| | | | |  | | By Carmen Paun, Evan Peng, Ben Leonard and Erin Schumaker | Programming note: We’ll be off Monday and Tuesday for the Fourth of July but will be back in your inboxes on Wednesday.
| | |  It's looking bleak for PEPFAR reauthorization this year. | AP | | | “The president fired the first shot.”
— Rep. Chris Smith (R-N.J.) | | Until now, the President’s Emergency Plan for AIDS Relief has enjoyed the backing of religious conservatives and liberals as well as bipartisan support in Congress. It’s also served as a public relations boon to Republicans since President George W. Bush created it in 2003. The comity is no more, and the prospects this year for Congress reauthorizing the program credited with saving 25 million lives in the developing world are fading, Carmen reports. Republican lawmakers’ claims that President Joe Biden is using PEPFAR to support abortion rights have caused the unique coalition that’s long supported it to fray. Why it matters: PEPFAR can continue without congressional reauthorization — albeit without policy changes or additional authorized funding. But the program’s supporters are concerned that Congress’ failure to reauthorize it for another five years will signal diminishing support from U.S. leadership in the battle against AIDS. They worry that could threaten over time the nearly $5 billion the program gets in yearly funding, which would impede the international goal of ending the AIDS epidemic by 2030. “If the U.S pulls back, it gives an excuse to other big donors to pull back, and that’s the last thing we want,” said Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University. What’s going on? The Heritage Foundation released a report in early May accusing the Biden administration of using PEPFAR as a “vehicle to promote its domestic radical social agenda overseas,” and the conservative think tank signed a letter to Congress along with dozens of other anti-abortion groups demanding changes to the program should it be renewed. Now Rep. Chris Smith (R-N.J.), who chairs the House Foreign Affairs subcommittee with jurisdiction and who wrote the last bill reauthorizing it in 2018, says he won’t back reauthorization without languaging barring program administrators from funding groups that advocate for abortion rights. The Biden administration denies Smith’s charges and, along with Democratic lawmakers and some outside public health advocates, said there’s no evidence PEPFAR funds have gone to providing or promoting abortion. “They’re taking what was an initiative of George Bush that has been successful across the globe, particularly in Africa, and are now trying to make it a political issue about abortion,” said Senate Foreign Relations Chair Bob Menendez (D-N.J.), adding that Smith’s claim that PEPFAR is supporting abortion is a “smear.” What’s next? Prospects for reauthorization look bleak.
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The Statue of Liberty | Carmen Paun | This is where we explore the ideas and innovators shaping health care. United Healthcare announced it’s offering many members, including those on high-deductible plans, free virtual visits 24/7 beginning July 1 through the end of 2024. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Alice Miranda Ollstein talks with Daniel Payne about his chat with Rochelle Walensky, whose last day leading the Centers for Disease Control and Prevention is today. They spoke about what's next for the CDC and Walensky's successor.
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After surging last summer, mpox has remained mostly dormant this year. | Jakub Porzycki/NurPhoto via AP | The mpox outbreak that began last spring infected more than 30,000 people and killed 43 in the U.S., but so far this year, the disease hasn’t spiked. The Centers for Disease Control and Prevention’s seven-day average sits at one as of June 28. This time last year, cases were rapidly rising, hitting a seven-day average of 79. What explains it? Efforts by government and community organizations to inform the public of the risks and promote vaccinations have helped. According to a CDC analysis, through Jan. 31, only 23 percent of the at-risk population in the U.S. had received shots, which studies show provide good, but incomplete, protection against infection. Men who have sex with men are most at risk, with spread facilitated by prolonged physical contact. Mpox, formerly called monkeypox, causes painful skin lesions that can leave scars. Last July, the World Health Organization declared the global outbreak a public health emergency. Officials warned about the risk of spread at Pride gatherings last summer as the caseload reached a seven-day peak in August of more than 450 cases a day. But Pride celebrations this year haven’t triggered any sustained outbreak in the U.S. or other countries that experienced 2022 outbreaks. “I can’t a hundred percent answer the question of why we’re not seeing larger clusters,” Demetre Daskalakis, deputy coordinator of the White House's national monkeypox response, told Evan. “But I do think it’s some combination of immunity in the population, whether that’s vaccination or prior infection, but also I think the community that we’re working with really knows how mpox transmits, and folks are taking precautions.” Treading carefully: Anticipating more cases, the CDC issued a health alert in May, warning that the outbreak wasn’t over and that a cluster of cases had occurred in Chicago between mid-April and early May. Thirteen people, including nine who’d received the Jynneos vaccine, contracted the disease. That cluster subsided, as did one in Colorado. But a new one emerged in Los Angeles last week.
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An opioid itself, buprenorphine helps wean people from stronger drugs. | Elise Amendola/AP Photo | Public health advocates were pleased in December when Congress eliminated the requirement for clinicians who want to offer buprenorphine to patients with opioid use disorder to apply for a special waiver, expecting that it would increase uptake of the effective treatment. But the law that nixed the X waiver also established a new eight-hour training requirement that all prescribers must complete. It took effect on Tuesday. What’s involved? The nearly 2 million practitioners registered with the Drug Enforcement Administration to prescribe controlled substances will have to undertake the one-time training before their next registration renewal, regardless of whether they ever prescribe opioids. They, or their employers, will have to pay for it. How is this less onerous? The training requirement for the X waiver was eight hours for doctors and 24 for non-physician prescribers, so it’s a substantial reduction for nurse practitioners and physician assistants. Previous X waiver training will count, and they’ll only have to reup on the training every three years when DEA licenses come up for renewal. In addition, those who complete the training will be able to treat an unlimited number of patients. Congress eliminated the previous cap of 30. Even so: The American Medical Association expressed reservations with the new blanket training rule when it was being considered in Congress. In a July 2022 letter to the Senate Health, Education, Labor and Pensions Committee, AMA CEO James Madara expressed concern at possible impacts on access to care for both addiction and pain patients. The eight-hour blanket training rule, though, acted as a compromise to quell the concerns of some about potential abuse of buprenorphine, which is itself an opioid, said Michael Lynch, an emergency physician and toxicologist in Pittsburgh who specializes in addiction medicine. “Fundamentally what this is all about is removing the X waiver, which is a good thing,” said Lynch. | | | | Follow us on Twitter | | | | Follow us | | | | |
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