A proposed COVID-19 appropriations bill released on Monday by U.S. Senate Republicans takes solid steps toward providing urgently needed relief and resources, but it also falls short of necessary responses, according to the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA).
While the sweeping GOP proposal would provide crucial funding to meet some immediate needs and strengthen foundations for future responses, gaps in the overall package will undermine efforts essential to controlling the COVID-19 pandemic, the groups said in a joint statement released on July 28.
U.S. Senate Appropriations Committee Chairman Richard Shelby (R-AL) on July 27 sponsored the 2020 Coronavirus Response Additional Supplemental Appropriations Act, S. 4320, which proposes a total of $306 billion in emergency appropriations to aid American families and businesses impacted by the pandemic.
“With the additional resources this legislation provides, I believe we can give them greater confidence that we are getting our arms around this virus,” said Shelby. “That, I believe, is the key to unleashing the American economy and hitting our stride as a nation once again.”
If enacted, S. 4230 would authorize $105 billion to schools; $16 billion in grants to states for testing, contact tracing and surveillance; $20 billion for vaccine, therapeutic and diagnostic development; $20 billion to assist America’s farmers and ranchers; and nearly $30 billion to protect the U.S. military and defense industrial base, among other provisions.
The Republican bill is in response to one proposed by Democrats in the U.S. House of Representatives, which on May 12 introduced the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, H.R. 6800, to respond to the COVID-19 outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses.
The House on May 15 voted 208-199 to approve the bill and sent it to the U.S. Senate where it was referred to the U.S. Senate Small Business and Entrepreneurship Committee, which marked up the bill on July 23.
Among myriad provisions, the House bill would authorize $75 billion “to prevent, prepare for, and respond to coronavirus, for necessary expenses to carry out the COVID-19 National Testing and Contact Tracing Initiative,” according to the text of the bill, which is a far cry from what Republicans propose in their bill, according to the IDSA and HIVMA.
“Significantly, while public health experts agree that testing and contact tracing are crucial to reducing transmission, the $16 billion for testing, contact tracing and surveillance in states proposed in Monday’s [GOP] package falls far short of the $75 billion proposed by the House for these essential services, as well as for isolation and quarantine measures,” according to the groups’ joint statement.
The groups also shrugged at a provision in the Senate bill that would provide $5.3 billion for Defense Production Act manufacturing and establishing state stockpiles of medical products, including personal protective equipment and ventilators.
“The package increases federal stockpiling and manufacturing capacities. While these provisions are important, the need for a stronger national strategy toward transparent and equitable distribution of medical supplies continues,” said IDSA and HIVMA.
The groups also slammed $25 billion that S. 4320 would allocate to the Provider Relief Fund, saying the amount “falls far short of the House bill allocation of $100 billion for the fund.”
“In the long term,” they pointed out, “more funding, targeted to the infectious diseases and HIV workforce will be needed. While these fields supply unique and essential expertise, they struggle to attract physicians due to student loan burden and low compensation relative to other specialties.”
IDSA and HIVMA also said that S. 4320 overlooks “essential and glaring gaps in healthcare access” by providing no new federal funding to support state Medicaid programs or replace lost employer-sponsored coverage.
And while treatments for COVID-19 drive high levels of antibiotic use and disease incidence drives increases in secondary infections, the groups said that S. 4320 does not designate funding to assess the impacts of antimicrobial resistance on coronavirus illnesses, to strengthen antibiotic stewardship or to develop new antibiotics.
Equally troublesome, according to IDSA and HIVMA, the Senate bill also doesn’t provide ample emergency funding for global health programs, and would allocate zero funding to help low-income countries strengthen responses to the pandemic.
On the plus side, IDSA and HIVMA applauded the Republican bill’s proposed expanded access to specimen samples, which can support development of diagnostic tests, as well as the requirement that the U.S. Department of Health and Human Services consult with medical product manufacturers, suppliers and other relevant sources to identify and support testing supply needs.
“As COVID-19 tests rely on many of the same supplies used for seasonal influenza tests, supply issues must be resolved promptly, before the start of influenza season,” the groups added.
IDSA and HIVMA also praised the GOP bill’s proposed allocation of $3.4 billion for the U.S. Centers for Disease Control and Prevention (CDC), which they said “recognizes the agency’s important role and unique capacities.”
Specifically, S. 4320 would allocate to the CDC $1.5 billion to continue supporting state, local and territorial public health needs; $500 million to enhance seasonal influenza vaccination efforts; $200 million to enhance global public health security efforts; and $200 million to modernize public health data reporting, among other items.
The Senate bill also would allocate $6 billion to develop and execute a new COVID-19 vaccination distribution campaign coordinated through the CDC, using the agency’s expertise and structures to work with existing state and local public health systems, another provision supported by IDSA and HIVMA.
The groups noted that while negotiations continue in Congress on the next COVID-19 response package, several components should be included in S. 4320, such as authorization of 10 regional Centers for Public Health Preparedness, which will support state and local health departments, healthcare coalitions, and the public.
Additionally, they would like to see retained the $15.5 billion for the National Institutes of Health; $20 billion for vaccine, therapeutic and diagnostic development through the Biomedical Advanced Research and Development Authority; and the extension of Medicare telehealth flexibilities through Dec. 31, 2021 or the duration of the pandemic, among other provisions.