A Senate committee has approved a bipartisan blueprint to overhaul the nation's public health system, applying the lessons of COVID-19 to future outbreaks through a new chain of command, a stronger medical supply chain, and clearer crisis communications.
The Health, Education, Labor and Pensions committee approved the PREVENT Pandemics Act by a vote of 20-2 Tuesday.
But it's only a first step. If the ambitious vision does eventually pass Congress, lawmakers must still deliver the tens of billions of dollars it will take to translate it into reality and maintain focus after the coronavirus recedes. Right now, Congress is even having trouble meeting a White House request for additional funds to keep COVID-19 at bay the rest of this year.
"We owe it to everyone who has worked so hard to address the challenges of this pandemic to make sure (that) we are never in a situation like this again," said Sen. Patty Murray, D-Wash., chair of the Health, Education, Labor and Pensions Committee.
She and ranking Republican Richard Burr of North Carolina worked for over a year on the contours of the bill, which also calls for a national task force modeled on the 9/11 Commission to investigate what went wrong in the coronavirus response and make recommendations to the president and Congress. And the legislation incorporates creation of a new advanced medical research and development agency — dubbed ARPA-H — that President Joe Biden has called for.
"The central issue facing us today is how can we better anticipate what threat we will face next, and innovate quickly enough to rise to the challenge," said Burr. "The future, unfortunately, is hard to predict."
The bill starts by formally placing responsibility for pandemic response — in Burr's words, "mission control" — within a new White House office, on a similar footing as national security. In the Obama White House, the National Security Council had a global health unit, but that was disbanded under the Trump administration.
Congressional oversight of the Centers for Disease Control and Prevention would be strengthened by requiring Senate confirmation of its director. Confusion over CDC's health recommendations has been recurring problem in the pandemic, so the legislation calls for an advisory council to instruct health officials on how to get fact-based information across to the public more clearly.
On the scientific front, the legislation takes multiple steps.
They include more active surveillance of emerging diseases, building a capability to forecast epidemics and improving data collection and distribution. The Food and Drug Administration would be assigned a higher priority on medicines and countermeasures targeting infectious diseases.
The bill calls for close attention to the medical supply chain, everything from raw materials for drug manufacturing, to protective equipment that was in such short supply in the first wave of the pandemic, to tests that continued to be an issue in the omicron wave.
Two Republicans voted against the measure in committee, Sens. Rand Paul of Kentucky and Mike Braun of Indiana. Paul used the occasion to mount another attack on his nemesis, Dr. Anthony Fauci of the National Institutes of Health, the government's top infectious disease expert. Paul's amendment to strip Fauci of his post and break up his National Institute of Allergy and Infectious Diseases was soundly rejected. He and Fauci have repeatedly and publicly clashed during the pandemic.
How much money would be needed to make the blueprint a reality remains unclear.
A new report estimates that overhauling U.S. public health and preparedness could take $100 billion in the first year, $20 billion to $30 billion in the following two years, and $10 billion to $15 billion annually thereafter.
"We've got to spend in proportion to the damage done, and the damage done has been huge," said Dr. Ezekiel Emanuel of the University of Pennsylvania, one of the authors. "Being penny-wise now would be foolish."
Some major public health groups say they like the overall direction of the Senate bill but want to examine the details more closely before officially taking a stand. Dr. Georges Benjamin of the American Public Health Association said there's concern that making the CDC director a Senate-confirmed position might inject too much politics into the agency's work.
"Obviously we are supportive of funding to rebuild the public system," said Benjamin, adding that "we have some questions about the bill as it has evolved."
Meanwhile, Congress has still to act on Biden's request for $22.5 billion in immediate funding to maintain momentum on the COVID-19 response. The White House issued a new warning Tuesday of a potential rebound in virus cases if it doesn't get new money for vaccines, treatments and other priorities. Republicans have questions about how previously allocated funds have been spent and Democrats object to redirecting money that had already been promised to states.