COVID-19 cases are rising across the United States, and the country is expected to be hit with a larger wave this fall and winter when the weather turns colder, with as many as 100 million Americans infected.
The virus has been defanged to a large degree compared to the early days of the pandemic, by vaccines and by new treatments like the highly effective Pfizer pills, called Paxlovid.
But that is only true if those tools are actually available. With the government running out of money for the COVID-19 response, the Biden administration warns that it will run out of those crucial supplies without more funding.
And that funding is stalled in Congress, with no clear path forward.
Republicans have long said they do not see an urgent need for the funding, and have insisted it be paid for with cuts to money from previous COVID-19 relief bills.
Both parties reached a deal in early April on a $10 billion package that would be paid for, a smaller amount than the White House’s $22.5 billion request. But even that amount is now stuck in immigration politics, with Republicans calling for a vote on reversing the lifting of a Trump-era border policy known as Title 42 as part of any deal, which Democrats have so far not agreed to do.
Here are five risks if the funding does not go forward.
Not enough vaccines for everyone in the fall
Pfizer and Moderna are working on new versions of their vaccines that are aimed at working better against the omicron variant, which is currently circulating and spawning new subvariants. Those vaccines are expected to be ready by the fall, at a time when immunity will have waned for many people since their last shots.
But the Biden administration says it will not have enough money to buy those updated vaccines for all Americans if it does not get new funding.
“Never thought I’d see the day when the United States does not have enough funding for vaccines during a pandemic,” tweeted Topher Spiro, associate director for health at the White House Office of Management and Budget.
If Congress does not provide new funding, a senior administration official said last week, the administration would have to take all money out of testing, new treatments and vaccine outreach, and even then would only maybe have enough money to buy updated vaccines only for the elderly.
Orders have to be placed months ahead of time, since other countries are also getting in line to buy the updated vaccines and additional treatments.
“We have more tools than we’ve ever had,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, and a former White House COVID-19 adviser. “All of these things are time limited in the sense that they’re not unlimited in quantity.”
If new orders are not placed ahead of time, he said, “we’ll need to get in line.”
Running out of treatments
Perhaps the biggest upgrade to the U.S. virus response since vaccines became available was the authorization of the Pfizer treatment pills known as Paxlovid in December 2021.
If started within five days of symptoms beginning, the pills cut the risk of hospitalization or death by about 90 percent.
Supplies of the pills are expected to run out in October or November, the senior administration official said, meaning that if people got the virus over the holidays they would not have the treatment as an option.
Unable to buy new treatments
There are also new potential breakthroughs in COVID-19 treatments that the U.S. would not have enough money to make happen without new funding.
The Japanese pharmaceutical company Shionogi is working on its own potentially promising treatment pills, for example.
The senior administration official said the treatment could have even higher effectiveness than Paxlovid, but the U.S. cannot enter into contracts for it because it does not have enough money. By the fall, other countries will already have reserved all of the immediately available doses, the official added.
Shortages of tests
During the surge over the winter, people across the country scoured store shelves for rapid tests that quickly sold out, or waited in long lines at testing sites.
Such shortages could repeat next winter if there is not money to maintain testing supplies. Government funding can help maintain testing capacity and avoid layoffs at testing companies when demand is lower, so it will take less time to ramp production back up again when a surge hits.
The senior administration official said the goal is to go into a fall wave with a supply of about 1 billion tests, and that the country would instead have 400-500 million without more funding, a supply expected to be depleted before Christmas.
Inglesby, of Johns Hopkins, said it is hard to predict exactly when a surge will hit and how large it will be. “We have seen in the past couple of years major surges arise with very little warning time,” he said.
Cutting back global aid
Experts have long said that vaccinating the world is key to fighting the pandemic, not only for humanitarian reasons, but to help prevent new, dangerous variants from forming that would threaten the United States as well.
Only 14 percent of people in low-income countries have at least one dose of vaccine, according to a tracker from the Kaiser Family Foundation.
The White House’s funding request includes $5 billion for global efforts to fight the virus, including vaccinations. Even that amount is less than many advocates have called for.
While supply of the vaccine doses themselves has improved, the funding can help get shots into arms, through building up proper storage capacity, recruiting staff and other tasks.
Samantha Power, the administrator of the U.S. Agency for International Development, told Congress in written testimony this week that the agency has already spent 95 percent of the funds for the global virus response and expects to exhaust “virtually” all of the rest by July.
“Without additional resources, many of our programs will begin wrapping up activities and closing down this fall,” she said.