy Democratic moderates in their caucus. Last week, Senator Kyrsten Sinema of Arizona said that she didn’t support the package at its current size.
Congress has not been stingy in its recent provisions to public-health agencies, but the CDC has been a primary beneficiary of that largesse. Since March of last year, Congress has provided nearly $28 billion to the CDC to fight the COVID-19 pandemic. The most recent tranche—more than $10 billion for the CDC in the American Rescue Plan, passed earlier this year—was also approved for spending on general pandemic preparedness. The CDC declined to comment on how or whether that money has been spent.
If you step back, you can understand the funding fight as part of a broad shift in American governance. For all the agony of the past year and a half, the federal government saw through two miracles: It helped develop safe, effective vaccines at a record-breaking pace, and its muscular economic policy buffered Americans from the worst of the COVID-19 recession. While the first accomplishment has gotten more attention, the second is also stunning. Throughout last year, Americans saw their personal income grow at the fastest pace in two decades, even as the virus raged and unemployment soared. The U.S. is now reaping the returns of that generosity as it enjoys a faster recovery than Europe or other developed economies.
This economic feat is so impressive because it holds out the promise that Congress, if it so chooses, could end the worst aspects of recessions forever. The government now has the opportunity to do the same for pandemics, tackling unlikely but catastrophic risks before they have even begun. Instead of waiting for a disease outbreak to explode, the U.S. could maintain a forward-looking, proactive approach, Adalja said.
“I’m someone who is very impressed with the microbial world, so I don’t know if I’d be so bold to say that it would end pandemics forever,” Adalja told me. “But it would give humans an entirely different jumping-off point for how we attack pandemics.”