Rated the No. 1 most prepared country in the world to tackle an epidemic, the U.S. could see its preparedness put to the test as it responds to the growing COVID-19 outbreak.

While the administration is pointing to that rating from a recent global survey to calm fears about the risk in the U.S., the coronavirus emergency is spotlighting cracks in the nation’s preparedness. One big crack is funding. The Trump administration asked Monday for at least $2.5 billion for fiscal 2020 – half in new funds and half to be shifted from other funds. Rather than act on that funding request, Congress continues to debate the amount, with some lawmakers using President Donald Trump’s request for political talking points.

With some Republicans calling for $4 billion in emergency funding, Sen. Chuck Schumer (D-N.Y.) upped the ante Wednesday, requesting $8.5 billion in new funding. Later that day, Trump said, “We will be satisfied whatever – whatever it is.”

Right now the urgency isn’t about how much but about how soon Congress will greenlight supplemental funding. As Health and Human Services Secretary Alex Azar told the House Energy and Commerce Subcommittee on Health, the department can ask for more money as needed.

What’s at stake is ongoing development of a COVID-19 vaccine, diagnostics and therapies, as well as government contracts for personal protection equipment (PPE) and the surveillance needed to answer some tough scientific questions.

At the subcommittee hearing, Rep. Diana DeGette (D-Colo.) asked Anthony Fauci, director of the NIH’s National Institute for Allergy and Infectious Diseases, “If we gave you more money, could we develop a [COVID-19] vaccine more quickly?”

Fauci responded, “We would need more money to take it to the next step.” The vaccine is in phase I, but Fauci said about $140 million is needed to move it into phase II.

However, he reminded the lawmakers that while the funding is necessary, it won’t make vaccines, therapies or diagnostics happen overnight. Because of all the testing needed to ensure safety and efficacy, it will take at least a year to have a COVID-19 vaccine available.

Fauci reiterated that timeline at a White House press briefing later in the day. “Although this is the fastest we have ever gone from a sequence of a virus to a trial, [the vaccine] still will not be … applicable to the epidemic unless we really wait about a year to a year-and-a-half,” he said.

That means public health officials can’t rely on a vaccine to stop the spread of the virus this year, but a vaccine could be available should the virus return next year – something Fauci said “we have every reason to believe is quite conceivable.”

PPE shortages, unanswered questions

The funding request also could help alleviate the threat of PPE shortages. Some of the funding HHS is seeking permission to shift would be used to contract “with domestic manufacturers of N95 [respirator] masks so that we can scale up production,” Azar told the subcommittee.

While spot shortages have been reported of PPE, the supply of N95 respirators may be the most critical. Currently, 65% of the respirators are manufactured in China and Mexico, Rep. Debbie Dingell (D-Mich.) reminded Azar, citing reports that the U.S. supply of respirators could be exhausted within two weeks.

FDA Commissioner Stephen Hahn assured the Energy and Commerce Subcommittee on Health that “currently we know of no overall shortage related to PPE. However, this is a very dynamic situation.”

One domestic respirator supplier, 3M, of St. Paul, Minn., announced late last month that, with demand exceeding supplies, it was ramping up production of its respirators at its manufacturing facilities around the world, including in the U.S. It committed to maintaining its pre-COVID-19 price for the product, but noted that it couldn’t control the pricing of dealers and retailers.

Additionally, the supplemental funding could help with ongoing surveillance that’s needed to answer pertinent questions about the spread of the novel coronavirus. “We know it is a very transmissible virus,” Fauci told the subcommittee. What isn’t known is the relative infectability of a patient and the methods of transmission. Fauci and Robert Redfield, director of the CDC, said they hope to get those answers by monitoring patients in the U.S. and other countries.

“These are key questions and we continue to try to get the data to answer them,” Redfield said.

“We are tracking the patients that we do have in this country to see how long they actually have a virus that can be isolated from their respiratory secretions,” he added. “It's probably going to be longer than many of us originally anticipated. I think that at this stage, we have individuals out about 18 days from the time they initially actually got sick.”

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