Insufficient funding for pandemic in revised Build Back Better plan

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Public health officials and outside experts warned the federal government for years before the coronavirus pandemic that the United States was not focusing enough on preventing public health. They were right. Now they are again begging the federal government to invest more money in preparedness, to learn a lesson from Covid-19 about what happens when we don’t prioritize these programs.

But the country risks repeating the same mistakes. Advocates expected a lower investment in readiness for the upcoming Build Back Better Act than they saw fit. External experts have estimated that up to $ 75 billion should be spent over 10 years on public health infrastructure, preparedness and prevention.

The revised Build Back Better legislation totals around $ 10 billion in public health infrastructure and pandemic preparedness funding over the next few years – a down payment for better preparedness, Democrats say, but without a guarantee of future installations.

“Too often when there is a crisis, the reaction is to invest money in public health. Once the crisis is over, funding tends to dry up, ”Ron Bialek, president of the Public Health Foundation, told me. “This is not the recipe for success.”

There is additional funding in the bill to expand the medical workforce, a need experts and hospital officials also say the pandemic has made impossible to ignore.

It’s hard to say exactly how the past 18 months could have turned out differently if more funds had been spent on preparation. But the country would likely have had more funding for healthcare workers, more support for disease surveillance and data-sharing systems, and more focus on preventing the chronic diseases that make the virus more deadly.

Experts inside and outside government are urging Congress to approve new sustained funding for public health programs. Congress has approved temporary funding throughout the pandemic, but public health officials and advocacy groups want dedicated annual funding streams – the kind of resources they say are needed to prevent a repeat of the failures of Covid-19 in the United States when the next deadly pathogen breaks through.

“It’s hard at the local and state level to make long-term decisions about building infrastructure and hiring people when you don’t know if the money is going to run out,” Anand Parekh, medical adviser chief at the Bipartisan Policy Center, told me.

Several proposals attempt to estimate the amount of sustained funding required. The Bipartisan Policy Center included in its list of recommendations $ 7.6 billion in new funding annually, or $ 76 billion over 10 years once funding is fully in place. Trust for America’s Health has requested at least $ 4.5 billion per year ($ 45 billion over a decade) in funding for public health infrastructure. The White House Biden presented its own 10-year pandemic preparedness proposal, which a senior official compared to the Apollo lunar missions, which requires $ 65 billion in total.

The White House Biden originally asked Congress to make a $ 30 billion pandemic preparedness down payment as part of its infrastructure plan.

But aware that it can be difficult to get so much money in this reconciliation bill, given concerns from centrist Democrats about the overall cost of the legislation, the White House has lowered its request to $ 15 billion. , which the House reconciliation bill, as currently drafted, would roughly cost to meet.

And so, with centrists pressuring Democratic leaders to cut the costs of the bill, Congress is preparing to pass a bill with a fraction of the funding that experts believe is needed to prepare for the next pandemic, in what could be the last great legislation of this Congress. While more money could in theory pass later, public health experts fear an opportunity may be wasted.

How public health funding can help fight pandemics

Public health preparedness covers many different things – all of which have been relevant to the fight against Covid-19.

As part of the White House’s larger 10-year plan, the first priority would be to enable the rapid development of new vaccines and treatments when a threatening pathogen emerges.

He requested that half of the total cost of $ 65 billion be spent on these biomedical activities, with the goal of producing enough vaccine for the entire American population within 130 days of the identification of a new disease. infectious and sufficient for the entire world within 200 days. Operation Warp Speed ​​has been one of the most effective parts of the US response to Covid-19 by supporting vaccine development, and the goal of the White House plan is to accelerate the timeline even further. with sustained readiness funding.

The Bipartisan Policy Center and the Trust for America’s Health have also recommended that Congress create a permanent public health “infrastructure” fund. These dollars could be spent on hiring staff, as well as building and maintaining the systems needed to monitor infectious diseases and communicate with the public.

“We have seen how important it is to get accurate and timely data,” Philip Huang, director of the Dallas County, Texas Department of Health told me.

In his county, Huang said he wanted to invest in data systems that would allow rapid dissemination of information. He pointed out that at their mass vaccination sites, staff were still forced to take paper vaccination cards and manually enter the information into a digital database. Dallas County has also relied on online providers to communicate virtually with its constituents, sending them text messages and other important alerts.

Better data sharing and better communications are two ways the United States could improve its response to the pandemic. But that would require money to, for example, renew the licenses of some of these online services.

“Historically, people have short memories of these things. People invest a little bit of money in supporting infrastructure, but in between they forget and this is one of the first things that are cut, ”said Huang. “This should hopefully show once and for all that we need to invest in this stuff.”

Finally, preparedness means investing in preventive public health programs that actually improve the health of the population before a deadly virus or bacteria arrives. Poor health in the United States also contributed to America’s struggles during the pandemic.

According to a study published earlier this year in the Journal of the American Heart Association, about two-thirds of all Covid-related hospitalizations in the United States through mid-November 2020 were attributable to one of the following four health conditions: diabetes, obesity, hypertension, and heart failure. About one in 10 Americans has diabetes, about four in 10 are obese, and almost half of adults have high blood pressure. These are chronic and widespread problems that many Americans struggle with that make them more vulnerable to certain communicable diseases, including Covid-19.

Public health officials and other experts have plenty of ideas on how to prevent more Americans from developing these conditions and improving the health of those who already have them – healthy eating initiatives, programs. screening, etc. the efforts would pay off the next time a health emergency arose.

“You really need a resilient population to be able to withstand an emergency,” Parekh said. “Much of what we see in healthcare is preventable. Public health is a set of activities that can prevent much downstream from what our health system sees. “

But the problem, as always, is the money. The Affordable Care Act actually created a public health prevention fund, but what happened to it after the law was passed is a microcosm of the whole problem of funding public health.

The prevention fund was supposed to build up over time. But almost immediately, Congress began withdrawing money from the fund to offset other spending plans. At this point, according to Parekh, the fund was supposed to reach $ 4 billion, but it’s actually only $ 900 million. The Bipartisan Policy Center’s public health financing plan would increase the prevention fund, on an ongoing annual basis, to that figure of $ 4 billion.

The past 18 months suggest that the United States might have done better to spend this money as originally planned. But the will to invest in public health is always short-lived. Despite calls from the public health community, Congress could once again prove short-sighted when it comes to investments in public health.

“Now is the time to prepare for the next one,” Parekh said. “It’s not a question of if, but it’s a question of when we face the next pandemic.”


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