THE PROGNOSIS

Partisan fights over ensuring a future coronavirus vaccine is affordable for Americans nearly derailed Washington's newly struck deal to combat the coronavirus.

Yet affordability hasn't been a problem in previous epidemics — and it's unlikely to be a problem this time around.

The federal government has a long-standing authority and pathway to work with industry to develop vaccines, diagnostic tests and other measures to counter the threat of a pandemic influenza. Through the Biomedical Advanced Research and Development Authority, or BARDA, the Department of Health and Human Services can partner with drug companies on developing a vaccine and, once it's ready, typically distribute the vaccine to Americans without charging out-of-pocket costs.

That's what happened in the 2009 H1N1 epidemic, when the same companies that make seasonal flu shots developed a vaccine that was then made widely available. For this novel coronavirus, Janssen Pharmaceuticals and Sanofi are contracting with BARDA to share research and development costs and develop a bank of potential vaccine candidates.

“With pandemic vaccines, [affordability] has never been a problem,” Sen. Roy Blunt (R-Mo.) told CQ Roll Call last week. “They’re usually developed with a lot of government assistance, and there’s no example of a pandemic vaccine that wasn’t affordable. … And that’s what will happen again this time.”   

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Yet Democrats made vaccine affordability a flash point as lawmakers and aides worked around the clock to reach consensus on an $8.3 billion emergency spending bill that could reach President Trump's desk by the end of the week.

Democrats in the House and the Senate urged the administration last week to ensure any funding bill guarantees vaccines are affordable for those who need them. They seized on comments by HHS Secretary Alex Azar, who brought political fire on himself by refusing to guarantee that a vaccine would be affordable for everyone.

We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” Azar told the House Energy and Commerce Committee. “Price controls won’t get us there.”

Azar's comments — puzzling to many — nonetheless reflect the building tensions in Washington over lowering drug prices. Democrats seized the opportunity to blame inaction on high drug prices on Republicans, who in turn felt their opponents were picking a fight better saved for once the coronavirus crisis has passed.

In an interview with Fox News's Sean Hannity last night, Trump said Democrats “weaponize” the virus against his administration although he later added the criticism has gotten “50 percent less” lately.

The fight over vaccine affordability won't be practically relevant for months. Officials say a vaccine won't be ready for at least a year or more — until after the epidemic is likely to have lessened or subsided.

Yet as both sides negotiated over a coronavirus funding package, late-stage talks got hung up over language Democrats sought to include to address vaccine affordability and differences over the total level of funding. 

There were concerns the deal wouldn't get done, per The Washington Post's Erica Werner, tweeting yesterday morning:

But Congress managed to reach a consensus. The House overwhelmingly approved the measure yesterday, 415 to 2, sending it to the Senate, where GOP leaders hope to bring it up today

“President Trump is expected to sign the legislation, which is more than triple the size of the White House’s budget request from last week,” my Post colleagues Erica Werner and Mike DeBonis report. “It sends billions to address nearly every aspect of the outbreak, from vaccine research and development, to support for state and local public health agencies, to medical supplies and preparation at home and abroad.”

“Congress is acting with the seriousness and sense of urgency the coronavirus threat demands,” House Appropriations Committee Chairwoman Nita M. Lowey (D-N.Y.) said during the floor debate ahead of the vote. “While we all ardently hope that this public health emergency does not worsen, House Democrats will not hesitate to act again if we must augment this funding with more resources.”

Some members might be taking the coronavirus too seriously. Per Politico's John Bresnahan:

Rep. Jim Himes (D-Conn.):

Per Erica and Mike, the package includes: 

  • More than $3 billion for research and development on vaccines, therapeutics and other treatments.
  • $2.2 billion for the Centers for Disease Control and Prevention to support the response from federal, state and local public health agencies, including for lab testing and infection control.
  • Close to $1 billion for medical supplies, health-care preparedness and community health centers, among other things.
  • $1 billion in loan subsidies for small businesses, to enable the Small Business Administration to provide $7 billion in low-interest loans for companies affected by the outbreak.
  • Some 85 percent of the money in the bill would be spent domestically, but there is also $1.25 billion for the State Department to assist in battling the spread of the coronavirus overseas.

— Last night Trump questioned the 3.4 percent global death rate reported by the World Health Organization, in his interview with Hannity. That prompted another round of criticisms that the president doesn't understand the virus, even as he navigates the U.S. response to it.

“I think the 3.4 percent is really a false number,” Trump said. "Now, this is just my hunch, and -- but based on a lot of conversations with a lot of people that do this, because a lot of people will have this, and it's very mild. They will get better very rapidly. They don't even see a doctor. They don't even call a doctor. You never hear about those people.

“So, you can't put them down in the category of the overall population in terms of this corona flu…you just can't do that.”

The president also said he “never knew” the seasonal flu kills tens of thousands of people every year. 

The Post's Aaron Blake:

Vox's Aaron Rupar:

CNN’s Daniel Dale:

Former congressman Joe Walsh (R-Ill.), who recently ended a primary campaign against Trump:

Rep. Ted Lieu (D-Calif.):

Pence said the aim is to have coronavirus testing available for anyone who wants it:

— The outbreak is revealing serious gaps in the U.S. health system’s ability to respond to a major epidemic, forcing hospitals and doctors to update and improvise emergency plans on a daily basis even as they remain uncertain how bad the crisis will get, The Post's Christopher Rowland and Peter Whoriskey report.

“Nursing homes are emerging as especially vulnerable to the virus, with more than a million residents, many of them frail, and many facilities with a history of struggling to contain even mundane infections,” they write. “But the gaps are spread out across the country and affect medical facilities of all types.”

  • Doctors in Rhode Island were testing patients with mild symptoms in a hospital parking lot rather than allowing them to enter the emergency room.
  • Officials in Washington state's King County said this week they are purchasing a motel to house patients in isolation.
  • In rural areas of Texas, small hospitals do not have test kits, and central labs for testing samples are hours away.

— Post Style writers Maura Judkis and Avi Selk explore how coronavirus has already touched everyday life.

“America this week began to consider the existential threat of a doorknob,” they write. “The horror of a touch-screen in the self-checkout lane. The inescapable doom that accompanies any trip on public transportation. The realization of how much, exactly, we all touch our faces each day: constantly … The coronavirus … has already transformed our personal worlds. A subway pole is now a t. An itchy eye is a trap. A cough is a harbinger."

President Trump claimed he hasn't touched his face “in weeks:"

AHH, OOF and OUCH

AHH: Chief Justice John G. Roberts Jr. and Justice Brett M. Kavanaugh probably will be key to the outcome of a Supreme Court case involving a Louisiana abortion restriction, our Post colleagues Robert Barnes and Ann E. Marimow report.

In oral arguments yesterday, Roberts asked a variation of the same question at least three times: Should the court undertake a fact-dependent, state-by-state review when examining a law’s restrictions? “He did not indicate that he had made up his mind on the question,” Robert and Ann write.

It's the first major abortion rights case facing the court since Trump appointed two justices to the bench. The law in question requires physicians at abortion clinics to have admitting privileges at nearby hospitals to perform the procedure. Providers have warned the law could force two of the state’s three abortion clinics to close. 

There’s also a question of precedent. The law is nearly identical to a Texas law the Supreme Court struck down in 2016. 

“The justices’ examination of the Louisiana law could be momentous if it signaled that the court was ready to revisit past decisions,” our colleagues write. “And whatever it decides before the end of June will come in the midst of a heated presidential election in which Democrats have made abortion rights a priority and President Trump has said his ultimate goal is to overturn Roe v. Wade. ”

— Senate Majority Leader Charles E. Schumer appeared to threaten conservative Justices Kavanaugh and Neil M. Gorsuch as the court heard oral arguments — earning a rare rebuke from Chief Justice John Roberts, Robert and Colby Itkowitz write. 

Speaking at a rally, Schumer said this: “I want to tell you, Gorsuch; I want to tell you Kavanaugh: You have released the whirlwind, and you will pay the price. You won’t know what hit you if you go forward with these awful decisions.”

Roberts in turn scolded Schumer. “Justices know that criticism comes with the territory, but threatening statements of this sort from the highest levels of government are not only inappropriate, they are dangerous,” Roberts said in a statement. “All Members of the Court will continue to do their job, without fear or favor, from whatever quarter. ”

OOF: New House and Senate bills would ban the practice of using confidential therapy notes against immigrant children in detention and during deportation proceedings, our Post colleague Hannah Dreier reports. 

The action from Congress follows a stunning report from Hannah about Immigration and Customs Enforcement’s frequent practice of using therapy session notes against unaccompanied minors.

“Intimate confessions, early traumas, half-remembered nightmares — all have been turned into prosecutorial weapons, often without the consent of the therapists involved, and always without the consent of the minors themselves, in hearings where the stakes can be life and death,” Hannah wrote.

Forty-one national organizations have urged Congress to hold oversight hearings on the practice. The American Psychological Association said the practice constituted an “appalling” breach of privacy, and wrote to HHS and ICE calling it “a violation of broadly accepted mental health ethical standards.’” 

OUCH: The Trump administration’s changes to the food stamp program have sent some states scrambling to try to mitigate the impact on their residents. 

About 700,000 people may lose their benefits unless they adhere to work, training or school requirements, and social service agencies warn they won’t be able to help address any gap in resources, the Associated Press’s Sophia Tareen reports. 

“Currently, work-eligible, able-bodied adults without dependents under 50 can receive monthly benefits if they meet a 20-hour weekly work, job training or school requirement. Those who don’t are limited to three months of food stamps over three years. However, states with high unemployment or few jobs have been able to waive time limits,” she writes. “Every state except Delaware has sought a waiver at some point, according to the National Conference of State Legislatures. The new rules make it harder to get waivers.”

In Pennsylvania, for example, where up to 100,000 people could be impacted by the changes, the state is “working with social services groups to create 30 job training programs for SNAP recipients.”

In Hawaii, officials are looking to “develop a pilot program to help 400 Molokai residents keep benefits. The rural island once had a waiver because of high unemployment, but the new rules assign Molokai to the same job market as nearby, more prosperous Maui, even though a 30-minute plane ride is the only way to travel between the islands.” 

— And here are a few more good reads:

HEALTH ON THE HILL

Politics
As Elizabeth Warren weighs dropping out of the race, her allies and those of Bernie Sanders are discussing ways for her to depart in a graceful way that also helps him.
Annie Linskey and Sean Sullivan
Medicare-for-all keeps outperforming Bernie Sanders with Dem primary voters.
Vox
Jessica Cisneros, who had been backed by Rep. Alexandria Ocasio-Cortez and other progressives, lost to incumbent Rep. Henry Cuellar, a conservative Democrat.
BuzzFeed News

STATE SCAN

A federal judge in Washington, D.C., has issued a summary judgment Michigan’s Medicaid work requirements, citing a higher court ruling involving other state.
MLive.com

AGENCY ALERT

Federal officials on Wednesday banned electrical shock devices used to discourage aggressive, self-harming behavior in patients with mental disabilities.
Associated Press

INDUSTRY RX

Emma Kleck’s trip to a Canadian strip mall pharmacy underscores the lengths to which people with diabetes will go to save on this lifesaving drug.
Stat
Even after accounting for rebates and discounts.
Axios

DAYBOOK

Today

  • The House Science, Space and Technology Committee holds a hearing on “Understanding the Spread of Infectious Diseases and Mobilizing Innovative Solutions." 
  • The House Appropriations subcommittee on defense holds a hearing on the Defense Health Program. 
  • The House Veterans’ Affairs subcommittee on technology modernization holds a hearing on the “Challenges with the Go-live of Electronic Health Record Modernization."

SUGAR RUSH