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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Experts hope for 60 to 80 percent of Americans vaccinated by year's end

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Good morning, and welcome to a wild week on the Hill. Our inboxes are open for tips. 📨 

Biden's massive social spending faces a huge test this week and the new booster guidelines are causing confusion. But first: 

Five experts weigh in on vaccination benchmarks

The country wants to know when the pandemic will end. 

Unfortunately, nobody really knows. President Biden’s strategy to stop the spread of the coronavirus relies on vaccinations, and he laid out a plan earlier this month to use the full power of the federal government to mandate shots. 

The Health 202 turned to five public health experts to predict the country’s vaccination rate by the end of this year and learn what activities they’re participating in in their daily lives. (The interviews have been edited for length and clarity.)

The Health 202: The U.S. has achieved roughly [55] percent of Americans fully vaccinated. What threshold do you think we can realistically get to by the end of the year given Biden's new vaccine requirements? 

Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security: “We are vaccinating at a fairly high rate now, so I think that we could possibly expect to be in the 60s in terms of percentage by that time (may be a little bit higher if an emergency use authorization for children between 5 and 11 is issued next month).” 

Joseph Allen, director of the healthy buildings program at Harvard T.H. Chan School of Public Health: “I don’t think it’s very useful to look at one number for the country as a whole and here’s why: We know two of the most important risk factors for covid are age and vaccination status, but this one number doesn’t capture the vast differences we see across the country. … We’re past the point where a one-size-fits-all approach works for the entire country.” 

Carlos del Rio, professor of medicine and global health at Emory University: “It all depends if the mandates are ruled as legal. If that is the case, another 50 million or so may be vaccinated, which will get us to close to 80 percent of the U.S. population vaccinated by December 31.” 

Shira Doron, infectious-disease physician at Tufts Medical Center: “It partly depends on when and whether the vaccine is approved for children, and what the uptake is. The White House has stated that the president's plan to mandate vaccines for workers in companies with at least 100 employees covers two-thirds of Americans. That should make a pretty big dent.

Monica Gandhi, professor of medicine who studies infectious diseases at the University of California San Francisco: “I am hoping we can get to at least 70 percent [fully] vaccinated by the end of the year with the expansion of vaccine mandates. That may be lofty, but countries with at least 70 percent vaccination rates hit by the delta variant did so much better than we in terms of severe illness.” 

The Health 202: In your own life, how do you decide what activities to participate in on a day-to-day basis? 

Adalja: “There is not a one-size-fits-all timeline. For me, since I’ve been fully vaccinated, I have returned to every pre-pandemic activity available.” 

Allen: “I’m vaccinated, in my mid-40s, and generally healthy, so I feel very comfortable getting back to the things I used to do before I was vaccinated: I’ve taken long flights, played indoor sports, worked in my office, had vaccinated friends over the house without masks, went to a family reunion, danced under the tent at an outdoor wedding."

Del Rio: “Life is much more normal now than what it was one year ago. I am still anxious going to restaurants for indoor dining and have not gone to a movie but have gone to a concert and to the U.S. Open and felt safe as, at the concert, everyone was vaccinated and masked, and at the U.S. Open everyone vaccinated.”  

Doron: “I live in a household where everyone is vaccinated and in very good health, so I choose my activities based on whether they bring meaning and joy to my life. I gather with friends and I eat indoors, but I avoid close interactions with strangers whose vaccination status I do not know. If I lived with someone elderly or otherwise vulnerable, I would make different choices.”

Gandhi: “I am not fearful of severe disease with my fully vaccinated status and have a high risk tolerance, but I want to avoid even mild breakthroughs as a health-care worker as I am around vulnerable patients. So, I avoided indoor dining during the delta surge in San Francisco until vaccine passports were established, and then I returned to indoor dining only then.”

DEA issues a warning about fentanyl-laced pills

Breaking this morning: The Drug Enforcement Administration has issued a public warning that a growing number of pain medications bought on the black market are laced with the synthetic opioid fentanyl or the stimulant methamphetamine, driving overdose deaths to record levels.

“We decided to do this because the amounts are staggering,” DEA Administrator Anne Milgram said in an interview with The Post's Devlin Barrett. “We are in the midst, in my view, of an overdose crisis, and the counterfeit pills are driving so much of it.”

“Officials said the DEA hasn’t issued such a public safety alert since 2015, when the agency warned that agents were seeing an alarming amount of heroin laced with fentanyl,” Devlin writes.

On the Hill

This week: Biden’s social spending bill faces a big test

House Speaker Nancy Pelosi (D-Calif.) wants her chamber to pass Biden’s $3.5 trillion package this week — and vote on a bipartisan infrastructure bill Thursday as well as fund the government. That sets up a frenetic week on the Hill, where Pelosi must work to assuage both the centrist and moderate wings of the party. 

The problem: It’s not clear that House leadership has the votes to pass the social spending bill the party wants to use to make major changes to the health-care system. 

  • Pelosi tried to project some confidence Sunday, The Post’s Tony Romm reports. But in the same breath, she told ABC News she doesn’t bring “a bill to the floor that doesn’t have the votes.”

This weekend: The House Budget Committee advanced the social spending bill, which includes measures to expand Medicare, extend Medicaid to over 2 million people and let Medicare negotiate drug prices. But in a sign of the difficulties to come, Rep. Scott Peters (D-Calif.) — who had previously registered concerns with the prescription drug pricing provisions — voted against it.

Three is the magic number: That's how many Democratic defections Pelosi can afford and still pass legislation out of her chamber (without any help from Republicans). 

Coronavirus

Inside the confusion on shifting booster shot eligibility 

Vaccinated patients and their doctors aren't clear about the latest booster guidelines after government advisers and regulators released a dizzying number of conflicting messages, The Post’s Carissa Wolf, Frances Stead Sellers, Ashley Cusick and Kim Mueller report.

Here’s what else you need to know

  • Pfizer CEO Albert Bourla said on ABC News’ “This Week” that the company would submit data on the coronavirus vaccine for kids to the FDA “pretty soon,” adding it was a “question of days, not weeks.”
  • Schools with mask mandates have fewer pediatric coronavirus cases and outbreaks than those without, The Post’s Moriah Balingit reports. 
  • New York Gov. Kathy Hochul is considering calling in the National Guard in anticipation of widespread staff shortages at hospitals and health-care facilities if workers don’t meet the state’s deadline for mandated vaccinations, the New York Times’s Víctor Manuel Ramos reports.
  • Black and Hispanic youth are more likely to have lost a family member to covid-19, fallen further behind in school and have higher unemployment rates. Young women of color are also more likely to take on care responsibilities at home — all of which has taken a psychological toll, the New York Times’s Alisha Haridasani Gupta reports.

Reproductive wars

House passes bill to codify Roe v. Wade

House Democrats on Sept. 24 attacked Texas’s restrictive abortion law ahead of passing legislation that would create a statutory right to abortion. (Video: Justin Scuiletti/The Washington Post)

But it won't become law, at least for now.

The House passed legislation Friday to prohibit restrictions on abortion services, amid an intensifying political and legal battle over the procedure, The Post’s Felicia Sonmez and Ann E. Marimow report. The Women’s Health Protection Act passed 218 to 211, largely along party lines. Rep. Henry Cuellar (Tex.) was the only Democrat to vote against the measure.

The vote was largely symbolic. That's because the bill faces an uphill battle in the upper chamber. All but two Democratic senators — Sens. Bob Casey (Pa.) and Joe Manchin (W.Va.) — have signed onto the measure. But it needs 60 votes to pass, and it’s unlikely to garner much GOP support.

Agency alert

CDC grapples with declining morale and widespread burnout

Centers for Disease Control and Prevention staff are reluctant to join the agency’s pandemic response team, citing record burnout and fatigue after playing a crucial role in the country’s response to the coronavirus pandemic for nearly two years, Politico’s Erin Banco reports. CDC Director Rochelle Walensky has tried to recruit additional staff to join the pandemic response team to fight the delta variant, to no avail.

“The reports of burnout highlight the extent to which the CDC is struggling to maintain productivity and morale at one of the most pivotal and confusing moments of the pandemic,” Erin writes. “They also raise questions about the agency’s ability to recruit qualified scientists and leaders to help handle the increased covid-19 workload that health experts say will come when Americans begin to gather indoors for the holidays, driving up new infections.”

Daybook

Happy Monday morning. Here’s what’s on tap this week:

  • On Wednesday, the CDC's Advisory Committee on Immunization Practices will meet to discuss vaccines, including those for TBE and hepatitis B.
  • Also on Wednesday: The Senate holds a hearing on Texas' abortion ban. On Thursday, the House Oversight and Reform Committee will discuss actions the federal government can take to protect abortion rights.
  • By Thursday, Pelosi wants lawmakers to vote on the $1 trillion bipartisan infrastructure bill. She also wants a vote this week on Biden's $3.5 trillion social spending bill.
  • Also on Thursday: HHS Secretary Xavier Becerra will appear before the Senate HELP Committee on school re-openings during the pandemic.
  • Government funding expires Sept. 30. But it's anybody's guess when Congress will clinch a deal.

Sugar rush

Thanks for reading! See y'all tomorrow.

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