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A painful and foreboding reality is setting in for the White House as it enters a potentially dangerous stretch of the Covid fight: It may soon need to run its sprawling pandemic response on a shoestring budget.
Just two months after the administration unveiled a nearly 100-page roadmap out of the crisis, doubts are growing about Congress’ willingness to fund the nation’s fight. It has forced Biden officials to debate deep cuts to their Covid operation and game out ways to keep the federal effort afloat on a month-by-month basis.
Among the sacrifices being weighed are limiting access to its next generation of vaccines to only the highest-risk Americans — a rationing that would have been unthinkable just a year ago, when the White House touted the development and widespread availability of vaccines as the clearest way out of the pandemic.
But as the government’s cash reserves dwindle, officials are increasingly concluding that these types of difficult choices will soon have to be made. And they are quietly preparing to shift responsibility for other key parts of the pandemic response to the private sector as early as 2023.
"There's a great deal of concern that we're going to be caught shorthanded," said one person familiar with the discussions. "On the face of it, it's absurd."
The contingency planning is aimed at preserving the bare-minimum tools needed to protect against the virus this year, federal officials and others familiar with the discussions said. But many of those decisions still hinge on Congress authorizing $10 billion in new Covid spending, a prospect that remains uncertain in the face of GOP opposition.
Senate Republicans have stalled the funding request for weeks over demands they first get an unrelated vote on President Joe Biden’s decision to end Covid-era border restrictions. Despite Biden administration warnings the U.S. could record 100 million more infections through the fall and winter, some GOP lawmakers are also separately skeptical that there’s an urgent need for more money, accusing the administration of failing to account for the hundreds of billions of dollars it has already spent.
Should the Senate manage to break its impasse, people familiar with the planning said that the funding would still only be enough to keep the government's core Covid activities running. Nearly half that amount would immediately go toward paying the administration’s debt to drug company Pfizer, which has yet to be fully compensated for supplying 20 million doses of its antiviral treatment earlier this year.
The roughly $5 billion remaining would likely be split among investments to bolster supplies of tests, treatments and vaccines. Under a best-case scenario, the administration might make those stockpiles last through the end of the year. Even then, the White House's ability to react to a dangerous new variant would be severely limited, and funding to aid the global response would be nonexistent.
But at worst, the people said, the richest country in the world could find itself out of money to combat a Covid resurgence on its own soil.
“All that needs to happen is to have a variant emerge that’s highly infectious and causes more morbidity and mortality and we’re back to ground zero,” said Georges Benjamin, executive director of the American Public Health Association, which represents public health workers. “We have not finished the job.”
The stubborn difficulty in providing new funding for the emergency response has cast a pall over the administration, where officials view Biden’s ability to keep Covid under control as essential to the success of his presidency.
The White House in recent months sought credit for effectively ending the crisis, touting its vaccination campaign and widespread distribution of tests and therapeutics as key to allowing most Americans to safely resume their everyday lives. Yet the administration has struggled simultaneously to make the case for pouring continued resources to fight the pandemic — with officials surprised by the level of Republican resistance and unwilling to hold up other legislative initiatives to use them as vehicles for getting Covid funding passed.
The White House’s initial $22.5 billion request was cut to $15.6 billion in March, but that allocation fell apart after House Democrats objected to paying for it by clawing back Covid funds from individual states. Republicans further whittled the deal down to $10 billion and demanded a separate immigration vote. Biden and fellow Democrats sought to put the funding in a larger Ukraine aid package. But they decided this week to decouple the two and no clear strategy remains for breaking the stalemate.
Without the money to keep its Covid operations running, Biden allies say they now fear a resurgence of the virus in the summer or fall could wipe out the gains the president has staked his health record on — and plunge the country back into crisis just ahead of the midterms.
"Inaction in Congress is already forcing difficult and unnecessary compromises that have dire consequences for the American people," a White House spokesperson said, adding that failing to authorize additional funding would force "even more difficult tradeoffs."
Biden officials have stressed to lawmakers that securing funding now is critical to the administration’s preparedness later this year, particularly when it comes to purchasing new vaccines meant to better target Omicron variants. The government can’t commit to purchasing them until it has the money, sparking concerns that competing countries will get first access to the limited supply or that the U.S. will only be able to afford enough shots for the highest-risk populations.
More immediately, the administration is holding off investing in the manufacturing of potential new Covid treatments, people familiar with the matter said.
Biden officials originally planned to aid the development of a pair of antiviral pills that could expand the government’s arsenal of treatments that cut the risk of severe illness in infected patients. Instead, that money has now been withheld in case it’s needed for more urgent priorities.
Within the administration, the funding stalemate has also prompted fresh deliberations over the long-term viability of the Covid response. While the White House has publicly maintained it needs at least $22.5 billion from Congress overall this year, there is internal acknowledgment that getting anything beyond the initial $10 billion investment is a long shot.
“They’ve never suggested that $10 billion would last very long,” said Sen. Roy Blunt (R-Mo.), who met last week with White House Covid coordinator Ashish Jha on the issue. “But $10 billion may be the most that there’s any appetite for right now.”
On a private call with health experts last Thursday, Jha said some lawmakers have floated winding down the federal subsidies that guarantee free Covid vaccines and treatments to all Americans instead, suggesting private insurers take over the process.
The White House doesn’t view that as an immediate option, Jha said, according to three people on the call, due to how complex and disruptive it would be for Americans and the health system. But other administration officials in recent weeks have weighed the prospect of transitioning responsibility for vaccines and some treatments to the traditional insurance market as early as next year, two people familiar with the matter said, spurred by the realization that the government may soon have no other choice.
The shift would be complicated and fraught and take months to engineer, the people said, and no decisions have been made. There is also widespread recognition that such a move could represent a setback for the White House’s much-touted pledge to ensure an equitable response, by making it harder for low-income and uninsured people to access and afford vaccines and treatments.
“It’s really concerning that, two-plus years into a global pandemic, we’re still needing to have these arguments on how best to protect people,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents metropolitan health departments. “The people who will be impacted the most are the most vulnerable.”
Hoping to break the impasse, Jha and other top officials, including senior Biden adviser Steve Ricchetti, have met with lawmakers on both sides of the aisle to walk through the looming consequences of not passing additional Covid funding. Among outside allies, there is greater discussion of enlisting governors and prominent health coalitions to call for action on the funds.
Yet with little ability left to force Senate Republicans’ hand, there’s growing fear that perhaps the only way to keep the Covid response alive will be for Covid itself to swamp the nation in infections once again.
“We need to decide as a country how we want to deal with the fact that Covid’s going to be with us for a long time,” said Bob Kocher, who served on the Obama administration’s National Economic Council. “The path we are perhaps unintentionally choosing leads to a more disruptive, longer and more economically painful Covid experience for America.”
Marianne LeVine contributed to this report.