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Committee leaders in both the House and Senate are pushing for changes to how the nation prepares for the next pandemic, warning time is running out to make significant investments in outbreak response.
Democrats are coalescing around a bipartisan package of reforms (S. 3799) that includes a major overhaul at the Centers for Disease Control and Prevention, as well as administrative changes aimed at improving the nation’s stockpile of medical countermeasures and an investigation into the federal response to Covid-19.
This attempt could be the last one to help the US beef up its public health response, as any effort to pass legislation is set to become more difficult in a divided Congress.
The Democratic and Republican leaders of the Senate Health, Education, Labor and Pensions Committee—the main sponsors of the bill—have been pushing to get the package into a year-end spending bill, committee Chair Sen. Patty Murray (D-Wash.) said Tuesday. The Democratic leaders of the House Select Subcommittee on the Coronavirus Crisis similarly have called for the bill’s passage.
Public health groups say public health agencies need new authorities and more pandemic funds—but neither is guaranteed.
“It’s challenging,” Georges C. Benjamin, executive director of the American Public Health Association, said of passing any pandemic-related legislation. “But the question is: will they put money on the table to fund it?”
Lawmakers are closing out this Congress warning their colleagues not to forget the lessons of the Covid pandemic and the government failures that led to an unnecessarily high death toll in the US.
“The Covid-19 pandemic was not the first public health crisis our nation has faced—nor will it be the last,” Sen. Gary Peters (D-Mich.) said in a statement.
The US fared far worse in responding to the virus than many other developed nations. According to data from Johns Hopkins University, the US had nearly 329 deaths per 100,000 people, compared with Canada’s 126 deaths per 100,000.
Failure to Invest
Peters, chairman of the Homeland Security and Governmental Affairs Committee, headed a two-year investigation that closed out last week on the response to the first outbreak of Covid, concluding the US had failed to invest in public health preparedness for years before the virus began to spread.
Among Peters’s recommendations: improving public health surveillance tools and streamlining leadership roles in the next emergency.
The House select subcommittee recommended changes for the CDC, noting the agency dropped the ball in creating tests to detect Covid early in the pandemic.
The problems with producing tests to find the virus appear to have persisted into this year: Testing for monkeypox was severely limited, with government labs administering as few as 23 tests per day in June. Early Covid tests were also hampered by technical and procedural issues.
Congress has been split on whether new Covid funds are needed. The White House requested $10 billion for Covid and other infectious disease resources in November, but key Republicans have so far called it unnecessary spending. Whether that disagreement spills over into pandemic preparedness isn’t clear.
Sen. Richard Burr (R-N.C.), the top Republican on the Senate HELP Committee, told reporters reforms for the CDC have been needed for years and aren’t costly.
“We desperately need to reform the CDC,” he said.
Outdated Health System
Health departments are still using fax machines and lack standardization so the data that are submitted appear in different formats, Benjamin said.
The CDC has to enter into data agreements with every state to get the data shared. Data should be interconnected the way the US highway system is, he said.
“Right now, if you want to drive across the country, you can drive across the country, everything’s connected, it’s a relatively rational system,” he said. But there’s no national health information highway. “You can’t move a piece of data quickly from one place to another,” he said.
Congress provided $1.1 billion for a data modernization plan, but Benjamin said the process has been too slow and senior leadership both in Congress and the administration need to demand a new data system.
He noted the CDC received criticism it was slow to identify the racial and ethnic disparities in patient outcomes for Covid that providers were seeing on the ground, but a lot of the existing data systems didn’t show race and ethnicity.
“There is a need for some basic information that should flow from the health-care system to the public health system,” Benjamin said.
Disjointed Health Highway
CDC Director Rochelle Walensky likewise used the highway metaphor at the Milken Institute’s Future of Health Summit last week.
The agency receives data from 3,000 local public health departments, 576 tribes, as well as states and territories, but not all the highways connect, she said.
“We have work to do in our data modernization efforts to make sure the highways connect,” Walensky said. “Once those data connect, we need cars running through those highways.”
Walensky has lobbied lawmakers for new authorities to require data. She said some assume the CDC already has the authority to compel data from states and local jurisdictions— but it doesn’t; it must set up often very specific data use agreements.
For example, she pointed out that the US has been funneling people who arrive from Uganda through five different airports to handle the latest Ebola outbreak; there have been more than 6,000 travelers to Uganda over the last several months, she said.
“We don’t have the authority to ask them their final destinations to give us the data on how they’re doing,” Walensky said. “It’s very, very hard to run a public health response that way.”
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