Rethinking our approach to a pandemic

Jan 24, 2022

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By Sarah Owermohle

Presented by Humana

With Megan Wilson

QUICK FIX

— CDC Director Rochelle Walensky sat down with POLITICO to discuss dire public health funding needs and to reassess pandemic approaches.
— Health care lobbying saw a 2021 bump, with most major players boosting their spending as Biden and congressional Democrats push industry reforms.
— Antivirals were meant to be a Covid game changer but instead are caught in logistical confusion and access concerns.

WELCOME TO MONDAY PULSE — As you saw Friday, Adam is on to new and exciting projects, though he'll still be in shouting distance. I'm your solo Pulse writer for the moment, so keep those tips and news coming at sowermohle@politico.com.

A message from Humana:

In 2022, older Americans are getting more out of Medicare Advantage. Many Americans turning 65 or who are new to Medicare have access to plans that provide supplemental benefits tailored to address key social health needs like food security, transportation, and in-home support services. Learn more about how Medicare Advantage plans are helping address members' whole health.

DRIVING THE DAY

'THE CDC ALONE CAN'T FIXTHIS' — The country needs to rethink its Covid-19 response and rebuild its public health system, Centers for Disease Control and Prevention Director Rochelle Walensky told POLITICO roughly a year after taking over the agency in the midst of the Covid-19 response and early vaccine rollouts.

Now, as the pandemic enters its third year, Walensky told Erin Banco that the CDC needs help to fight Covid-19. If the pandemic is to turn endemic — a situation top Biden health officials say they could more easily control — the U.S. needs to overhaul the nation's public health workforce, she said.

"I actually really think many people have thought, this is CDC's responsibility, to fix public health [and] the pandemic," Walensky said. "The CDC alone can't fix this. Businesses have to help, the government has to help, school systems have to help. This is too big for the CDC alone," she said.

The to-do list: Walensky is calling for broadscale investment in public health, including helping to hire more nurses locally, staffing emergency departments and recruiting statisticians and data crunchers.

Her press for better resources, especially on the state and local scale, comes amid criticism of the CDC's guidance on quarantining and masking and persistent calls for better vaccination data. Walensky, in recent weeks, stepped up media engagement, hosting the agency's first solo press call since the Trump administration ended them.

"I would love to say I know exactly where we are because I think people really do want to know," Walensky told POLITICO. "But the most important thing that we can say is that we don't know exactly where we're heading."

What's next: Health officials across administrations have long rallied for increased public health funding, but Walensky said the coronavirus could finally be a catalyst for change.

"Ebola didn't touch everyone. Zika didn't touch everyone. Even during those what I would call public health crises, people didn't always know what the CDC stood for. People were not talking about science on the nightly news," Walensky said. "And I think this pandemic has by far touched everyone every day for the last two years. And I think people have realized that we can't be in this place again."

HEALTH INTERESTS POUR CASH INTO D.C. LOBBYING — Spending by most health-focused lobbying shops increased in 2021 as President Joe Biden and a democratically controlled Washington moved to enact top party priorities like reducing prescription drug prices and expanding health coverage for Americans, Megan reports.
A quick breakdown:

The Pharmaceutical Research and Manufacturers of America spent more than any other health industry group, dropping $29.57 million on advocacy in 2021 — a 16 percent increase over 2020.

"We have faced potential policy changes that threatened to disrupt biopharmaceutical innovation, restrict patient access to lifesaving medicines, and destroy jobs across our industry," PhRMA spokesperson Sarah Sutton said in an email. She added the group is working to improve pandemic preparedness and push Medicare reforms aimed at curbing patients' costs.

Other top spenders include the American Hospital Association, which spent $20.81 million in 2021 versus $18.92 million in 2020. The American Medical Association spent $18.84 million in 2021, and roughly the same amount in 2020 and AARP spent $13.68 million in 2021 — 66 percent more than it did in 2020. The Biotechnology Innovation Organization and America's Health Insurance Plans spent $13.29 million and $11.29 million last year, respectively.

POLITICO analyzed the top 50 health care industry spenders on lobbying and found that 33 increased their 2021 advocacy spending over the previous year.

However, there were some outliers: Drugmakers Pfizer and Amgen each decreased their lobbying slightly over 2020, spending $10.25 million and $9.75 million — a 6 percent and 13 percent drop, respectively. Both were still top spenders in the health field, though.

Rounding out the top 10 health spenders are Horizon Therapeutics and health insurer Cigna. Horizon spent $9.48 million in 2021, a 65 percent jump over the $5.76 million it spent in 2020. Cigna increased its spending by 27 percent: $9.14 million in 2021 compared with $7.22 million in 2020.

IT'S STILL NOT EASY TO GET ANTIVIRALS— The prescription pills billed as a game changer for Covid-19 treatment are mired in regulatory, testing and logistical hurdles, complicating their rollout — and the ease of at-home, early treatment.

"It should be easy, and it's chaos." Emergency authorization for the pills — molnupiravir from Merck and Ridgeback Biotherapeutics and Paxlovid from Pfizer — is written so that prescribing power is limited to doctors and certain health care workers often found in a physician's practice, POLITICO's Lauren Gardner writes. That could create an access merry-go-round where patients may need to visit a testing site, a doctor's office and then a participating pharmacy to get the drugs — a prospect one state health official said was akin to "sending you on a goose chase to try and find these meds."

There are also key caveats. Regulators have warned, for instance, that molnupiravir presents risks for pregnant people and children. Meanwhile Paxlovid interacts with a host of blood pressure, cholesterol and other widely used drugs, meaning patients may have to suspend taking those medications.

Pharmacy groups say one way to mitigate that issue would be to give pharmacists prescribing authority for the antivirals just as they can administer Covid-19 vaccines under the PREP Act. But that falls outside the "traditional" categories of prescribers the FDA stipulated in its authorization.

"This determination was based on several factors, including the drugs' side effect profiles, the need to assess potential for drug interactions, the need to assess potential kidney function problems," FDA spokesperson Chanapa Tantibanchachai told POLITICO.

And allotment hurdles. Joshua Barocas, an infectious disease specialist at the University of Colorado School of Medicine, said he's worried only patients with access to hospitals will be able to get Covid therapies, mainly because of testing requirements to get the prescriptions. Barocas suggested the federal government, perhaps with the National Guard, could help ensure treatments are steered toward vulnerable populations.

"We cannot expect vulnerable and sick patients to do everything themselves," he said.

A message from Humana:

Around the Agencies

FIRST IN PULSE: SENATORS CALL FOR MEDICARE TESTING COVERAGE — Eighteen senators led by Michigan Democrat Sen. Debbie Stabenow sent a letter to top health officials today pressing for Medicare to broadly cover at-home coronavirus tests.

The letter to Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure comes on the heels of federal guidance requiring insurers to cover up to eight over-the-counter Covid-19 tests a month.

"However, those enrolled in original Medicare and private Medicare Advantage plans do not have this same access," Stabenow and the other senators wrote, adding that older adults and people with disabilities enrolled in Medicare are at the highest risk of severe illness and death from the disease. "The current policy leaves them on the hook for potentially significant out-of-pocket costs."

AROUND THE WORLD

BEIJING ORDERS MASS TESTING BEFORE OLYMPICS — A court on Sunday ordered roughly 2 million people in a large Beijing district to undergo mass coronavirus testing amid a rash of infections ahead of the Winter Olympics.

The government told people in areas of the Chinese capital deemed at high infection risk not to leave the city after 25 cases were found in the Fengtai district and 14 elsewhere, the Associated Press reports.

The ruling Communist Party has amplified enforcement of its "zero tolerance" strategy in recent weeks as its capital prepares to open the Winter Games on Feb. 4. That includes strict isolation policies and travel bans for other Chinese cities reporting new cases.

The Associated Press said that nationwide, 56 new confirmed infections were reported in the 24 hours through midnight Saturday. The National Health Commission said 37 were believed to have been acquired abroad.

China has reported 4,636 deaths out of 105,603 confirmed cases and seven suspected cases since the pandemic began.

What We're Reading

The first year of the Biden pandemic fight included mixed messages as the virus, vaccination and testing efforts and national sentiments evolved, The New York Times' Michael Shear, Sheryl Gay Stolberg, Sharon LaFraniere and Noah Weiland write.

Severe staff shortages are worsening in nursing homes as frustration builds among low-wage workers who describe untenable pressure and years of mistreatment, The Washington Post's Rebecca Tan reports.

"The Supreme Court is at an institutional crossroads," Bloomberg News owner Michael Bloomberg wrote in an op-ed urging the court to preserve current abortion rights in the upcoming Dobbs v. Jackson Women's Health Organization case.

A message from Humana:

Medicare Advantage plans are evolving to meet the needs of Americans turning 65 or who are new to Medicare. With food insecurity and a lack of transportation making it difficult for many older Americans to seek care, supplemental benefits like transportation support and meal assistance can make a real difference in their lives. In 2022, more Medicare Advantage plans are providing meal assistance and transportation help, and the number of Medicare Advantage plans offering in-home support services doubled from 2021. Learn more about why 40% of people eligible for Medicare choose Medicare Advantage and how Medicare Advantage plans are supporting older Americans beyond the doctor's office.