This Week in Congress

House and Senate

Both chambers were back in session this week.

Appropriations

Continuing Resolution (CR)

House and Senate negotiators continue to work to reach a consensus on the provisions in the CR before the midnight September 30 deadline, when the current fiscal year expires. Still under discussion is how much to include in the legislation for the Administration’s additional $47 billion emergency funding requests for Ukraine ($13.7 billion), COVID-19 preparedness ($22.4 billion), monkeypox ($4.5) and natural disasters ($6.5 billion). Another controversial issue involves energy infrastructure permitting provisions.  Dozens of House Democrats, led by House Natural Resources Chair Grijalva, oppose attaching the permitting legislation to the must pass bill. Senator Manchin and Schumer agreed to advance the permitting legislation by the end of this month as part of their negotiations over Democrats’ climate, health and tax law.

End Date

A small group of Senate Republicans and larger number of conservatives in the House are opposing the plan to extend the CR until mid-December while House and Senate negotiators resolve their differences on the FY’23 funding bills. Instead, they are proposing a CR through sometime next year.  Their view is that, after the November election, the GOP will gain control of the House and could also control the Senate, and that final decisions on FY’23 bills should wait until early next year when the new majority is seated.

Bolstering Biomanufacturing

President Biden signed an executive order laying out a strategy to bolster domestic biomanufacturing and to reduce the country’s reliance on China for new medicines. US national security officials are concerned about the US’ reliance on China’s advanced biomanufacturing infrastructure, and COVID-19 created a sense of urgency to develop a clear industrial strategy. This new initiative aims to create new jobs, strengthen the supply chain, and lower prices. The order also contains the outlines of how the US should develop a trained, diverse workforce capable of using naturally occurring processes to create bio-based products and materials.The order can be found here

Other Legislation and Happenings Around the Nation

Monkeypox

NCSD Director David Harvey’s Comments on the Rise in STD Rates and Monkeypox

According to the CDC, total STD infections beat the record number of STIs documented in the U.S. in 2020 — increasing from 2.4 to 2.5 million. Syphilis rates jumped 26 percent last year — the biggest annual increase since the Truman administration — amid a broader rise in STDs that worsened considerably during the COVID-19 pandemic. The preliminary data from the CDC shows the steep escalation of an alarming national trend and comes as local health departments are still battling COVID and contending with an unprecedented monkeypox outbreak. Leandro Mena, the director of the CDC’s Division of STD Prevention, said that chronic underfunding of public health programs is largely to blame. Public health officials warn their scarce resources could be further strained and outbreaks could proliferate if a Texas lawsuit succeeds in eliminating Obamacare’s requirement that insurance cover services like STD tests and HIV prevention drugs

NCSD Director Harvey stated: “Monkeypox is inundating these programs and it is interrupting our ability to diagnose and treat other STDs,” “It’s shining a bright light on the fact that safety net clinics who provide essential services are in desperate need of federal support.”

The monkeypox outbreak faces funding issues similar to COVID. Sexual health clinics, which have largely been on the front lines of the monkeypox outbreak, are struggling to meet the needs of patients. A public education campaign combined with the release of vaccines has helped slow case rates in the United States, but public health experts warn the future of the monkeypox outbreak could go one of two directions at this point — and much of that depends on how much money Congress allocates.

NCSD Harvey further stated: “Firefighters are not expected to fight fire without water, nor are members of the military expected to fight wars without weapons. Yet, for the past three months, we have been on the frontlines pleading with officials for the support our network so desperately needs.”

Press Conference

On September 12, NCSD convened a press call with public and sexual health leaders to discuss the need for federal funding for monkeypox. David C. Harvey, Executive Director, National Coalition of STD Directors; Dr. Michael Fraser, Association of State and Territorial Health Officials (ASTHO); Lori Freeman, National Association of County and City Health Officials (NACCHO); Cesar A. Arias, M.D., MS, PhD, FIDSA, Board Member, Infectious Diseases Society of America (IDSA); and Janet Hamilton, Council of State and Territorial Epidemiologists (CSTE) urged Congress to fully fund the $4.5 billion requested by the Biden Administration to address monkeypox outbreak.   The press conference can be viewed here

Senate Hearing on Monkeypox

This week, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing to discuss the Federal response to the US monkeypox outbreak. Witnesses included CDC Director Walensky; NIAID Director Fauci; FDA Commissioner Califf; and Assistant Secretary for Preparedness and Response O’Connell. Dr. Walensky addressed the rocky federal start of outbreak response but noted that cases are now declining. She also highlighted CDC outreach at a time when the disease was brand new to most frontline clinicians. Some lawmakers expressed frustration with the slow rollout of monkeypox vaccines and the delays in vaccine shipments to the US from abroad. Senator Burr (R-NC) called the administration’s response “catastrophic,” and said the CDC is an agency unwilling to change and think outside the box for infectious disease threats. Senator Murray (D-WA) encouraged the administration to address community monkeypox needs in a more effective manner and said too many missteps across federal agencies led to a few hundred cases growing to more than 20,000 over the course of the summer. “It is unacceptable to communities that already experience difficulties accessing healthcare, like the LGBTQ+ communities,” she said. The article can be found here. The Transcript of the Senate hearing can be found here.

TPOXX Updated CDC Guidance

On September 15, the CDC issued updated guidelines for use under expanded access for investigational new drug protocol. The new guidance was based on data recently released by the FDA which suggest that broad use of the antiviral drug, TPOXX, could promote resistance and render antiviral drugs ineffective for some patients.  Specifically, TPOXX should be considered for use in people who have severe disease — hemorrhagic disease, lesions, sepsis, encephalitis, eye infections, or other infections that require hospitalization. TPOXX should also be considered for use in people who are at high risk for severe disease, including those who are immunocompromised, children, pregnant women, and people with skin infections. For those patients for whom TPOXX is recommended, early administration is best.  The new guidance can be found here

CDC Launches Pilot to Close Equity Gaps

This week the CDC launched a pilot program to set aside up to 50,000 doses of JYNNEOS monkeypox vaccine for groups who’ve faced barriers accessing the shots. The program will focus on smaller events and projects that can help reach groups with language differences, distance to vaccination sites, vaccination hesitancy, government mistrust, lack of access to online scheduling technology, disability issues, immigration status and stigma. White men have received more than twice as many doses as either Hispanic or Black men who account for the majority of confirmed monkeypox cases. State, local, and tribal health departments will apply for doses to be administered at pop-ups or other events in non-clinical settings, in coordination with community-based organizations. The information can be found here

COVID-19

WHO Director-General Tedros Adhanom Ghebreyesus said this week that the number of coronavirus deaths worldwide last week was the lowest reported in the pandemic since March 2020, marking what could be a turning point in the years-long global outbreak. In its weekly report on the pandemic, the U.N. health agency said deaths fell by 22% in the past week, at just over 11,000 reported worldwide. There were 3.1 million new cases, a drop of 28%, continuing a weeks-long decline in the disease in every part of the world. At a press briefing, the WHO Director-General said the world has never been in a better position to stop COVID-19. “We are not there yet, but the end is in sight.”

Polio

In the past few weeks, White House, CDC, and HHS officials have met with the National Security Council to discuss how to improve polio virus surveillance and increase vaccination rates following the detection of polio virus in New York State wastewater samples and the confirmation of one known infection. Senior health officials are worried that the virus may be more prevalent than reports reflect, as most infections are asymptomatic or mild, it can cause paralysis.

Abortion

Nationwide Abortion Ban

Republican Senator Lindsey Graham introduced legislation that would ban abortions nationwide. The bill would ban abortions nationwide after 15 weeks of pregnancy, except in cases of rape, incest, or risk to the physical health of the mother. Graham’s bill would leave in place state laws that are more restrictive. That provision is notable because many Republicans have argued that the Supreme Court’s ruling leaves the abortion issue for the states to decide. But Graham’s bill makes it clear states are only allowed to decide the issue if their abortion bans are more stringent. Graham said it would put the U.S. on par with many countries in Europe and around the world. The legislation has no chance of becoming law in the Democratic-held Congress.

Oregon. Minnesota. Illinois. New Mexico

These abortion friendly states are opening a number of new abortion clinics in anticipation of women willing to cross borders to get an abortion. Some critics have labeled this the new “abortion tourism,” creating regional abortion outposts next to states where the procedure has been outlawed.

Ohio

This week an Ohio judge paused, for 14 days the state’s six-week abortion ban that went into effect after the Supreme Court overturned Roe v. Wade. The legislation, known as the “Heartbeat Law” was signed by Ohio Gov. DeWine (R) in 2019, and bans abortion after a fetal heartbeat is detected, generally at the sixth week of pregnancy. The judge ruled the law violates a clause in the state constitution that prohibits laws that penalize the sale or purchase of health care and that abortion falls under the constitution’s definition of health care. He also ruled the law discriminates against pregnant women, violating a separate equal protection clause in the state constitution.

West Virginia

This week, the West Virginia legislature approved an abortion ban which only allows the procedure in cases of medical emergencies, rape, and incest. The bill now heads to the desk of Gov. Jim Justice (R), who called a special session of the legislature in July to “clarify and modernize” the state’s abortion laws in the aftermath of the Supreme Court overturning Roe v. Wade.