WASHINGTON — Members of Congress seemed interested Wednesday in the idea of starting a separate fund — one that would be unaffected by budget caps — to prevent and deal with future epidemics.
“This idea of a health defense fund really bears considerable merit,” Rep. Tom Cole (R-Okla.), ranking member of the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, said at a hearing on the response to COVID-19. “The chair and I have talked about something like this, and talked about the accounts you’d want to have.”
“We’re not trying to open up the budget or crack the budget caps, but the defense budget on Jan. 1, 1942 was a lot different than it was on Dec. 1, 1941,” he said. “Spending billions to save trillions is a no-brainer to me, and I think that’s where we’re at.”
Problems with One-Time Funding
The fund was suggested by Thomas Frieden, MD, MPH, one of the hearing’s two witnesses. Frieden, former director of the CDC under President Barack Obama, is currently president and CEO of Resolve to Save Lives, a healthcare nonprofit.
“Without sustained support, our health will be avoidably at risk,” he said. “One-time funds are very problematic. From the point of view of someone running an agency, you can’t hire the best staff, you can’t enter into partnerships with countries and organizations where you can keep up your end of the bargain, and you can’t hold contractors accountable for an ongoing contract.”
Frieden added that discretionary funding is subject to caps and sequestration, and even mandatory funding doesn’t ensure stable support.
“We propose a new approach for specific public health programs … to prevent, detect, and respond to health threats. We suggest calling this the Health Defense Operations budget designation. It would exempt only these critical health protection funds from Budget Control Act caps so our public health agencies can protect us,” he said.
Programs getting this designation would have to submit a proposed budget to Congress annually. This way, Congress can appropriate the resources required to sustain the public health systems needed to keep us safe, Frieden added.
“This investment can save millions of lives and potentially trillions of dollars. Good public health is good business,” he noted.
Frieden also outlined 10 “plain truths” about the pandemic in the U.S., including the need for “massive” testing and distribution of a vaccine as soon as possible.
“Nothing else will enable life to get back to pre-COVID normalcy,” he said. “Treatment can help, but it’s unlikely to be as game-changing as a vaccine would be.”
Frieden also urged more protection for frontline healthcare and essential workers as well as for vulnerable populations. “Unless we take urgent action, there will be 100,000 deaths in nursing homes throughout the country…. And we must act now to reduce higher rate of death among African Americans, Native Americans, and Hispanic people.”
Boxing it In
In addition, Frieden unveiled what he called a “Box It In” strategy for reducing the virus’s spread. The four corners of the box included:
- Aggressive testing
- Isolation of infected people
- Contact tracing
- Quarantining for 14 days the contacts of those who are infected
Caitlin Rivers, PhD, MPH, senior scholar at the Johns Hopkins Center for Health Security, emphasized the importance of diagnostic testing. “Last week we did 1.6 million tests,” a big improvement over testing levels in April, she said. However, the estimates of the number of tests needed to really get the economy open again “start at 3.5 million per week and go up from there.”
“We urgently need a national plan for how we’ll close that gap … Where are the bottlenecks? Where are the untapped resources … the swabs, the PPE [personal protective equipment] for care providers, and the viral transfer media?” she said. “If this work has been done, I haven’t seen it, and I fear that neither have the governors, mayors, the business leaders, the university presidents and the school principals, all of whom have to make decisions about how and when to reopen.”
Rivers also pushed for more contact tracing. “One thing I don’t hear a lot about, about contact tracing, is that it’s also a key source of data that we badly need.”
She added that we currently have very little understanding about where people are getting infected.
“Are most new cases in long term care facilities or correctional facilities? We know those are high-risk settings, but we don’t have good sense of whether 99% of our cases originate in those settings or if it’s a small fraction … Getting a better understanding of what that looks like will help us to guide better interventions,” Rivers said.
The hearing was mostly cordial, with members asking the witnesses their opinions on topics such as the ability of domestic companies to meet the needs for medical supplies and equipment.
Frieden said that “there are some technical improvements that can improve our supply chains,” but that “in terms of vaccines and therapeutics, we don’t have any so we don’t know how difficult to manufacture they will be.”
Element of Risk
Rep. Andy Harris, MD (R-Md.), questioned whether shelter-in-place orders have been effective in slowing the spread of coronavirus. “There’s no data on that, is there?” he asked.
Frieden said that there was evidence from other countries showing that “if people stay home it reduces the spread” of the infection, “but it’s also clear that there are countries, including Singapore and South Korea, that have been able to limit the amount of physical distancing and still control the virus, and there are differences in different environments.”
Harris also questioned Frieden’s “Box It In” idea. “How do you box in something when you’re not recommending testing asymptomatic people?” he asked. “Why wouldn’t we just have very intensive educational processes so every American follows social distancing, wearing a mask, hand hygiene?”
“I think that’s correct,” said Frieden. “I think we can do both and we have to do both.”
“But I’ve seen where it’s been suggested, ‘Don’t reopen until you have contact testing in place,'” Harris said. When Frieden responded that people will be safer with contact tracing, Harris interrupted. “We’re safer from death if we’re not born. The bottom line is, there’s some element of risk,” he said.
Harris added that some areas — such as the rural part of Maryland that he represents — should be able to open sooner than other parts of the state because the risks there are lower. “Why do we have a one-size-fits-all approach when we could be much more nuanced about it?”
Subcommittee chairman Rosa DeLauro (D-Conn.) thanked the witnesses for their ideas. “At the federal level what we ought to be doing is speaking with one voice and giving simple directions,” she said, adding that Congress should give people “the sense that while we do not have all the answers, we have a focus, and we can give them a direction forward.”
Disclosure: Thomas Frieden, MD, is a second cousin of story author Joyce Frieden. She did not speak to him for this story and communicates with him only occasionally.