U.S. may need $7 billion for monkeypox, Biden administration estimates

The Biden administration privately estimated to Congress this month that it may need nearly $7 billion to mount a response to the nation’s monkeypox outbreak that matches “the scope and urgency of the current situation.”

The funding estimate, the details of which were contained in a memo addressed to President Biden and obtained by The Washington Post, reflected early talks among congressional Democrats and White House officials in pursuit of a spending package that could boost the availability of monkeypox tests, vaccine doses and treatments.

The amount did not mark a formal request for aid to Congress. Rather, it was one of a series of options reflecting various amounts that could fund varying levels of federal mitigation efforts. White House aides recently presented the ideas at the request of Democratic leaders on the Senate’s top health-focused committee, according to the memo. A Democratic aide, who spoke on the condition of anonymity to describe the private conversations, confirmed the funding details to The Post.

The Biden administration also called for as much as $31.4 billion in new funds to combat the coronavirus pandemic, as it seeks to ensure the government has the resources necessary to purchase more treatments, testing and vaccines this year.

The White House already had urged Congress repeatedly to approve another tranche of aid targeting covid-19. But Republicans have raised numerous fiscal objections to additional federal spending, resulting in a stalemate that has forced the Biden administration to ration the funds that remain. The new discussions around monkeypox aid could face similar political obstacles, because some GOP lawmakers previously have said they are only willing to repurpose existing funds, not authorize new dollars.

The private discussions have unfolded as public health experts warn that monkeypox, which can spread by skin-to-skin contact and cause fever, lesions and severe pain, is at risk of becoming permanently entrenched in the United States. Federal officials have identified about 3,500 cases, overwhelmingly among gay and bisexual men, and have warned that the virus is likely to spread to broader populations.

The World Health Organization on Saturday declared that the global monkeypox outbreak was a public health emergency of international concern, its highest-level warning, and Biden officials are contemplating a similar declaration, although the current outbreak has yet to be linked to any U.S. deaths.

After publication of this story, an administration official confirmed the White House’s current discussions with Congress about monkeypox funding.

“As part of our routine conversations with Congress about various resource needs, the Administration this weekend responded to a request from Hill staff for additional information on the Administration’s public health response efforts, including our monkeypox outbreak response and the additional resources needed to continue it,” the official, who spoke on the condition of anonymity, wrote in an email.

According to the memo obtained by The Post, officials estimate that $6.9 billion in new funding for the monkeypox response would allow the Department of Health and Human Services to support “domestic end-to-end vaccine manufacturing capacity and technology transfer” in the United States. The only vaccine specifically approved by the Food and Drug Administration for monkeypox, Jynneos, is produced in Denmark, which has caused significant complications in the U.S. response — for instance, hundreds of thousands of Jynneos doses were stranded overseas for weeks, awaiting U.S. inspection and transport.

With that much funding, officials further estimate that they would be able to secure 19 million new doses of vaccine for monkeypox and replenish about 4 million doses for paused smallpox preparedness efforts, as well as purchase more antiviral treatments, expand testing, improve vaccine distribution, and provide coverage of services for uninsured and underinsured Americans, among other goals.

Health officials also estimated the effects of a “medium” second option, seeking $2.2 billion in monkeypox funding to purchase some vaccine doses and treatments that would be targeted toward the gay and bisexual community, where the outbreak is currently concentrated. But the amount may only provide an effective response if the outbreak remains contained and does not spill into broader populations, “which is not guaranteed,” the memo cautions.

Officials also estimated a bare-bones fallback option of $500 million that would allow for purchasing some vaccine doses and continuing “minimal” operations.

Health officials have said they are funding the current monkeypox response by drawing on existing appropriations and a response fund maintained by the Centers for Disease Control and Prevention. The Biden administration has distributed 330,000 vaccine doses and contracted for a total of 6.9 million Jynneos doses by mid-2023, in addition to other investments in tests and treatments.

The discussions come as Democrats on Capitol Hill sound alarms about the need for the federal government to act swiftly and more aggressively. Party lawmakers fired off a flurry of letters over the past week that evinced some of their discomfort with the situation, in some cases arguing the U.S. government has not done enough to offer tests, treatments and vaccinations to those in greatest need.

In one letter to the Biden administration, sent Monday, more than 100 House Democrats led by Reps. Jerrold Nadler (D-N.Y.) and David N. Cicilline (D-R.I.) called for “additional funding” that could support health clinics tasked with responding to monkeypox. Lawmakers said the lack of financial resources had imperiled local work to conduct contact tracing and provide other essential services, adding to the burden on doctors and aides who already are overtaxed because of the coronavirus pandemic.

“What we’re hoping is the experience of covid will inform the response to this outbreak,” Cicilline said in an interview Tuesday.

Separately, another 22 Democrats led by Sens. Jeff Merkley (D-Ore.) and Edward J. Markey (D-Mass.) aired their growing “concern” about recent caseloads and called on the Biden administration to increase vaccine access. The lawmakers said the short supply of immunizations had hurt “at-risk” populations, particularly the lesbian, gay, bisexual and transgender communities, for whom health care already can be “inaccessible or otherwise denied.”

“In light of this high demand and the communities that have been impacted by the outbreak in the United States to date, we implore you to work with urgency to take the necessary action to respond to this public health concern and ensure adequate doses and equitable distribution of the vaccine in the United States,” the Democrats wrote in their missive.

And Markey on Tuesday further called on the CDC to “reduce barriers” to access a key treatment, known as tecovirimat, that has been hard to obtain for monkeypox patients. In doing so, Markey asked HHS and CDC officials if they needed “additional funding” to ensure its availability.

Meanwhile, Senate Republicans have continued to press the White House on its emerging response to monkeypox and ongoing response to the coronavirus. Sen. Richard Burr (R-N.C.), the top Republican on the Senate’s health panel, earlier this month sent a letter to Biden officials, criticizing their “egregious failures” on monkeypox testing and vaccine distribution and demanding the administration’s “detailed strategy” on how to respond to the current outbreak. Burr has also spent months warning the White House that he does not plan to support more coronavirus funding until he is assured that trillions of dollars in prior funding was well-spent.

Broadly, Republicans have demanded that Democrats repurpose past stimulus dollars to cover the costs of any new public health spending. Without GOP support, Democrats cannot advance any aid package in the narrowly divided Senate.

The Biden administration has repeatedly called for more coronavirus funding, warning that it has increasingly been forced to shift money from other needed initiatives, such as a move last month to take $10 billion from testing and other programs to buy more vaccines. The White House on Tuesday hosted experts who made the case for “the next generation” of coronavirus vaccines that could last longer and provide more protection against the virus, the administration’s latest effort to spotlight the need for more investments.

“We have to continue to innovate, be creative, and propel great ideas forward in action. We must continue to fund those ideas with support from Congress,” said Alondra Nelson, the acting director of the White House science office.

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