‘It’s time’ for more vaccine mandates — Inside the breakdown of state VA homes — Pelosi seeks centrist deal for budget framework

From: POLITICO Pulse - Tuesday Aug 24,2021 02:03 pm

Aug 24, 2021

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Quick Fix

— President Joe Biden wants Pfizer’s vaccine approval to motivate more mandates and jump-start vaccination rates, but polls are unclear about the impact.

— The coronavirus pandemic exposed long-standing oversight struggles at state-run nursing homes for veterans after hundreds died of preventable causes, POLITICO found in a five-month investigation.

— House Speaker Nancy Pelosi floated a deal to get centrists on board with the multitrillion dollar infrastructure package containing key drug pricing legislation.

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Driving the Day

‘IT’S TIME’ FOR MORE VACCINE MANDATES — Biden Monday pleaded with public and private employers to use the first coronavirus vaccine approval as an impetus for vaccine requirements , the latest in the White House bid to jump-start immunization rates amid the Delta surge.

A moment of awe: The Pfizer-BioNTech vaccine was developed, launched and approved in a record 16 months and is the first-ever approved product using messenger RNA technology, opening the door for what could be a new vaccine and drug wave. Hundreds of millions of doses have been administered worldwide.

A moment of fear: Billions more are needed. Many low-income countries are still awaiting first batches, while the U.S. and others prepare for fall rounds of booster shots. The Delta variant’s spread means more people are hospitalized and already-vaccinated people are increasingly reporting breakthrough infections.

Eight months after the first Covid-19 shots were administered in America, the country is at a pivotal point to outrace the virus.

“The moment you’ve been waiting for is here.” That’s what Biden told millions of vaccine holdouts in his Monday remarks. But there’s a big question about how much this could move the needle. While 30 percent of skeptics told Kaiser Family Foundation in a recent poll they would be more likely to get an approved shot, two-thirds of respondents in the same poll said … they already thought the various vaccines were approved.

“It's an interesting experiment we're about to do,” said Paul Offit, a vaccine expert at the University of Pennsylvania and a member of the FDA's vaccine advisory panel. “In a more rational world, the full approval is not a giant leap from the emergency use authorization for the simple reason that we have an enormous amount of information on this vaccine that has been given to half of the American public.”

And a potential bright spot: Most Americans believe vaccine requirements are needed for the common good, according to a recent USA Today poll.

But what else does the government have? Biden mandated vaccinations or routine testing for millions of federal workers; some state governments, many health facilities and an increasing number of private corporations followed suit. Still other areas of the country — like Florida and Texas, where Republican governors already oppose mask mandates — could set up for an uneven reality in vaccination requirements and immunization itself.

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INSIDE THE VA’S STATE NURSING HOME DISASTER — For years, Veterans Affairs has spent upwards of $1 billion annually funding state-run nursing homes for veterans, while requiring only a single yearly safety inspection, Joanne Kenen, Allan James Vestal and Darius Tahir report.

The pandemic threw fresh light on a long-standing problem. More than 1,400 people — at least 1,394 residents and 40 staff — died after becoming infected with the coronavirus in 110 state veterans homes, according to a POLITICO analysis. The death toll is almost certainly even higher; data from another four dozen homes, mostly in the South, hasn’t been publicly reported even as those states contend now with the worse Delta variant.

Tragic, not inevitable. Residents often died in large clusters, like 110 people (and two staff) at a 126-bed home in western New York. More than half the overall deaths occurred well into the pandemic, after testing, protective gear and other resources became more available, and after much had been learned about how to contain the virus and prevent its devastating spread, including by infected staff with no symptoms.

Even though the VA moved in February to tighten up the annual inspections amid increasing scrutiny of Covid-19 deaths, the system remains dangerously decentralized, according to a five-month POLITICO investigation that included interviews with current and former state and federal officials, as well as people who had family members die after contracting Covid-19 in state homes.

“I know what the military can do when guys are pinned down, when guys are in a bad place, when guys are about to die,” said Todd Larkin, an Afghanistan vet whose great uncle Donald Hawkins, a Vietnam vet himself, died at an Oklahoma hospital in January. At his nursing home, Larkin said, “It was like no concern; these were old guys, dying anyway.”

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In Congress

PELOSI TRIES TO WOO MODERATES ON BUDGET FRAMEWORK — House Speaker Nancy Pelosi floated a deal to the leader of a centrist group of defectors that she hopes will end a party standoff and clear the way for the $3.5 trillion budget framework, Heather Caygle and Sarah Ferris report.

What is happening: Nine moderates led by Rep. Josh Gottheimer (D-N.J.) have vowed to tank the package —which the White House has touted as a winner on drug pricing legislation — if they don’t get a standalone vote on the infrastructure bill.

The details of Pelosi’s deal are still up in the air, but one element is a wonky maneuver that would wrap consideration of debate ground rules of and the budget resolution itself into one vote, instead of the original plan that required two votes to advance the spending plan, Heather and Sarah write.

Pelosi also suggested promising a vote on the infrastructure bill by Oct. 1, when current surface transportation programs expire.

She also wrote a letter over the weekend laying out her planned timeline, meant in part to appease the centrists. But she added that “any delay to passing the budget resolution threatens the timetable for delivering the historic progress and the transformative vision that Democrats share,” casting this week’s series of votes as a loyalty test to the president.

SENATORS PRESS FDA ON MCKINSEY AND OPIOID CRISIS — Sens. Maggie Hassan (D-N.H.), Chuck Grassley (R-Iowa) and Sheldon Whitehouse (D-R.I.) are asking the agency about potential conflicts of interest because the consulting firm simultaneously worked for the FDA and opioid manufacturers such as Purdue Pharma.

McKinsey earlier this year settled claims from 49 state attorneys general that it worked closely with Purdue to keep Oxycontin available to patients. The consulting firm also worked with Johnson & Johnson, Mallinckrodt, and Endo International over the years. The FDA first hired McKinsey in 2008 for a series of contracts, including one to track and trace prescription drugs that could be harmful to U.S. consumers.

“In short, the FDA contracted with McKinsey to help build a system that could potentially place a significant new burden on its other clients,” the senators wrote. “In addition, the 2010 and 2011 contracts strongly suggest that McKinsey, while representing the FDA, was actively engaging with its private-sector clients that were the targets of this new regulatory process — an obvious conflict of interest.”

The senators, co-signed by West Virginia’s Joe Manchin and Massachusetts’ Ed Markey and Elizabeth Warren, asked for answers by Sept. 20.

What We're Reading

Hospital and insurance costs are still a black box for consumers and employers choosing between higher monthly payments and larger deductibles, largely with bad math, write The New York Times’ Sarah Kliff, Josh Katz and Rumsey Taylor.

The ongoing pandemic is threatening to upend a third school year amid variant surges and open questions about when young children could be immunized, Sarah Zhang writes in The Atlantic.

Officials must learn from the original vaccine rollout in the booster plan to come, Jennifer Bard and Chloe Reichel write in a Stat News op-ed.

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