Hi, good morning. Yesterday was a no bones day. And we want to know what that means for today's prospects of an agreement on Biden's economic package. 

FDA advisers backed the first coronavirus shot for kids, and health care remains a sticking point in the social spending bill. But first:

Deborah Birx's pandemic tell-all

Deborah Birx believes more than 130,000 American lives could have been saved if the Trump administration had championed key public health tools to mitigate the coronavirus's spread.

In a closed-door interview with congressional investigators, the former White House coronavirus coordinator painted a portrait of an administration “distracted” by last year’s election and caught between top advisers advocating for wildly different responses to a raging pandemic, The Post’s Dan Diamond reports. 

Birx’s account comes amid the first wave of books detailing Trump’s coronavirus response, essentially serving as the first drafts of history on a pandemic that’s led to over 737,000 U.S. deaths. Democrats immediately seized on her comments, alleging they showcased last year’s “failures.”

  • In a pointed question, investigators asked if Birx believed Trump “did everything he could” to stop the virus and save lives. “No,” Birx replied, according to interview excerpts released by the House select subcommittee on the pandemic. “And I’ve said that to the White House in general, and I believe I was very clear to the president in specifics of what I needed him to do.”

Here are three key takeaways:

1. The election took the White House’s time away from the pandemic response, Birx says.

In a televised interview earlier this year, Birx said the “worst possible time” for a pandemic to strike is during a presidential election year. When pressed by congressional investigators, Birx elaborated on those comments, saying the campaign “distracted” officials inside the administration.

  • “That was my feeling, that they were actively campaigning and not as present in the White House as previously,” she said, adding the administration wasn't convening frequent coronavirus meetings.

The view from Trump: A spokesperson praised the former president’s response, and instead laid blame on the Biden administration. 

  • “President Trump led an unprecedented effort to successfully combat the coronavirus, delivering PPE, hospital beds, treatments, and three vaccines in record time,” spokeswoman Liz Harrington said in a statement to Dan.

2. Birx wanted nothing to do with Scott Atlas. 

Last year, Atlas — a Stanford University radiologist with no prior infectious-disease experience — joined the Trump administration for a 130-day detail as a pandemic adviser. For several months, he was the only medical adviser the president met with regularly.

Birx refused to be in meetings with Atlas. The two had a well-known, acrimonious feud, and during her tenure, she told Vice President Mike Pence’s office she didn’t believe Atlas was giving Trump sound advice.

In her interviews with investigators, she said he used “partial data” to support his theory that some Americans should deliberately get infected with the coronavirus so the population can reach “herd immunity” — the point when the virus has infected so many people it can’t easily spread.

  • “I was concerned about giving credence to his positions in forums where the majority of the people in the room were not epidemiologists, not infectious-disease experts, and may misinterpret his statements,” Birx said. “And so I made it clear that I would not attend meetings where he would be present kind of to create a line in the sand.”

The view from Atlas: He disputed Birx’s portrayal, arguing in a statement to Dan that he “never advised the President, the Task Force, or anyone else while in Washington to allow the virus to spread.”

3. Tens of thousands of coronavirus deaths could have been prevented.

That’s according to Birx, who contended the administration failed to heed her recommendations to curb the pandemic. 

By the numbers: Birx said she analyzed data from states with more robust mitigation measures, concluding there was between a 10 to 15 percent increase in fatalities without a mask mandate. Couple such a requirement with a reduction of indoor dining and gatherings with friends — as well as increased testing — then the U.S. could have decreased fatalities by roughly 30 to 40 percent.

  • To Birx, roughly one-third of the 400,000 deaths after the first wave could have been prevented “with optimal mitigation across this country” — a case she claimed she’d been making for months.

Coronavirus

FDA advisers back a Pfizer vaccine for kids ages 5 to 11

A coronavirus shot for children cleared another hurdle yesterday. 

The Food and Drug Administration’s panel of experts voted 17 to 0 — with one person abstaining — to recommend emergency authorization of the vaccine for the 28 million children between 5 and 11 years old, The Post’s Laurie McGinley and Katie Shepherd report.

While the group’s opinion is advisory, its vote all but guarantees that the FDA will greenlight the vaccine, possibly as soon as this week.

Advisers debated whether the benefits of the shot outweighed the risks, including the fact that the vaccine has been linked to rare cases of heart inflammation. Some advisers expressed discomfort about making the decision without more information.

  • How to get to yes: “I think I know enough to move forward with the yes vote, but, you know, it’s always never when you know everything, it’s when do you know enough?” Paul A. Offit, a vaccine expert at Children’s Hospital of Philadelphia.
  • Who needs the shot? Some members of the committee questioned whether all children needed the vaccine or just those with underlying medical conditions. Michael G. Kurilla, an infectious-diseases expert at the National Institutes of Health who abstained from voting, suggested that many kids would be fine with a single dose of the vaccine and those who’ve had prior covid infections “may not need anything more.”
  • To mandate or not to mandate: A few advisers voted in favor of authorization but expressed that it would be premature to make the vaccine mandatory in schools until more data is available. Peter Marks, a top FDA official, sought to reassure them, claiming that “in general people have not done mandates with emergency use authorization.”

Meanwhile, some parents are anxiously awaiting rushing their child out to get the vaccine. But others are taking a more cautious approach — and it’s falling on trusted messengers to help sort through the litany of questions they may have.

“You don't make them feel like you're pushing it on them. If you answer their questions and keep the doors open, so that hopefully, they'll come back in and want the vaccine,”  Sally Goza, the immediate past president of the American Academy of Pediatrics who works outside of Atlanta, told The Health 202.

On the Hill

Health-care provisions are a major sticking point for reconciliation

Democrats in Congress are fast-approaching their self-imposed goal for clinching a deal before Biden goes overseas Thursday. While leadership has expressed optimism that a final deal is imminent, lawmakers are still in the middle of hashing out key details.

Three major sticking points include expanding Medicare, lowering prescription drug prices and extending Medicaid to those in states that didn’t take up Obamacare’s expansion. 

Sen. Joe Manchin (D-W.Va.), whose opposition to the Democrats’ original $3.5 trillion proposal has pushed lawmakers to cut the size of the bill drastically, told reporters Monday that he sees Medicare expansion as fiscally irresponsible.

On the other side, Sen. Bernie Sanders (I-Vt.) has doubled-down on his desire for Medicare expansion and drug price reform. 

  • “A serious reconciliation bill must include expanding Medicare to cover dental, hearing aids and eyeglasses,” Sanders told reporters yesterday, without acknowledging whether it is a red line for him, our colleague Tony Romm reports.

While keeping her powder dry publicly, Sen. Kyrsten Sinema (D-Ariz.) has been critical of Democrats’ efforts to empower the federal government to negotiate drug prices. Both Sinema and Manchin went to the White House Tuesday night.

Two Democratic senators are raising doubts over Biden’s prospective FDA pick

President Biden is widely rumored to be closing in on former Food and Drug Administration commissioner Robert Califf to lead the agency again. 

After the news broke earlier this month, Sen. Richard Blumenthal (D-Conn.) was the only senator who immediately publicized concerns. But at least one other is now vocalizing opposition to Califf — and both are lawmakers who opposed his confirmation to the top FDA slot in 2016 over his approach to regulating opioids, Stat's Nicholas Florko reports.

  • “Right now, I would be counted as an opponent,” Blumenthal told Stat — a position that remains unchanged since the senator cited concerns earlier this month to The Health 202.
  • “That’s a problem,” Manchin said. He would not say whether he would vote against a potential nomination.
  • Sanders, who also vocally opposed Califf’s nomination in 2016, declined to comment.

But the nomination isn't tanked: The criticisms suggest Biden may have to rely on Republican support if he picks Califf, who received nearly unanimous GOP support in 2016. 

In other health news

  • Merck's experimental covid pill could be broadly available in low- and middle-income countries. The drug maker agreed to share its license with a nonprofit, making it possible to manufacture it around the world, if authorized, The Post's Adam Taylor and Claire Parker report.
  • Facebook was slow to curb vaccine misinformation. In March, company researchers found they could curtail misleading information about coronavirus vaccines by changing how the posts were ranked in users’ news feeds, The Associated Press’s David Klepper and Amanda Seitz report. But the company shelved some recommendations for a fix and didn’t make others until April.
  • Congress is seemingly falling behind on a bipartisan effort to prepare for the next pandemic. Senate health committee chair Patty Murray (D-Wash.) and ranking member Richard Burr (R-N.C.) had hoped to hammer out a draft of their priorities for the legislation this summer, but that may not be ready until later this year or early next, Stat’s Rachel Cohrs reports.

Sugar rush

Thanks for reading! See y'all tomorrow.