The Senate Health, Education, Labor and Pensions (HELP) Committee met again June 23 to discuss the federal government response to the COVID-19 pandemic, and one clear signal that emerged from the hearing is that Congress will have to provide annual funding to build a sustainable infrastructure for vaccine development and manufacture if the nation is to deal appropriately with the next pandemic.

Committee chairman Lamar Alexander (R-Tenn.), noted that the use of teleconferencing allows some witnesses to testify when they otherwise might not be able to make the trip to D.C., suggesting this is a trend that may outlive the pandemic. Alexander also pointed to a white paper he recently released, which tackled the problem of short social and congressional memory where crises are concerned.

“Even the experts underestimated the ease of transmission” of the SARS-CoV-2 virus, Alexander stated, adding that one of the key considerations is the federal government hierarchy and whether state and local officials are aware of which parties at the federal level are responsible for decision-making during crises.

Frist: U.S. was clearly ‘woefully underprepared’ in 2005

Bill Frist, a physician who was formerly the Senate majority leader as a Republican from Alexander’s home state, affirmed the notion that a consistent federal government narrative is critical, and that this requires a widespread understanding of which officials are in charge of a given federal response. Frist noted that he predicted in a 2005 speech at the National Press Club that a new pandemic, which might come from China, was inevitable. “It was crystal clear then that we were woefully unprepared” for the type of pandemic presented by COVID-19, he said, adding that one of the problems was a “dangerously inadequate” vaccine manufacturing base.

An annual appropriation of about $4.5 billion for vaccine infrastructure would allow some funding to be allocated to the National Institutes of Health and to the Biomedical Advanced Research and Development Authority (BARDA), Frist said. This would enable the federal government to respond to short-term needs and to longer-term considerations. “It’s going to have to be flexible and it’s going to have to be nimble,” he said of such funding streams, adding that congressional oversight will ensure that Capitol Hill remains engaged.

Frist said the recent expansions of Medicare coverage of telemedicine must be made permanent in order to “unleash this revolutionary power of virtual care.” Increased utilization of telehealth will aid the response to a second surge of the COVID-19 and any future pandemics, he said, adding that many public health officer positions have been lost over the past decade, a trend that must be reversed in order to ensure that underserved communities receive the same attention from the medical infrastructure.

Public health security is national security, “so let’s treat it as such,” Frist continued, adding that global access to immunization is needed to deal with future pandemics.

Ranking HELP Committee member Patty Murray (D-Wash.), blasted the Trump administration, stating, “the White House is pretending this pandemic is over.” Murray also criticized Republicans, including Senate majority leader Mitch McConnell (R-Ky.), for claiming that recent jobs reports suggest there is less urgency for another economic recovery package. She cited the disproportionate impact of the pandemic on communities of color.

Also among the witnesses at the hearing was Joneigh Khaldun, chief medical executive for the Michigan Department of Health and Human Services, who said, “the greatest tragedy of this pandemic is how it has ravaged communities of color.” Khaldun said this is not unique to Michigan, and argued that health care in the U.S. is inherently racist. She called for a national testing infrastructure to thwart future pandemics, stating that disparities can be ameliorated with more dispersed testing sites, along with coverage that eliminates co-pays and the need for a physician’s order.

Julie Gerberding, formerly the CDC director and the chief patient officer at Merck & Co. Inc., of Kenilworth, N.J., said this pandemic “is a harbinger of things to come,” and recommended the creation of a health security agenda for the U.S.

“We are nowhere near the end of the mitigation phase of this crisis,” Gerberding said, pointing to the economic cost of social distancing as another factor that must be addressed. She said a vaccine for this pandemic must be successful in a single dose, must be durable, and must be robust enough to deal with antigenic drift. Because any vaccine will have to be applied to vulnerable populations, the vaccine “must have a higher bar for safety,” she said, adding, “we must not sacrifice safety for the sake of speed” to engender public trust. Gerberding said the budget process should insulate the CDC from budget caps and from budgetary horse-trading.

Gerberding said the federal government might invoke a public-private partnership to stand up vaccine production infrastructure that would be vigorous enough to handle conventional pathogens and the rare unexpected pathogen. However, she recommended that vaccine manufacturing sites be based on a platform approach that is as virally agnostic as possible, which would help suppress the last-minute scramble for manufacturing capacity. However, Gerberding said capacity can never be stood up to handle pre-production for more than 100 candidate vaccines, as has been proposed recently, adding that legislators should not assume that collaboration with the private sector will be administratively simple.

Leavitt says state, local authorities not off the hook

Michael Leavitt, formerly the Secretary of Health and Human Services, said pandemic summits with the states were held when he was at HSS. He placed some of the onus on pandemic response on the states, remarking, “everyone needs a pandemic plan,” including state and local governments. Unlike ordinary communicable disease outbreaks, pandemics are “intensely local,” he said, in part because resources cannot be reallocated from other states. Officials with state and local governments who believe that “somehow the federal government will ride to [their] rescue” suffer from a dangerously mistaken mindset, Leavitt said.

Leavitt seconded many of Gerberding’s remarks about vaccine manufacturing capacity, stating that excess capacity should have been maintained “so that they are warm and could be stood up quickly.”

Several members of the committee questioned why there is a need to plan for future pandemics with one currently still in process, and Alexander responded that the past four presidents and multiple congresses have worked on the subject, to little discernible effect. “When do you think would be a better time” to deal with issues such as spare vaccine manufacturing capacity, he asked. “We haven’t been able to do it for 40 years, why not do it in the midst of a pandemic?” Alexander also responded to calls for more federal taxpayer dollars for contact tracing by noting that recent legislation has already provided in excess of $160 billion to that end, much of which remains unspent.

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