As the world goes to war with COVID-19, the U.S. is ripping open the purse strings to fund mobilization against both the coronavirus and the economic devastation it’s causing.

The Trump administration late Tuesday sent Congress a second fiscal 2020 supplemental spending request. This one is for $48.5 billion, more than nine times the $8.3 billion authorized in the first supplemental, which was signed into law 12 days ago.

That $8.3 billion was more than triple what the administration initially projected would be needed to fund the response through Sept. 30, 2020. Testifying in a House subcommittee budget hearing last month, Health and Human Services (HHS) Secretary Alex Azar said the administration was requesting at least $2.5 billion to support the response through fiscal 2020, recognizing that more might be needed in fiscal 2021.

The rapid escalation in funding requests reflects how quickly the pandemic has spread and how little was known about the novel coronavirus even just a few weeks ago and the threat it posed.

As of Feb. 26, the day Azar testified before the House Energy and Commerce Subcommittee on Health, there were a dozen travel-related COVID-19 cases diagnosed in the U.S., along with three cases in patients with no travel history and 46 cases reported among U.S. citizens repatriated from a cruise ship. Those cases were limited to a few states. Today, the virus has spread to all 50 states, with more than 7,000 cases diagnosed and nearly 100 deaths attributed to what Trump called an “invisible enemy” at a press conference Wednesday.

In submitting the new supplemental request to Congress, Russell Vought, acting director of the White House Office of Management and Budget (OMB), said, “With the pandemic growing, resource needs have also grown.” He cited the need to cover unanticipated costs federal agencies are facing in the midst of the outbreak. The supplemental also seeks additional authorities so agencies can better respond to the emergency.

In addition to the supplemental, the White House amended its fiscal 2021 budget proposal to include a 19% increase in funding for the CDC and an 8% increase for the NIH’s National Institute of Allergies and Infectious Diseases (NIAID).

The amendment requests a total fiscal 2021 funding level of nearly $8.33 billion for the CDC, up almost $1.33 billion from the original ask of $7 billion. The additional funding would be used for priority CDC activities such as immunization and respiratory diseases, emerging and zoonotic infectious diseases, global health, public health preparedness and response, and the infectious diseases rapid response reserve fund, according to the OMB. It also would be used for the proposed America's Health Block Grant to allow states and localities to address their most pressing noninfectious disease issues.

The proposed amendment would give NIAID about $5.89 billion – that’s a $440 million bump intended to continue critical basic and applied research on coronaviruses and other infectious diseases.

Supplemental details

The administration’s new supplemental request for fiscal 2020 funding includes:

  • $8.3 billion for the Department of Defense to mitigate the risk of COVID-19 to military members and their dependents by expediting access to rapid diagnostics, ensuring access to medical care, and addressing the impacts of the pandemic on logistics and supply chains, including drugs and personal protective equipment (PPE);
  • new legislative authorities for the FDA to improve its capabilities to respond to the pandemic, including addressing shortages and supply chain issues;
  • $80 million in FDA funding to cover operational and response needs, including mitigation of drug shortages and pre- and postmarket work on vaccines and therapies;
  • $1.336 billion for HHS’ Health Resources and Services Administration accounts for health centers to expand triage and treatment capacity and telehealth, rural hospital technical assistance and the Ryan White HIV/AIDS Program;
  • $532 million for HHS’ Indian Health Service to purchase and distribute PPE, cover operational costs to support expanded telework and other uses;
  • $3.415 billion for the CDC to support comprehensive COVID-19 response and preparedness efforts and lab capacity at the state, local and CDC levels, and provide additional funding for the Infectious Diseases Rapid Response Reserve Fund;
  • $441 million for NIAID research projects to accelerate and expand the evaluation of coronavirus therapeutics and for multidisciplinary research projects across various NIH institutes and centers;
  • $5.2 billion for HHS’ Assistant Secretary for Preparedness and Response to support the development and manufacture of vaccines, therapeutics and diagnostics; help procure supplies for the Strategic National Stockpile; and fund emergency medical management and field operations, pandemic forecasting and situational awareness, and activities related to emergency workforce modernization and telehealth infrastructure;
  • $13.1 billion for the Department of Veterans Affairs to cover health care treatment costs, testing kits, PPE and the cost of temporarily converting beds to intensive care units;
  • billions of dollars across the federal government to cover overtime costs related to the COVID-19 response, expanded telework capacity, disinfecting of facilities and the purchase of PPE where needed.

The supplemental also requests $50 million for the National Science Foundation (NSF) to support near real-time research at molecular, cellular, physiological and ecological levels to better understand coronavirus characteristics such as genetics, modes of action, transmission, virulence and population dynamics. The funding would be distributed through NSF's Rapid Response Research mechanism.

In addition, OMB is seeking $3 billion to create an “unanticipated needs” account modeled on the Emergency Response Fund enacted after the Sept. 11 attack. The account would be set up so the OMB director, after notifying Congress, could transfer funds to federal departments and agencies as needed to cover unanticipated costs associated with mitigating the impacts of the virus.

“The aim of this request is to maintain [full operational] capacity and ensure that resource needs created by the pandemic response are met,” Vought said of the supplemental.

He added that the supplemental “is not intended as a broad-based solution to the major economic dislocation wrought by the virus.” That is being worked out in a separate request.