WASHINGTON – The US government is preparing to drastically reduce its role in fighting the Covid-19 pandemic even as an explosion of cases in China is raising fresh concern about the virus within the Biden administration.

Spending legislation that Congress is poised to send to President Joe Biden this week includes no new funds for vaccines, testing or treatments.

The White House has signalled that Mr Biden – who has declared the pandemic “over” – would sign the bill even though lawmakers spurned his request for US$9.25 billion (S$12.5 billion) to keep shots and medications free.

The shift, driven by congressional penny-pinching, marks a political, economic and public health gamble.

In the US, most Americans long ago put away their masks and relegated the virus to an afterthought, and pandemic fatigue far outweighs any lingering pressure to continue Covid-19 safeguards.

But it’s a far different scene in China, where the virus first emerged three years ago.

The tsunami of Covid-19 that’s taking hold across the country after Beijing’s government abandoned its “Covid Zero” policy is spurring concern that a dangerous new variant could emerge for the first time in more than a year, just as genetic sequencing to catch such a threat is dwindling.

China is likely experiencing 1 million Covid-19 infections and 5,000 virus deaths every day in what is expected to be the biggest outbreak the world has seen, according to a new analysis from Airfinity Ltd., a London-based research firm.

“We know that anytime the virus is spreading in the wild that it has the potential to mutate and to pose a threat to people everywhere,” State Department spokesman Ned Price said in a briefing on Monday. 

‘Permanent reset?’

Even in the vaccine-rich US, several hundred people still die from Covid-19 daily, according to the Centers for Disease Control and Prevention, underscoring the degree to which living with the virus has become the new normal. 

“This would be unheard of, prior to Covid,” Jennifer Kates, senior vice-president with the Kaiser Family Foundation, said of the current US death rate. “So, is this a permanent reset? Are we as a society comfortable with that? And I think that’s the question that I wonder about.”

Mr Biden took office pledging to quell the pandemic. A year ago, he warned in a holiday speech about the surge of the Omicron variant, which would go on to infect millions of Americans by January and kill thousands. 

But since making vaccines and treatments widely available, he’s urged Americans to resume normal lives.

In a speech on Thursday, he encouraged people to enjoy the holidays while casting Covid-19 – which typically spikes in their wake – as a fading risk.

“We’re surely making progress. Things are getting better,” he said. “Covid no longer controls our lives. Our kids are back in school. People are back to work.” 

To connect with the holiday spirit, Mr Biden said earlier in his speech, “Just look into the eyes of a child on Christmas morning or listen to the laughter of a family together this holiday season after years – after years – of being apart.”

Administration officials continue to search for whatever funding they can to keep the US response going, but acknowledge that they’re quickly running out of options.

It’s not clear yet whether the US government will be able to keep buying vaccines and treatments, even for the uninsured, or whether the government will have money to spur drugmakers to develop the next booster shot, tailored to whatever variants are circulating next year.

US hospitalisations for Covid-19 are ticking upwards, according to the CDC, though they remain far lower than this time last year.

That’s giving administration officials some hope that vaccinations and Paxlovid – the Pfizer drug that’s proved effective at treating infections – have rendered the pandemic manageable, even heading into a holiday travel season that ignited a surge a year ago.

“We don’t want this winter to look like last winter or the winter before, and it doesn’t have to,” Ashish Jha, the administration’s Covid-19 czar, told reporters last week. “What’s different is that we have an updated vaccine that targets a version of the virus we’re fighting. But we need people to get that vaccine.”

Unlike the past two years, holiday travellers won’t be required to don face masks after a federal judge in April struck down a nationwide mask requirement for aeroplanes, trains, buses and other public transportation. The Biden administration has made no push to reinstate it.

The president is facing calls to end the public health emergency, which could happen next year. They’ve so far demurred.

Still, some regions are adopting a more vigilant posture as cases surge. Officials in New York City, for example, have recommended that residents resume wearing face masks – even in crowded outdoor settings.

The total US case count isn’t clear, as experts suspect fewer cases are being reported in official data as the proportion of at-home tests grows.

Clouding the picture further is the confluence of Covid-19, flu and RSV (Respiratory syncytial virus) as the US heads into winter, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a former Covid-19 adviser to Mr Biden’s transition team.

“We don’t know, and that’s what we’ve got to be honest about,” Mr Osterholm said of the current Covid-19 situation.

Pandemic fatigue

Vaccine uptake, meanwhile, has been sluggish – just 14 per cent of Americans have had an updated booster shot.

Congress’s rejection of the administration’s funding request will almost surely fuel the shift of vaccines and treatments from government programmes to the commercial market, raising questions about whether access will slump. 

“The administration has repeatedly asked Congress for funding on Covid, and Congress has not budged on it, and there’s just no appetite,” Ms Kates said. “The biggest issue is: when those supplies run out, there’s just no money for new supplies.”

US officials have long warned that a lack of funding could mean they can’t order new vaccines and treatments or fund development of new ones – like, for instance, the next generation of booster shots that Americans might be offered next autumn. It’s possible they may reallocate other funding to try and do so. 

Congress is being far too short-sighted in quelling Covid-19 and, perhaps more importantly preparing for future pandemic threats, administration officials said.

Instead, the Biden administration has turned to more modest measures, including reopening a programme that sends free tests to homes by mail, using a stockpile accumulated with earlier funding. 

The omnibus bill did carry some health provisions – one measure extends Medicare coverage for Paxlovid to address any gap that could have emerged after current stocks run dry but before it’s fully approved by regulators. That’s seen as important because Medicare recipients are the ages most at risk of serious or fatal Covid-19 cases.

The bill also included new funding for some preparedness measures at the Department of Health and Human Services. 

But, with China’s runaway Covid-19 numbers looming large in public health officials’ minds, there’s little sign that the past three years have bolstered US capacity to deal with another crisis.

“Are we better prepared for the next pandemic? We’re not,” Ms Kates said. “And that’s scary and a little disheartening. And I hope we can get there.” BLOOMBERG