Five COVID-19 challenges on the two-year anniversary of the pandemic

Two years ago Friday, the World Health Organization officially declared the coronavirus a pandemic. In that time, there have been nearly 1 million American deaths. But while cases are plummeting, and many Americans are getting on with their lives, there are still challenges ahead.

Here are five of them.

Regaining trust in public health

Americans' trust in public health officials and institutions, particularly the Centers for Disease Control and Prevention (CDC), has eroded since the beginning of the pandemic, and experts say it will take an effort to rebuild.

"Regaining trust is a lot harder than losing it. It's easy to lose trust. And so [CDC's] got some work to do," said Georges Benjamin, executive director of the American Public Health Association.

President Biden earlier this month unveiled the newest phase of the administration's plan for fighting COVID-19, aimed at returning to a more normal life. The lengthy document leads off with a simple goal: "Restore trust with the American people."

Experts say trust in public health institutions is crucial during a pandemic, as mitigation measures like masking or even vaccines won't be successful unless people trust the messengers.

An NBC News poll conducted in January found 44 percent of those surveyed said they trusted the CDC on the virus.

Last May, a poll from the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health found that 52 percent of Americans had a "great deal of trust" in the CDC.

There have been missteps in the past two years, including political interference, though a lot of the recent damage has been self-inflicted, through muddled messaging and ever-shifting guidance.

Continued funding for the U.S. response

The Biden administration is running out of funding for its COVID-19 response, and there's no clear path forward in Congress for the White House funding request.

Lawmakers earlier this week were poised to vote on $15.6 billion in emergency aid - including $5 billion for global vaccination and response - as part of a broader government spending bill, but the provision was stripped amid a dispute among Democrats over how to pay for it.

The White House has called the money an "urgent" priority, even though it was far less than the $22.5 billion officials said is needed.

House Democrats are aiming to vote on a stand-alone bill next week that will fund the White House request without the problematic offsets, but it is unlikely to advance in the Senate since Republicans insist it needs to be fully paid for.

"Without additional resources from Congress, the results are dire," White House press secretary Jen Psaki said Thursday.

Without more money, the White House said testing capacity will start declining this month. Monoclonal antibody treatments will be exhausted by May, and antiviral pills, like Pfizer's highly effective Paxlovid, will run out by September.

Vaccinating children under 5 years old

Even as much of the country is relaxing COVID-19 restrictions, parents of children under 5 years old have been left in limbo, and authorization is still weeks, if not months, away.

In February, Pfizer and the Food and Drug Administration decided to delay an anticipated regulatory review of the company's shots for young kids, because two doses were found to be less effective against the omicron variant.

Pfizer CEO Albert Bourla said on CNBC Friday that data on a third dose is still weeks away. He said the decision was to initially submit data on two doses, even though they knew the vaccine would eventually be three doses, because omicron was so transmissible among children.

The goal was to understand if two doses would provide at least partial protection, and then FDA would authorize the eventual third dose later.

"We discussed the possibility to submit the two dose data knowing that it's not going to be spectacular on the second dose, but at least we can start giving the doses to the kids and then the third dose will come to demonstrate how effective the vaccine is," Bourla said.

But the FDA decided to delay and wait for data from all three shots to come in before considering authorization. One factor in the decision was that the risk for children overall has dropped as omicron cases have fallen.

Experts have said the best way to keep small kids safe is to surround them with people who are already vaccinated. But as preventive measures drop, the risk to the youngest kids increases.

Vaccinating the world

Last September, Biden committed to shipping 1.1 billion doses of coronavirus vaccine by the end of September 2022, but much like domestic efforts, the administration's global vaccination push is running out of money.

The White House only requested $5 billion from Congress, which advocates and some Democratic lawmakers have criticized as not nearly enough. They had been pushing for months for $17 billion to step up global vaccination and treatment efforts.

But with the provision stripped from the government funding bill, it's not clear if even the $5 billion will be authorized.

If the virus remains unchecked abroad, new variants can form that can threaten the U.S., just as omicron did after being detected in southern Africa. Nearly 90 countries are not on track to meet the global target of vaccinating 70 percent of their population.

Jenny Ottenhoff, senior policy director of the ONE Campaign, said having funding in place to support global vaccination efforts is more important for the immediate future than giving away doses.

"I think the real challenge in the next six months is making sure that the funding and support is in place to get shots in arms," Ottenhoff said. "And to be building up the capacity to send therapeutics and diagnostics [to low-income countries] to have them ready in place everywhere on Earth, that people can walk into a corner drugstore anywhere and get a therapeutic."

Preparing for the next wave, and future pandemics

Advocates and experts fear that the U.S. is letting its guard down, and is dangerously unprepared for the next pandemic, let alone the next wave of COVID-19.

"It's really tempting to think that the worst is behind us, I get that. But I think the warning that we should all heed is that turning away from COVID now would be short sighted and self-defeating," said Ottenhoff.

"We need to finish the job this time. And leaders really need to stay the course and make sure that this recovery that we're currently experiencing takes hold," she added.

In Congress, bipartisan legislation from Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.) is aimed at strengthening the nation's public health and medical preparedness and response systems.

Among other provisions, the wide-ranging bill would fortify public health supply chains, improve agency coordination and data systems, and create a bipartisan task force to review the nation's COVID-19 response.

The measure would not directly provide new funding for pandemic preparedness, though it would authorize some programs that could be funded as part of the annual appropriations process.