The Health 202: Coronavirus relief proposal on Capitol Hill would put billions toward vaccine distribution

Of the $908 billion proposal, $16 billion would go toward vaccines, testing and contact tracing.

The package has a growing number of Democratic and Republican backers, after a bipartisan group led by Sen. Joe Manchin (D-W.Va.) rolled out the compromise measure earlier this week. 

House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) have both said it should be used as the basis for negotiations, renewing hopes for fresh aid for small businesses, state and local government, unemployment benefits, and dozens of other priorities. A number of Senate Republicans also signaled openness to the package yesterday.

But it’s far from final: “Although there has been a sudden burst of bipartisan momentum for the package since Tuesday, it remains an incomplete legislative proposal that has not been drafted as a formal piece of legislation yet,” Jeff Stein, Mike DeBonis and Seung Min Kim report. “Still, the rapid mobilization of support shows how lawmakers from both parties are trying to come up with a compromise quickly after months of inaction.”

They add: “The measure is more than what Senate Republicans had originally offered but less than what House Democrats had wanted, but it is designed to try and provide immediate relief to some parts of the economy as the pandemic enters a dangerous and increasingly deadly phase.”

Rep. Frank Pallone (D-N.J.), chairman of the House Energy and Commerce Committee:

Without more money, public health departments say the distribution effort could be hindered. 

They need staff to allocate the vaccine and get it to medical offices and pharmacies. “It’s not enough to ship the vaccine to the hospital loading dock,” said Claire Hannan, executive director for Association of Immunization Managers. “Someone needs to be there to receive it who is trained on how to handle dry ice. Providers at the hospital need to know how to mix it, how to administer it, and they need to feel comfortable recommending it.”

“And all the health-care workers need to trust it, accept, and come back for a second dose. That type of training and preparation doesn’t happen without resources.

It’s not yet clear exactly how the bill’s $16 billion would be allocated. But ASTHO and the AIM leaders say they’re encouraged that the need for additional distribution funding is at least being acknowledged. Both groups requested at least $8.4 billion in an October letter to House and Senate leaders, along with $500 million for distributing the seasonal flu vaccine.

State public health departments will coordinate with medical providers to administer the vaccines.

The plan is to distribute the coronavirus vaccines in medical centers and pharmacies, rather than in pop-up vaccination clinics, which can be complicated to set up and run. 

Public health departments are also under immense pressure to track vaccine data — such as who got their first shot, their second shot and whether they had any serious side effects. The Centers for Disease Control and Prevention has set up a massive database being referred to as a “data lake” where administrators of vaccines can send information. Interacting with this database may necessitate upgrading computer systems in some places.

“Public health has not had much investment in IT in decades,” Plescia said. “Some of the systems are quite antiquated.”

Plescia said his biggest concern is one public health departments largely haven’t been able to address: vaccine hesitancy. Given the sizable number of Americans who say they don’t want to take the vaccines right away, he hopes public health departments can be given more resources to mount public education campaigns.

Hospitals have an even more immediate need.

The number of hospitalized covid-19 patients surpassed 100,000 yesterday, placing enormous strain on the nation’s acute care hospitals, where there roughly 730,000 beds.

“Overwhelmed doctors and other caregivers are appealing directly to governors for relief from the staggering increases in hospitalized covid-19 patients as the virus surges across the country,” Lenny Bernstein reports. “In Connecticut, Tennessee, Missouri and Mississippi, physicians have issued unusually public pleas for stronger responses to the pandemic as hospitals and their staffs near a breaking point.”

Yet many governors are wary of the resulting economic damage from widespread lockdowns – particularly without a new relief package from Washington.

“Governors have adopted a variety of approaches to grapple with the runaway virus while trying to keep parts of their economies alive,” Lenny writes. “That includes allowing some businesses, such as restaurants and gyms, to remain open with limited capacity and other restrictions.”

Ahh, oof and ouch

AHH: Vivek H. Murthy and Anthony Fauci will play central roles in Biden’s coronavirus response.

“Murthy, a former U.S. surgeon general, has been asked to reprise the role in an expanded version in the new administration, according to an individual familiar with the decision,” Toluse Olorunnipa and Amy Goldstein report.

And Biden told CNN that Fauci, the director of the National Institute of Allergy and Infectious Diseases, will become his chief medical adviser. Fauci will also continue in his current role in the National Institutes of Health, which he has held since 1984. 

“Biden’s health-care team will be crucial to the success or failure of his presidency, far more than for most administrations. He is posed to take office during a raging pandemic that has killed roughly 275,000 Americans and counting, and at a time when the outgoing administration has weakened the Affordable Care Act, a law that provisions insurance to millions, as many Americans have lost health coverage along with jobs in the pandemic,” Toluse and Amy write.

Other officials who have advised Biden on the pandemic could also take top roles. Politico reported Thursday that transition co-chair Jeff Zients is set to serve as the White House’s coronavirus coordinator, a role that would require shepherding a cross-agency effort to distribute vaccine doses and increase testing. Politico also reported that Marcella Nunez-Smith, co-chair of Biden’s coronavirus advisory board, is in line for a role focused on health disparities.

Biden also said he will ask all Americans to wear masks for the first 100 days after he assumes office.

“Just 100 days to mask, not forever. One hundred days. And I think we’ll see a significant reduction,” Biden told CNN’s Jake Tapper.

OOF: Nursing home staffers on the front lines of the pandemic are worn out.

“Unlike the ambulance drivers and hospital workers who have struggled to save lives during the pandemic, many say they feel no love from the outside world. If a hospital was a home to heroes, a nursing home, in the popular imagination, seemed to have become a place where bodies were found stacked in a closet,” Will Englund reports.

Nursing homes were already struggling with burnout and staff shortages before the pandemic, but the coronavirus has made that situation worse. While states have tried to fast-track certification for prospective nursing assistance, nearly 18 percent of facilities, about 3,000 nursing homes, report a shortage of nursing aides. More than 260,000 nursing home staffers had been infected as of mid-November. 

“All this puts more of a burden on those who remain — who have worked month after month with often inadequate supplies. Some have sent their children to live with relatives or ex-spouses. Inevitably, some are cracking under the strain,” Will writes.

Imee Villavicencio, a registered nurse in Manhattan, described her experience in a sort of daily Facebook diary:

“I remember vividly, one of my patients is dying … gasping for air while I’m adjusting her IV line … She opens her eyes … grabs my forearm and said, ‘I’m afraid! Don’t leave me.’ At the back of my mind … I can’t stay here … I’m exposing myself too long …”

OUCH: Pfizer cut its original vaccine rollout distribution in half.

“Pfizer and Germany-based partner BioNTech SE had hoped to roll out 100 million vaccines world-wide by the end of this year, a plan that has now been reduced to 50 million,” the Wall Street Journal’s Costas Paris reports. “Pfizer still expects to roll out more than a billion doses in 2021 as originally planned.”

Pfizer ran into challenges scale up the supply chain for vaccine ingredients after finding some components did not meet its standards. 

“We were late,” a person directly involved in the development of the Pfizer vaccine told the Journal. “Some early batches of the raw materials failed to meet the standards. We fixed it, but ran out of time to meet this year’s projected shipments.”

Britain, which approved the Pfizer and BioNTech vaccine this week, has placed an initial order of 40 million doses, while the U.S. government has ordered 100 million with the option to purchase an additional 500 million doses. The U.S. Food and Drug Administration is reviewing Pfizer’s vaccine application. 

More in coronavirus

Pfizer CEO Albert Bourla said it’s not certain whether people who have been vaccinated can spread the coronavirus.

He said researchers are still investigating whether people who have been vaccinated can spread the novel coronavirus. “We are not certain about that right now,” Bourla told “Dateline NBC” during a joint interview with top executives from Moderna and Johnson & Johnson.

University of Washington biology professor Carl Bergstrom explains why this question is so important:

Bourla also weighed in on the “obligation” that vaccine makers have to trial volunteers who received the placebo, saying that they should get the actual vaccine “sooner rather than later.” This question has divided researchers, some of whom have raised concerns that giving the vaccine to people in the placebo arm of the clinical trials could hurt the integrity of the trials.

Money and connections may help some skip the line for coronavirus vaccines.

“Athletes, politicians, and other wealthy or well-connected people have managed to get special treatment throughout the pandemic, including preferential access to testing and unapproved therapies. Early access to coronavirus vaccines is likely to be no different, medical experts and ethicists told STAT,” Stat News’s Olivia Goldhill and Nicholas St. Fleur reports. 

“It could happen in any number of ways, they said: fudging the definition of ‘essential workers’ or ‘high-risk’ conditions, lobbying by influential industries, physicians caving to pressure to keep their patients happy, and even through outright bribery or theft,” they continue.

An underground market for vaccines might spring up once new vaccines are available that don’t require ultracold storage. In the meantime, companies are lobbying to have their workers classified as essential. On Thursday, Uber asked the CDC to classify its ride-hailing and delivery drivers as essential workers. Meanwhile, several states have classified members of the financial services industry as essential workers, suggesting that they will be early in line for vaccines.

Wealthy people could also game the system through their personal doctors. In a market-based health-care system, doctors have an incentive to keep their patients coming back and some could exaggerate the severity of their patients’ illnesses — for instance, by portraying a mild case of asthma as more severe — to get them early vaccines.

Hackers are targeting companies involved in vaccine distribution.

IBM security researchers warned on Thursday that sophisticated hackers have carried out a phishing campaign targeted at companies and organizations involved in the ensuring that vaccines stay cold, William Booth reports.

“The IBM team said it was not known why the hackers were trying to penetrate the systems. It suggested that the intruders might want to steal information, glean details about technology or contracts, create confusion and distrust, or disrupt the vaccine supply chains,” William continues.

The IBM team said the “precision targeting of executives and key global organizations hold[s] the potential hallmarks of nation-state tradecraft.”

California announced a new stay-at-home order based on regional ICU capacity.

“Many parts of California could soon face deeper restrictions under Gov. Gavin Newsom’s latest plan to control the coronavirus outbreak surging throughout the state,” the Bay Area News Group’s Evan Webeck reports. “On Thursday, Newsom announced a new, regional stay-at-home order, which will force additional restrictions in any of the five regions of the state where fewer than 15% of intensive care units remain available.”

While none of the regions currently meet that threshold, Newsom warned that they could in the coming days. The order will allow schools that have reopened to remain open and allow retail stores to stay open at 20 percent capacity, but restaurants will be restricted to takeout and places of worship must practice outdoors. Barbershops, playgrounds, bars and movie theaters will be closed entirely.

The new shutdown orders come as coronavirus cases continue surging across the country, with more than 2,700 deaths reported Thursday. A new CDC forecast, which aggregates more than three dozen prediction models, projects that 9,500 to 19,500 people will die the week that encompasses Christmas, Joel Achenbach and Jose A. Del Real report.

Elsewhere in healthcare

Only a tiny minority of voters say that the nation should keep the current health-care system as is.

An online survey from the United States of Care, a nonprofit focused on expanding health-care access, found that only 13 percent of voters would prefer to keep the current health-care system unchanged. A slight majority of the 1,000 registered voters who responded to the survey said they would prefer to improve the system through incremental changes, while about a quarter of respondents wanted to see a large-scale overhaul. More than half of respondents chose affordability as the aspect of the U.S. health-care system that most needed improvement.

Sugar rush

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