WASHINGTON — With COVID-19 continuing to course through a mostly unvaccinated America early last year, President Biden repeatedly warned that it would be worse to do too little to fight the pandemic and its economic devastation than to do too much.
“The biggest risk is not going too big,” he said just days into his presidency as he pushed a massive $1.9 trillion aid bill without the vote of a single Republican. “It’s if we go too small.”
But when it came to money to directly attack the virus, it turns out Biden and congressional Democrats ended up going too small.
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Barely a year after he signed the American Rescue Plan Act into law, the US has burned through almost all of the $160 billion the legislation allocated for vaccines, treatment, and testing. Now, with case counts at their lowest level since last summer and polls showing declining public concern about the virus, the White House has struggled to get Congress to provide $22.5 billion more to replenish those funds.
Lawmakers appear close to a deal that would cut the administration’s request by more than half, to $10 billion. But Republican insistence that any additional money come from other unspent COVID-related aid, like still unallocated assistance to some state and local governments, has triggered another round of partisan fighting reminiscent of the battles over vaccines, mask mandates, and lockdowns. The dispute threatens to leave the nation vulnerable to another deadly surge from the still-mutating virus, public health officials said.
“For the United States, we’re not out of danger,” said Ali H. Mokdad, a professor at the University of Washington’s Institute for Health Metrics and Evaluation who predicts COVID cases will surge again next winter. “We have good days ahead of us and that’s the calm before the storm. So we need to be prepared.”
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Democrats argue the $160 billion in COVID aid was well spent, helping the nation weather deadly surges from two variants. And while it was difficult to predict last year how much money would be required for those efforts, there’s no doubt more is desperately needed now, administration officials said.
Washington does not have the cash to purchase enough boosters for all Americans if additional doses are needed, or to buy tens of millions of doses for a variant-specific vaccine if one is developed, and could fall behind other nations in placing orders. Planned federal purchases of COVID therapeutics, such as monoclonal antibody treatments, are being scaled back. The administration will be unable to help fund private manufacturing of tests beyond June. And a federal program that reimburses medical providers for treating uninsured Americans has stopped paying for testing and treatment and starting Tuesday will stop paying for vaccinations because it is out of money.
“We are at a critical juncture right now,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told a Senate committee on Wednesday. “We are low on funds in the federal government not only to purchase vaccines, boosters, tests, and therapeutics, but to deliver them and administer them to the American people.”
Biden publicly pleaded with lawmakers to provide the money.
“Americans are back to living their lives again. We can’t surrender that now,” he said on Wednesday before he received his second booster shot after the Centers for Disease Control authorized them for people over 50 years old. “Congress, please act. You have to act immediately. The consequences of inaction are severe. They’ll only grow with time.”
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But Congressional Republicans aren’t convinced the need is urgent, which has stalled the funding.
“I think that there’s a feeling of less urgency I can hear when people talk about it,” said Senator Richard Shelby, a Republican from Alabama. “But I think if the experts, the scientists, can show us that there’s a real need, Congress always reacts positively. But we don’t know that.”
Republicans unanimously opposed the $1.9 trillion American Rescue Plan, which was passed by slim Democratic majorities in the House and Senate using a complicated legislative procedure called reconciliation. GOP lawmakers argued there was far too much spending for things they deemed not directly related to the pandemic and that the legislation risked fueling high inflation with the economy already in the midst of a strong rebound.
The law allocated about $1 trillion to help Americans recover from the crisis, including $1,400 stimulus checks for most adults, a temporary boost to the child tax credit, and an extension of enhanced unemployment benefits, as well as $350 billion in aid to state and local governments.
Many economists now agree the spending has contributed at least somewhat to the nation’s decades-high inflation, which has been largely caused by supply chain problems and other factors as the global economy reopened following pandemic shutdowns. But the law also had positive effects, including helping fuel record job growth in 2021 and a major reduction in the percentage of Americans in poverty. Direct COVID money helped get about 218 million Americans fully vaccinated so far and deliver booster shots to close to half of them.
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Republicans have focused on inflation to argue that Washington should not authorize any new spending to fight the pandemic and instead use unspent funds from other parts of the law, such as clawing back money that was promised to states to boost their economies. Democrats need the support of at least 10 Senate Republicans to avoid a filibuster.
“There is an enormous amount of money out of the $2 trillion bill passed last year that hasn’t gone out yet,” Senate minority leader Mitch McConnell, a Kentucky Republican, said this past week. He and other Republicans are demanding the additional money come from there.
Democrats and some state officials have balked at that proposal, arguing the aid to localities and some state governments is purposefully being delivered in two tranches — the second coming this spring — and with a 2024 deadline to decide how to spend it, in order to promote a longer-lasting economic recovery. That core disagreement scuttled a deal in the House last month that would have provided $15.6 billion in new aid for vaccines, treatment, and testing.
“After giving states more than three years to spend funds and states consciously waiting to spend it … then to change the rule and say we’ll take it back from those who haven’t spent it yet, I think the unfairness argument resonates,” said Ed Lazere, a senior fellow at the Center on Budget and Policy Priorities, a progressive think tank that has been tracking how state governments spend their $195 billion from the American Rescue Plan. “States really are using this money and they have found important uses for it, and the notion they don’t need it is just not true.”
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He estimated about $120 billion of the state aid has been distributed. Massachusetts, which got $5.3 billion, and other states that were hard hit by the pandemic received all their money last spring. But 30 other states, including 22 with Republican governors, will get their second tranche in the coming weeks.
Senator Elizabeth Warren, a Democrat from Massachusetts, said it’s not right to take unspent aid away from states. She’s not opposed to finding other money in the bill, such as for any ineffective programs, that could be used to offset the new COVID spending, but expressed frustration with Republicans for putting up so much resistance to additional pandemic funding.
“People have died, people continue to die, people continue to get sick and Congress’ refusal to fund the efforts to keep us all safe is astonishing,” she said. “ Republicans are determined to continue to play politics with COVID and it hurts us all.”
Senator Brian Schatz, a Democrat from Hawaii, said that in retrospect the legislation should have included more money for vaccines, therapeutics, and testing in the original bill, but it was difficult to determine last year where the virus was headed and how much would be needed. Still, the pandemic remains a public health emergency and Congress should provide the necessary money without worrying about offsetting the spending as Republicans are demanding, he said.
“The best way to put this thing behind us is to arm ourselves with the tools to knock down the next variant and navigate our way through whatever may come next,” he said. “If whatever comes next is mild, great, we can keep that money in our pockets.”
But it’s looking like the administration will get much less than it requested, with a significant cut to the $5 billion it wanted to help vaccinate people in developing nations. Democrats and public health experts said that omission would be a mistake.
“Global vaccination is the most important thing we can do to prevent the emergence of a new variant,” said Stephen Kissler, a research fellow in the Department of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health.
Some European countries are experiencing a new surge from the highly contagious BA.2 Omicron subvariant, and cases are starting to tick up in Massachusetts and some Northeastern states. Still, Kissler said he’s cautiously optimistic that the US will continue to have low case counts for the next few months because vaccines are proving effective in combating the variant.
That immunity from vaccines and COVID infections will wane, however, and the federal government needs to be ready to fight another wave.
“Stockpiling vaccines, therapeutics, and tests is partly hedging against major surges in cases that could come either from just a sudden shift in the dynamics of Ba.2 or from a new variant,” he said. “The fact is that COVID is still here, that it still poses a threat both in its current form and in the form of future variants and we’d be foolish to not be preparing in some way for that.”
Pranav Baskar of the Globe staff contributed to this report.
Jim Puzzanghera can be reached at jim.puzzanghera@globe.com. Follow him @JimPuzzanghera.