Federal cuts endanger programs
Loss of funding could mean end of key research projects, free tests and vaccines for uninsured
For more than a year, Nathan Grubaugh has been one of Connecticut’s closest observers of COVID-19.
From his lab at the Yale School of Public Health, Grubaugh and his team monitor the disease, sequence test samples and track new variants. When a new COVID19 strain arrives in Connecticut with the potential to disrupt life in the state, Grubaugh is often among the first to know.
But as of recently, Grubaugh is no longer receiving the federal funding that has fueled his work. Before long, he said, he may be forced to scale down or cease his surveillance of new variants.
“We’re going to use some of our internal funds to keep it going for a bit while we try to see where we can get more sustained funding for it,” Grubaugh said. “How long we can keep it going on our own is hard to say.”
Grubaugh isn’t alone. Congress’s failure to include a fresh infusion of COVID-19 funding in President Joe Biden’s recent spending bill means no more federal money for research projects such as Grubaugh’s and no more free coronavirus tests, treatments and vaccines for millions of uninsured Americans. The potential loss of that critical funding comes at a time when experts say Connecticut is bracing for a spike in COVID-19 cases, driven by the BA.2 subvariant of omicron.
Like much of the world, the United States was caught off guard by COVID-19. The first year of the pandemic was defined by snarled supply chains, insufficient testing infrastructure and a scramble to develop and distribute vaccines. By 2022, most of those systems are now in place, but they might not be for long.
The feast-or-famine rhythm of funding for scientific research and preventive measures is familiar to most epidemiologists and public health experts. A crisis occurs, resources are thrown at the problem — and then the funding dries up, leaving the community vulnerable once again.
As of Thursday, Democrats and Republicans were reportedly working toward a compromise that could restore some of the initially allocated funding. But if they can’t find common ground — or if the funding is significantly slashed from Biden’s original proposal — the impact could reverberate to Connecticut.
Dr. Manisha Juthani, Connecticut’s public health commissioner, said the state can expand its testing and vaccination efforts to some extent but can’t fully cover for the loss of federal money.
“We weren’t expecting to [have to] foot the bill for vaccines and therapeutics,” she said. “The only people who have the pockets and the contracting ability to take on those kinds of giants is the federal government.”
‘House of cards’
In March, the White House announced that it would no longer foot the bill for uninsured patients who require COVID-19 tests, treatment or vaccinations. The two-year program, set to end in early April, has already stopped accepting reimbursement claims for treatment and testing.
About 31.2 million Americans under age 65 are uninsured, according to the CDC.
Though the White House has urged Congress to approve another multibillion dollar COVID-19 emergency aid package, the measure currently remains at an impasse in Washington. U.S. Rep. John Larson, D-1, said recently he thinks COVID-19 funding should continue “as long as this is an international pandemic.”
“COVID isn’t going way,” Larson said. “It should have been passed already, in my humble estimation.”
Howard Forman, a professor of public health at Yale, estimates the federal government could bankroll the next phase of pandemic response for as little as $50 per American. Instead, he said, Congress is “putting politics over policy.”
“The only way you’re going to get reliable data in a manner that actually serves the public is the way in which public goods are funded, which is through federal funds,” Forman said. “Without this funding, the house of cards will start to fall apart.”
While all residents could be affected by a potential decrease in supply of vaccines, tests and treatments, it is likely uninsured patients who will be impacted most dramatically.
“It’s a very big problem because these reimbursements made it possible for people being serviced by community health centers and even the public health departments to get testing and vaccination and treatment,” said Frances Padilla, the president of the Universal Health Care Foundation of Connecticut, a nonprofit that advocates for affordable, equitable access to health care.
Padilla noted that people without health insurance are already forced to make choices that are “really untenable,” between, for instance, getting a prescription filled and paying the electricity bill. Without federal support, those choices will become even more stark.
Moving forward, the ability of uninsured Connecticut residents to get COVID-19 vaccines, tests and treatment could depend largely on the magnanimity of care providers. Dr. Jim Cardon, chief clinical integration officer at Hartford HealthCare, said the health system would work with uninsured patients and will waive costs for those who truly can’t pay.
“We’ll treat it the same way we often take care of people who don’t have the funds or the ability to pay, and we work out a way around that,” Cardon said.
But Padilla emphasized that relying on the “goodwill of institutions” is not a sustainable structure for high-quality, affordable health care. And many of the community health centers that have served as safety nets throughout the pandemic cannot simply absorb such costs.
“[Federally qualified health centers] don’t have the reserves that you need to be able to provide free care,” she said.
Meanwhile, the loss of federal funding could mean fewer vaccines, tests and treatments flowing into Connecticut. Dr. Scott Roberts, associate medical director for infection prevention at Yale New Haven Hospital, said the hospital is bracing for a reduction in resources, which could lead to limits on who can access tests and treatments.
“The reduction [in funding] is not a good thing,” Roberts said. “We’ll have to think carefully about how we approach this going forward in order to continue delivering maximal and streamlined care where we don’t have the reductions we’ve seen previously.”
To Padilla, the stalled COVID-19 funding is an example of the way officials fail to prioritize public health even amid a crisis.
“If COVID didn’t teach us that as a country we need to invest in our public health infrastructure, nothing will ever teach us,” she said.
‘All of these programs will run out’
Even if federal COVID-19 funding were restored, a diminished sense of urgency around the pandemic could imperil longstanding research efforts in Connecticut and elsewhere.
Over the past two years, for example, Jordan Peccia’s lab at the Yale School of Engineering and Applied Science has overseen a highly accurate predictor of COVID-19 spikes: wastewater surveillance.
Wastewater data provides a realtime picture of how much COVID19 is in a particular community and is significantly less expensive to run than large-scale testing programs. Since the beginning of the pandemic, Peccia’s data has helped to inform public health decisions at Yale University, Yale New Haven Hospital and a slew of local health departments — in addition to being available to the wider public on Twitter.
But the funding for Peccia’s work has never been assured. In March 2020, his lab scrambled for resources to get its research off the ground. Eventually, the lab received a contract from the state Department of Public Health, which provided about $750,000 in federal funding to enable a year of wastewater surveillance in New Haven, Stamford, Bridgeport, Hartford, Norwich and New London. That contract ended in October 2021 and was not renewed.
Peccia’s lab then secured private funding from Connecticut scientist and entrepreneur Jonathan Rothberg, which enabled the continued surveillance of New Haven wastewater through the omicron surge. That money will run out in June, Peccia said, which means a hard stop for the project.
For Peccia, navigating the ebbs and flows of funding is a reality of scientific work. But the precariousness of research can have significant implications for a community’s ability to preempt and respond to crises.
“COVID’s going to be back in the fall for sure, maybe bad, maybe not so bad,” he said. “When that comes, there will be questions and there will be needs. I’ll be there to help if they need it, but someone’s going to have to pay to do the work. It’s not very expensive, but we need some commitment to do it.”
Juthani noted that the U.S. Centers for Disease Control and Prevention runs a wastewater surveillance program, in which DPH has encouraged local health departments to enroll their sewage treatment plants. A handful of municipalities have already begun collecting data, she said.
When it comes to COVID19 sequencing projects such as Grubaugh’s, the state may be able to re-appropriate CDC funds to continue such work, though that remains unclear.
“We were given a certain amount of money that we could put toward sequencing, and we’ve used most of it,” Juthani said.
Grubaugh’s funding originates from a federal COVID-19 relief bill passed last year, which allocated millions for virus surveillance. That money flows to states, which then contract with labs such as Grubaugh’s.
“One by one, without any new funding, all of these programs will run out,” Grubaugh said.
The end of federal funding for research such as Grubaugh’s won’t entirely end variant surveillance, as the CDC conducts genomic sequencing as well, but it would reduce it greatly and limit what researchers can glean. Grubaugh and his team work directly with Yale New Haven Hospital, allowing them to conduct detailed investigations into who is contracting which variant and what their outcomes are.
If the funding were to disappear, Grubaugh said, “we would lose a lot of the fine details about what is happening.”
“We’re not going to be completely in the dark,” he said, “but we will have less information.”
Forman, of Yale, said he’s hopeful that Congress will restore some amount of COVID-19 funding, allowing efforts like Grubaugh’s to continue. If not, he said, the nation’s pandemic response could slowly crumble.
“Once it falls apart, it will take a while to restart it,” he said. “So one hopes cooler heads will prevail and that they’ll be able to fix it before it falls apart.”