This Week in Congress

U.S. House of Representatives

The House is in recess until September 13. However, they are expected to return sometime during that recess period to vote on the reconciliation bill once it is passed by the Senate.
Reconciliation: Senate Democrats are optimistic about the passage of their health care, climate, and tax package before the Senate August recess. Majority Leader Schumer, D-N.Y., said he’s expecting a vote on the motion to proceed to the bill reconciliation bill (HR 5376) on August 6. Once Democrats secure the votes to move forward with the legislation, there will be 20 hours of debate before the “vote-a-rama,” when senators can offer unlimited amendments and motions to delay the process. It is expected that final passage won’t take place until Sunday or early next week.

Veterans Health

This week, by a vote of 86-11, the Senate passed and sent to the President legislation (S 3373) that would make servicemembers who contracted any of 23 conditions after being deployed to Iraq, Afghanistan and other combat zones automatically eligible for VA benefits. The road to final passage was cleared after Democrats agreed to allow a vote on an amendment offered by Senator Toomey that was designed to foreclose the possibility of what he called “a massive unrelated spending binge” by Democrats. Toomey and other conservatives had raised objections to the bill because it would reclassify nearly $400 billion in current-law VA spending from discretionary to mandatory accounts. Toomey’s amendment was rejected, 47-48, with Sen. Susan Collins, R-Maine, the sole GOP “no” vote. The amendment required 60 votes for passage.

Other Legislation and Happenings Around the Nation

COVID-19

COVID-19 deaths have remained steady since May at about 400 a day according to Johns Hopkins University data. The proportion of the more transmissible BA.5 Omicron subvariant continued to increase in the US last week, rising to 85.5% of sequenced samples, up from 81.6% the week before.

Monkeypox

Statistics: In the last week of July, the US saw the largest spike in cases, according to the World Health Organization (WHO). All told, 83 countries have reported 23,351 laboratory-confirmed cases. Together, 10 countries account for 89% of the world’s cases, including the United States (more than 6,600), Spain (4,298), Germany (2,677), the United Kingdom (2,546), France (1,955), Brazil (1,369), the Netherlands (879), Canada (803), Portugal (633), and Italy (479).

HHS Declares Monkeypox an Emergency: This week, the Biden Administration declared monkeypox a public health emergency. HHS Secretary Becerra stated that the declaration will help mobilize more resources to fight the outbreak, which has spread across the US since the first reported case in May. The WHO declared monkeypox a global health emergency last month. The US has distributed more than 600,000 vaccine doses and has ramped up testing, but lawmakers and local communities have criticized the pace of the response. The U.S. makes up 25% of confirmed infections worldwide. The largest outbreaks in the US are in New York, California, Illinois, Florida, Georgia, Texas, and the District of Columbia. In the past few weeks, New York, Illinois, and California declared state emergencies. Public health officials are concerned that the virus could start to spread more within households across the broader population as infections rise. Though physical contact during sex is currently the primary mode of transmission, people can get infected through hugging, kissing, contaminated towels and bedsheets, and through respiratory droplets. CDC officials do not believe monkeypox is spreading through small aerosol particles like Covid.

Vaccines: HHS has made 786,000 vaccine doses available for local authorities to start ordering this week. The U.S. has ordered more than 5 million additional doses with deliveries scheduled through the middle of 2023. Another 11.1 million doses are in bulk storage in Denmark. However, filling vials for administration will require additional funding from Congress, according to HHS. The U.S. also has more than 100 million doses of an older generation smallpox vaccine, called ACAM2000 that is likely effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for those with weak immune systems such as HIV patients, pregnant women, and people with eczema and similar skin conditions.
FDA Commissioner Califf said regulators are reviewing an approach that would stretch the current vaccine supplies by allowing health professionals to vaccinate up to five people, instead of one, with each vial of the Jynneos vaccine. Under this so-called “dose-sparing” approach, physicians and others would use a shallower injection under the skin, instead of the subcutaneous injection currently recommended in the vaccine’s labeling. Califf said a decision authorizing that approach could come “within days.” That would require another declaration, to allow the government to alter its guidelines on how to administer the vaccine. Health officials pointed to a study published in 2015 that found that Jynneos vaccine administered that way was as effective at stimulating the immune system as when the needle plunged deeper into other tissue. But experts also have acknowledged they are still gathering information on how well the conventional administration of one or two full doses works against the outbreak.”
David Harvey, NCSD Executive Director stated that “If there is evidence for the effectiveness of that, then that would be a strategy to stretch available vaccine. Still, he said, men who have sex with men “deserve” to have “the best regimen of vaccine possible. Shortages are just not acceptable,” he added. “Anything less than full effectiveness of vaccine doses treats gay and bi men and MSM [men who have sex with men] as second-class citizens.”

Coordinator: The White House named Robert J. Fenton Jr. as coordinator of the nation’s monkeypox response amid a surging epidemic. Mr. Fenton is a regional administrator for the Federal Emergency Management Agency, where he has worked since 1996. Fenton helped oversee the Biden administration’s efforts to set up coronavirus vaccination sites. The White House also named Demetre Daskalakis, a senior official at the CDC, as a top deputy for Fenton.

Pain Management: CDC Director Walensky, sent a letter to healthcare providers seeking feedback from surgeons and other physicians to inform optimal approaches for pain management. “To this end, CDC encourages providers and researchers to document and report the patient pain experience to determine the incidence of pain, predictive factors for developing pain, and successful methods of pain control associated with monkeypox,” wrote Dr. Walensky. The chief medical officer for the CDC Monkeypox Response, Dr. John Brooke, recently delivered a presentation summarizing what clinicians need to know about monkeypox to the Council of Medical Specialty Societies. The slide presentation can be found here:

Letters:
Senators Feinstein and Padilla: Amid a concerning spike in monkeypox cases in California, Senators Feinstein and Alex Padilla (both D-Calif.) sent a letter HHS Secretary Becerra urging him to provide at least 600,000 additional doses of the monkeypox vaccine to California. The state currently has the second highest positivity rate in the country. The Senators are urging that California receive a proportionate amount of doses that will be available in order to match the severity of the outbreak in the state. The letter can be found here.

Senator Blunt: Senator Blunt (R-Mo.), the top Republican on the Senate Appropriations LHHS Subcommittee, sent a letter to HHS Secretary Becerra demanding answers about the Administration’s monkeypox response plans. Blunt criticized the administration’s partisan approach and lack of transparency with regard to the information that has been shared with Congress on this issue. “As the number of confirmed cases of monkeypox in the U.S. steadily climbs, my appropriations staff has tracked and monitored the U.S. response, regularly asking the HHS for cost estimates and projected resource needs for the U.S. response. HHS has not provided a plan of action, cost estimates, or a supplemental funding request in response to these inquiries.” The letter can be found here.

Senate Gillibrand: This week, Senators Gillibrand (D-NY), Murphy (D-CT), Blumenthal (D-CT), Sanders (I-VT), Wyden (D-OR), Van Hollen (D-MD), Leahy (D-VT), Booker (D-NJ), and Heinrich (D-NM). sent a letter to President Biden requesting that he invoke the Defense Production Act to increase the production of vaccines that target the monkeypox virus to halt the spread of a disease representing a public health emergency of international concern. The letter can be found here.

Abortion

This week President Biden signed an executive order that lays the groundwork for Medicaid to help women seeking abortions to travel between states to obtain access to the procedure. The order will face legal challenges because Federal funding is prohibited to pay for abortions unless the woman’s life is in danger, or the pregnancy is the result of rape or incest. However, according to the White House, the executive order will invite states where abortion remains legal to apply for permission to use Medicaid funds to “provide reproductive healthcare to women who live in states where abortion is banned.” Crossing state lines to get abortions has become an increasing issue since the Supreme Court overturned Roe v. Wade and opened the door for new restrictions on abortion at the state level. Biden’s order also calls on health care providers to comply with federal nondiscrimination laws and streamline the collection of key data and information on maternal health at the NIH and the CDC. Biden described the court’s decision on abortion as a “health care crisis,” and he said he wants to make sure “every part of the federal government does its part at this critical moment where women’s health and lives are on the line.” The new order falls short of what many Democratic lawmakers and abortion advocacy groups have demanded of the Biden administration. One chief ask has been for Biden to declare a public health emergency on abortion, which White House officials have said would do little to free up federal resources or activate new legal authorities.