The warring emergencies in America- POLITICO

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— Lawmakers have begun HHS budget battles with debates over which crises to prioritize.

— Moderna is filing its vaccine for children under 6 today with more data expected next week.

— The vice president’s Paxlovid prescription shines a light on potential barriers for average Americans.

WELCOME TO THURSDAY PULSE — Most Americans don’t get enough exercise; The Atlantic’s Amanda Mull says a new approach to teaching fitness could help that. Send news, tips and favorite workouts to [email protected] and [email protected].

WHAT MAKES AN EMERGENCY? The word “emergency” was uttered at least 35 times in a Wednesday hearing on the Health and Human Services’ proposed budget. Lawmakers and HHS Secretary Xavier Becerra used it to describe the coronavirus pandemic, the U.S.-Mexico border, mental health care, climate change and more — with very little agreement on what constituted the most urgent crisis and the agency’s top job.

Of course, there is Covid-19, which chief medical adviser Anthony Fauci said on Tuesday was past the pandemic phase, only to be contradicted by Becerra during the hearing. “We’re still in a condition of pandemic [with] much better circumstances than we previously had found ourselves,” the health secretary told lawmakers.

Administration officials sought to smooth over the disconnect Wednesday even as Fauci underscored his view with a Washington Post interview.

“What Dr. Fauci was saying is that we are in a different phase of this pandemic, and that’s actually true,” White House Press Secretary Jen Psaki told reporters. “There’s no question that we are in a different moment in our fight against Covid, but we also note Covid isn’t over and the pandemic isn’t over.”

The discrepancy comes at a critical time for pandemic response funding, with Biden officials insisting they need billions soon to continue buying treatments, vaccines and tests, plus $82 billion to control the crisis in the next year.

But Republicans pitted the Covid funding asks against border control, questioning why the health agency would end Title 42, a Trump-era public health order expelling migrants at the border when it hasn’t ended the public health emergency used to justify the controversial measure.

Becerra didn’t find much relief from Democrats, some of whom appeared nervous about the health risks of a migration influx when the measure ends May 23.

“It’s important as secretary of HHS to have a plan if, in fact, Title 42 is lifted,” E&C health subcommittee Chair Anna Eshoo (D-Calif.) said. “You have a responsibility to plan … so that there is not any public health disaster relative to those at the border.”

Then there’s climate change vs. everything else. Subcommittee ranking member Brett Guthrie (R-Ky.) said the 174-page budget proposal “mentions climate change more than fentanyl,” evidence of an increasingly “politicized” health department.

That’s not quite a fair yardstick — HHS is asking for $3 million to start its climate change office and $110 million to study climate change’s impact, compared to $11.4 billion to combat the addiction crisis — but it shows the partisan tension over the Biden administration’s priorities, let alone the definition of a health emergency.

“Do you intend to declare the climate a public health emergency?” Utah Republican John Curtis asked Becerra after pointing out that it would receive more funding than nutrition research in the proposed budget.

“I think most people recognize that climate change has already become an emergency,” Becerra answered.

MODERNA FILES UNDER-6 EUA TODAY — Moderna is expected to formally ask the Food and Drug Administration to authorize its Covid-19 vaccine for children under age 6, three people with knowledge of the matter told POLITICO late Wednesday.

The request comes amid growing impatience from lawmakers and parents for the administration to greenlight a vaccine for the nation’s youngest children.

But Moderna still needs to send final datasets to the agency, which two people with knowledge of the matter said it likely won’t submit until May 4. The FDA has also committed to holding a meeting of its outside advisory committee before authorizing any vaccines for young children.

The Food and Drug Administration and Moderna declined to comment.

The filing is likely to ratchet up pressure on the FDA over its timeline for authorizing the vaccine. In the wake of intense scrutiny over officials’ initial suggestions, they may hold off on a verdict until drug company Pfizer seeks authorization for a competing shot.

“Let me be very clear; being thorough absolutely does not mean we are delaying review of these vaccines,” Marks said in a video posted by the FDA on Tuesday, emphasizing the importance of ensuring that parents can trust any authorized vaccines. “We’re going to move with all expediency without sacrificing our standards to complete our evaluations.”

WHY THE VP HAS A PAXLOVID ’SCRIP — News late last night that 57-year-old Vice President Kamala Harris is taking coronavirus antiviral Paxlovid surprised some public health experts who pointed to her asymptomatic status and relatively younger age compared with vulnerable seniors.

Her speedy access sharply contrasts with the rest of the country’s ability to get it. The sheer logistics of finagling a prescription and then finding the pills within days of symptom onset has complicated the drug’s rollout after it was first authorized in December, our Lauren Gardner wrote in West Wing Playbook with Alex Thompson and Max Tani.

That doesn’t mean the VP should be denied access, though. Céline Gounder, for one, doesn’t think it’s unreasonable. The infectious disease specialist and epidemiologist, who’s also editor-at-large for public health at Kaiser Health News, said, “We know that the way that presidents, or in this case vice presidents, are treated is not necessarily the way the average person is treated,” added Gounder, who advised the Biden transition on Covid-19. “It’s not just about what is best for that patient — it’s about what’s best for the nation.”

The Food and Drug Administration has authorized the pill for people “at high risk for progression to severe COVID-19,” which, according to the CDC, includes people over the age of 60, though people in their 50s are still at risk.

Mostly this shines light on ongoing challenges. Only doctors, physician assistants and certain registered nurses — not pharmacists — can prescribe the drug. That means patients may have to visit a testing site, a doctor’s office or a participating pharmacy just to get the pills.

100M FIRST BOOSTS — Approximately 100 million Americans have received at least one booster dose of a Covid-19 vaccine, HHS announced this morning.

The backdrop: But that still amounts to less than a third of the U.S. population who have been boosted since the CDC first recommended an additional dose for certain populations six months ago. Health officials have acknowledged that booster uptake has been slow compared with initial vaccinations, although older and more vulnerable Americans seem more likely to get boosted.

“Today, more than 257 million Americans have received at least one dose of a COVID-19 vaccine, two-thirds of adults over the age of 65 have gotten a booster shot,” Becerra said in a statement. “We’ve also closed the glaring gap in vaccine rates we usually see for communities often left behind.”

Last May, 63 percent of eligible white Americans had received their first shot compared with nearly 54 percent of Hispanic and Latino and 53 percent of Black Americans. As of March of this year, the first-shot rates are 85 percent, 87 percent and 86 percent, respectively.

FOXX HEADS INSURANCE ROUNDTABLE —  Education and Labor Committee Republican Leader Virginia Foxx (R-N.C.) hosts a roundtable this morning with party members and industry representatives to discuss employer-sponsored insurance. Panelists include America’s Health Insurance Plans’ Jeanette Thornton, National Federation of Independent Business’ Mitch Relfe and Council for Affordable Health Coverage’s Joel White.

Foxx has been an outspoken critic of the Biden administration’s insurance policies such as the recent family glitch fix, arguing the administration is “usurping” congressional authority and pushing more people on “government-controlled insurance.”

DEMS REIGNITE MEDICAID EXPANSION EFFORT — Rep. Carolyn Bourdeaux (D-Ga.) and Sen. Raphael Warnock (D-Ga.) on Wednesday relaunched an effort to include Medicaid expansion in the reconciliation package.

Twelve states — largely in the South and Midwest, including Georgia — haven’t expanded Medicaid to make more low-income citizens eligible despite federal promises to fund initial expansion. The most recent incentive passed with coronavirus aid would cover 90 percent of costs.

Bourdeaux and Warnock, joined by 29 other lawmakers mostly from nonexpansion states, penned a letter to House and Senate leadership about the stakes. The Medicaid gap “results in preventable suffering, death, and tragedy, and the costs of care when it’s too late are inevitably born by the public,” they wrote. “It is bad public health policy and it is bad fiscal policy.”

Andy Sekel joins mental health nonprofit Project Healthy Minds as a board member this week. Sekel is a managing partner at Marketplace Funds and the former CEO of UnitedHealth’s Optum Specialty Networks.

China has reported the first human case of the fast-spreading H3N8 avian flu, which has also spread in U.S. bird populations, Reuters’ Domonique Patton reports.

Canadian health officials are investigating a severe hepatitis “of unknown origin” among children, which experts say has affected nearly 200 kids worldwide, CBC’s Lauren Pelley writes.

McKinsey’s chief executive officer acknowledged the company failed to see the “broader context” of the opioid epidemic as consultants worked with both Purdue Pharma and the FDA, Bloomberg’s Matthew Boyle writes.