Today, Explained - Defunding Covid-19

Episode Date: March 15, 2022

The coronavirus pandemic isn’t over, but certain corners of Congress don’t want to spend a penny more on it. Dr. Ezekiel Emanuel argues for $100 billion in new spending to fight Covid-19. This episode was produced by Will Reid, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

And we're starting with breaking news from Capitol Hill just coming in. Congress just passed a $1.5 trillion spending bill. Guess how much money was set aside for fighting COVID-19? It's a nice, easy, round number. Zero dollars. Which is strange considering a thousand or so Americans are still dying a day. To figure out what's going on in Washington, I hit up Dr. Ezekiel Emanuel. I have no official capacity. He used to work at the White House. I happen to be a professor at the University of Pennsylvania. It's fair to say the White

House picks your brain sometimes. Hopefully not in an autopsy kind of way. Zeke and some of his health policy pals recently got together. We were not asked by the White House to get together. And came up with a strategic plan for how the United States can get past the pandemic. And it too costs a nice, easy, round number. A hundred billion dollars. We're going to figure out what's up with the discrepancy between the two figures. It's Today Explained. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express.

Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit Superstore.ca to get started. It's Today Explained. I'm Sean Ramos-Firm here with Dr. Ezekiel Emanuel, professor at the University of Pennsylvania. Dr. Emanuel, is COVID-19 over? No. But it seems like based on this latest spending bill from Congress, a lot of people are willing to act like it's over? Well, things are improving and improving pretty substantially,

but that doesn't mean we're out of COVID, that there's not a potential new variant, that there aren't many people suffering long COVID, and there aren't more things we need to do in terms of surveillance, developing therapeutics, getting the next generation of vaccines. And we should remember a year ago, in June, July 2021, it also looked like COVID was receding. The CDC releasing new projections showing that high vaccination rates could bring a sharp decline in COVID cases by July. The number of cases had dropped substantially. COVID positivity and deaths have hit all-time lows here in the city.

It was the summertime. People were feeling free. The hot vax summer. That's what they're calling it. People traveled. I myself took my first trip in 18 months, but then wham. The Delta variant is fueling a COVID resurgence. In August, we were hit with Delta that came out of India, and that was quickly followed by Omicron that came out of South Africa. The Omicron strain has now been detected

in at least 20 states. And so the fact is that we can't be confident, and we should not have what we called in our roadmap premature triumphalism, that somehow it's behind us. And even if we get past COVID, we should not assume that we're well prepared for the next infectious pathogen that might afflict the country. That is a lesson and a problem we keep doing. We get past the emergency and then we forget. We don't invest in being better prepared the next time. And I would say to you, the

countries that did very, very well in COVID, all of them looked at SARS in 2003 and said, whoa, this is a serious potential threat. We dodged a bullet. We now have in Singapore many individuals who have had experience of dealing with an epidemic. We're hiring epidemiologists. We're hiring infectious disease people for our public health. Toronto Western Hospital here redesigned their ICU recently with SARS in mind. And they did much, much better than the United States. We, on the other hand, SARS, no big deal.

And we can see that we've had hundreds of thousands of excess deaths by any measure. Let's talk about the politics here, because I'm sure you were paying attention last week. How much money did the White House want Congress to deliver on COVID research, COVID treatment, COVID prevention, whatever it might be? Well, I know that internal debates at the White House had put the number above $80 billion, but they were told that's unrealistic. Congress is not going to pass that. They pared it down to $22.5 billion, and Congress pared it back even further to $15 billion. That's not enough. It's just that simple. It's too little.

And this is $15 billion in a spending bill that ended up being hundreds and hundreds and hundreds of billions of dollars. Over $1 trillion. And yet it passed with zero of that $15 billion. Is that right? Republicans were basically, we're not signing on for this bill with the COVID money unless paying for that COVID money comes from the money that had already been allocated to the states, which the states hadn't yet spent. You had to have 60 votes in the Senate, and we couldn't get 60 votes without taking money out of the state allocations that were in the rescue package.

And the Democrats were, no, you're not pulling that money back out of the states. They needed to prepare themselves. And that standoff led the Speaker to pull the COVID part of the spending bill out. Republican obstruction required that we pass now taking off this bill to separate legislation containing funding to continue the fight against COVID. So Republicans essentially wanted to pay for the new COVID-19 spending bill by taking back money that had already been sent out to states in earlier COVID bills. Yeah, and Democrats who represented states that hadn't spent the money yet, but were planning to spend the money and beef up their public health,

their schools and other elements of their COVID response. We're like, no, this money is very important for a comprehensive response. I worked in the Office of Management and Budget for two years. This is a classic of, okay, we want to spend this money. Where is the resources going to come from? And the Republicans do not want to raise new money or go into deficit for this important element, but wanted to repurpose existing appropriated funds. What are the arguments Republicans made as to why they didn't want to designate any new money towards the pandemic? I think they would like to move on from the pandemic. It's not like Republicans have had a very good response to the pandemic. I think they would like to move on from the pandemic. It's not like

Republicans have had a very good response to this pandemic. We know that President Trump, he did succeed in facilitating the development of the vaccines in warp speed, and it really was incredibly fast in 10 months. But other than that, the response was pretty poor by any stretch of the imagination. It's going away now. It'll go away like things go away. Absolutely. But the Democrats, I think, recognize that we need a much more systematic, comprehensive response. Not only do we have to respond to the current crisis, we have to plan for future infectious pathogens. We need to have our biosecurity beefed up because it has not been very robust, as COVID has shown. So with zero dollars going towards any additional pandemic-related issues,

where does that leave all of the initiatives the White House wants to pursue? Are they sort of dead for the moment? Well, there is some money going forward, but it's incredibly, incredibly fragile. So domestically, for example, the ability to send monoclonal antibodies to immunocompromised patients and protect them is threatened. By May, our current supply of monoclonal antibodies will stock out. The ability to provide the antivirals from Pfizer, like Plaxavit, is also threatened. And within weeks, we expect testing capacity to drop if additional investments are not made soon. So there are lots and lots of things that are threatened. And I haven't even spoken about building a new surveillance system or long COVID research that needs to happen.

Globally, it's also a big threat. We've pledged hundreds of millions and actually more than 1.2 billion vaccines for the globe and the ability to distribute them, deploy them to under-vaccinated countries. The resources to do that all run out in a few weeks if we don't get more money. Tens of thousands, if not hundreds of thousands of lives are at stake. And we have to remember, we're almost at 1 million people dying from COVID. The economy lost $7.5 trillion. The government had to spend trillions of dollars to keep families and businesses like hospitals, airlines afloat. You know, a few hundred billion dollars investment may sound like a lot of money,

but the return on investment, even if a pandemic's a once-in-a-century event, is huge. Is Congress only going to react here? Is it not going to take preventative measures? Is it going to take another variant, surging case numbers numbers to get funding for COVID-19 again? Let's hope not. But like many things coming down to the wire, the stroke of midnight is what gets people to focus their attention and move. I have a colleague who I'm teaching a course with about how Washington really works. And he says these near-death experiences are necessary for Congress to understand the price or the value

of what they're looking at. And I have to hope he's right on COVID, that this near-death experience, people identifying this as a real threat to the American healthcare system and our ability to fight a next surge will get Congress to understand, you know, we really do need to allocate money. We do need to spend money. $15 billion, in my opinion, is not enough. In our roadmap, we call for $100 billion in the first year. And that's really what we need Congress to do. And they need to look deep in their hearts and understand that we need to be prepared as a

country. We cannot just stumble along and hope for the best. We need to prepare for another surge. That is what prudent businessmen would do with their business. That's what prudent households would do with their own homes. And that's what we need our legislators to do for our country. Zeke's going to tell us about his plan in a minute on Today Explained. Support for Today Explained comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend.

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free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Back in early January, Dr. Ezekiel Emanuel got a group of colleagues together to rethink the nation's approach to COVID-19. When we did this at the start of 2022, the White House was working 24-7 trying to address Omicron, trying to make sure there were enough tests and vaccines and treatments out there. They were busy. I've been in that role. I know how busy it is. The ability to step back and say, okay, let's take the big picture. That's very hard during that blizzard of activity that's needed to address an acute crisis. And so we put together

these people and said, all right, what would a comprehensive response to COVID be over the next 12 months? What should our strategic goals be? And what should the initial steps along those strategic goals be? So tell me in full here, what the plan you came up with looks like and what should the initial steps along those strategic goals be. So tell me in full here what the plan you came up with looks like and what it calls for. How much time do you have, Sean? It's a 136-page plan. It's got 250 recommendations from indoor air quality. Immediately funds school systems to make needed improvements in ventilation and air filtration. Masking and getting enough PPE. Launch a CDC-led public education program on how to select, fit, and use an N95 or similar respirator.

Vaccines, therapeutics, testing, and surveillance. Require hospitals, laboratories, and other health facilities to report all respiratory viral test results. Long COVID workforce in the health care system, because that's a rate-limiting step for having enough beds and being able to respond to surges. Require that health care facilities employ health plans fully cover mental health care. Public health infrastructure to be built for the next pandemic. Fund the recruitment and training of permanent public health workers to bring the workforce up to requisite size. We also argue that next generation vaccines, mucosal vaccines, vaccines that are good for COVID, good for other respiratory illnesses like flu or RSV,

we need to develop those. We can't rest on the kind of antiviral drugs we have. We need a multi-drug cocktail, just like we have for HIV, where you take three drugs at one time. You need the same thing for this virus. Otherwise, it'll mutate and be resistant to the drugs, and we can't afford that. So it's a pretty comprehensive approach that we need going forward. And how does that compare to, say, the ambitions of the White House? Do you know? Yes. We spent hours working with the White House and briefing them. And I like to say we're on the same road and we're going in the same direction. We have slightly different ways

of looking at things in some areas. And that's partly because they're focused on the federal government and we have a wider purview. So some of our recommendations, for example, are focused on localities. Change your building codes so that all new commercial buildings have MERV 13 filters or better. We have suggestions for school boards. Make sure that the air quality in your schools is improved. And if you can't change the central heating and air conditioning systems, put in HEPA filters in individual classrooms. So our purview could be slightly bigger than the White House, which is really focused on the federal government. But in terms of things like treatment or say research on long COVID, the White House is on the same page?

Again, I think it's fair to say that, yes, we're on the same road, going in the same direction. I would say we might be a little more aggressive in suggesting we need to move faster and suggesting very particular changes we might do. Like long COVID is one area where we think we need to be much more aggressive and much more urgent. We're kind of doing things on academic times. And I'm an academic saying that we need to do it on, this is a public health emergency time and we need results ASAP and we need to enroll people much, much faster. Can you tell me a bit about why more research, more spending, more studies on long COVID is so essential? Well, first of all, we don't know how many people actually have long COVID,

but if even 2% of the population has long COVID, and that's on the very low end of estimates, we're talking about 1.4 million people who have this very debilitating set of symptoms, fatigue, brain fog, inability to exercise, and many other potential symptoms. It could be as high as, you know, seven or 10 million Americans. That's a huge number to be disabled by this illness. Lots of people are fearful of it. And a lot of people, between 25 and 30% of the population, it appears, are very, very nervous and will not do things like take off their mask, go to indoor restaurants, begin to resume a normal life, unless we understand better and can tell them what the risks of long COVID are and the things they can do to minimize that risk. And you all estimate that

this whole thing will cost about $100 billion? Well, for the whole thing, initially $100 billion in the first year, and then $30 billion in years two and three, and then $15 billion over each year subsequently. That's not a whole lot of money when you think about we're a country of 330 million people. And as I said, this pandemic alone has cost $7.5 trillion in lost economic activity, not to mention the million people who've died and the hundreds of thousands or millions who probably have long COVID. Okay, so you and a bunch of people who understand public health, and even it sounds like people

who understand federal budgets, got together and came up with this figure, $100 billion in spending for 2022 to focus on a whole host of concerns surrounding this pandemic. The number Congress came up with last week is $0. How do you reconcile where you're at and where they're at? Well, they're headed for disaster, especially if we have another surge sometime in the next 12 months. And we think that if we invested our money, we'd be much better prepared for another surge,

but also put in the infrastructure to prepare us down the road for any infectious pathogen that might pop up. And we don't know what it might be. And it's a lot of the Republicans in Congress who are vociferously against spending any more on COVID-19. If Republicans take control of Congress in November, is that presumably, what, the end of COVID spending, full stop? I fear that, but I also would remind the public that it was the Republicans under President Trump who got rid of the biosecurity expert at the National Security Council just before COVID struck.

The Republicans have not generally been good about spending necessary for combating infectious pathogens and preparing the country for, you know, a biosecurity threat. And I don't have a lot of confidence that they've changed their attitude. It seems like the issue that you're up against here is that generally people are just sick of talking about this pandemic. They're sick of dealing with this pandemic. They're sick of regulations, obviously, surrounding this pandemic. How do you sell this story? How do you sell this program, this vision for the country to spend billions of dollars to invest in prevention and treatment when there's less and less appetite to even talk about this thing? Well, I hope I don't look like a marketing

professor to you because I'm not. How I sell it is not my expertise. And I can tell you one of the things I do think is important is to emphasize that this is part of larger national security, biosecurity, and we do need to be prepared for that. Ukraine has made quite clear we're entering a very scary period going forward of great international and global tension. And many commentators think that one of the reasons the Russians thought they could get away with invading Ukraine is that we, the United States, were back on our heels. We were not doing well as a result of COVID and the misinformation around COVID and that they could take advantage of that weakness. We really cannot afford to be

weak in this area. If we really want to be the world superpower, we have to be strong across the board. And this is one major area, biosecurity. And COVID is just an example of how bad things can be if we're not well-prepared. You know, we're speaking just around two years to the day since the United States shut down, since there were shutdowns around the world when people really realized how grave a situation we were in. Do you feel like, at least in the United States, we've learned some lessons? I hope we've learned some lessons. I think, as you've pointed out, we are fatigued. We all want this to go away. I can tell you, I just spent part of my morning, it's like, you know, let's dream about where we might travel if things actually are good during the summer. I'm like everyone else. I am ready to get beyond

COVID. And the best way to get beyond COVID is actually to make some investments to put it in the rear view mirror. And those investments require, you know, better vaccines, better therapeutics, better surveillance. You can't move beyond it unless you actually do certain things to make the situation substantially better for COVID, but also for the next bio threat, whether that's another respiratory virus or something we haven't dreamed of yet. One more question before we go. If you had to give the United States a grade, not just the former president, but this one, all told so far, two years in, on how it's handled the pandemic, what would the grade be? An overall grade? Now you're really making me act like a professor. I think we could probably get a B minus. A B minus? Yeah, B minus. Not as bad as I thought you might say. Well, look, let's be clear. We led the world in getting effective vaccines in rapid order. We've led the world in getting antivirals and some of these monoclonals. That is, I think, very, very good and important.

Most of the other things we haven't done very, very well at, and I think we need to do much, much better at. So maybe I'm grading on a curve, I don't know. Dr. Ezekiel Emanuel is a professor at the University of Pennsylvania. He does not work for the White House. You can read his strategic COVID plan at COVIDroadmap.org. Today's episode was produced by Will Reed, edited by Matthew Collette, fact-checked by Laura Bullard and engineered by Paul Mounsey and Afim Shapiro. I'm Sean Ramos for AMI-tv. It is Today Explained. you