U.S. President Joe Biden released details of a $2 trillion infrastructure plan March 31 that includes investments in vaccine development and improvements to healthcare infrastructure.
The infrastructure plan proposed by President Joe Biden includes efforts to fight future pandemics, using lessons from the past year to fortify drug and vaccine development, onshore pharmaceutical manufacturing and enhance hospitals and digital networks in the U.S.
The $2 trillion proposal focuses on creating jobs in clean energy and road- and bridge-building, but also aims to address weaknesses in the country's healthcare infrastructure exposed by the coronavirus outbreak. It would provide $30 billion over the course of four years — in addition to $10 billion from the American Rescue Plan — "to create U.S. jobs and prevent the severe job losses caused by pandemics through major new investments in medical countermeasures manufacturing; research and development; and related bio preparedness and biosecurity."
Julie Swann, department head and professor at North Carolina State University's Department of Industrial and Systems Engineering, called the plan "an important start."
"It's going to move the needle in some key ways, but we need to continue to look at how we are investing in public health as well as pandemic preparedness across the whole spectrum not only from the government but also from foundations and companies," Swann said in an interview.
Despite many shortcomings in COVID-19 readiness — due, in part, to a lack of funding — the U.S. showed foresight in developing vaccines, Swann said. The infrastructure plan would likely result in more public-private partnerships to facilitate future research and prepare for another pandemic.
"We moved early to invest in multiple companies, not knowing which ones would be successful — and that was expensive, but it was a good strategy," Swann said.
Biden's infrastructure plan calls for investment in prototype vaccines in early- to mid-stage trials, a strategy that Swann said is aimed at repeating the successes of mRNA vaccines like those developed by Pfizer Inc.-BioNTech SE and Moderna Inc., which were the first to gain emergency use authorization in the U.S.
North Carolina State University Department of Industrial and Systems Engineering professor and department head Julie Swann
Many pharmaceutical ingredients come from overseas as a result of cost and environmental restrictions in the U.S. and Biden's plan seeks to onshore these active ingredients. Bringing the supply chain under domestic control is one way to ensure more timely results, Swann said.
"We have a lot of supply chains that are vulnerable, and not only for vaccines and therapeutics associated with COVID-19, but even things like antibiotics," Swann said. "And this is going to require a whole set of creative solutions, from finding ways to identify these potential vulnerabilities in industry where data is not shared very widely at all, to addressing it through investments in onshoring, or partnering with countries that may be more geographically close."
The infrastructure plan also prioritizes the strategic national stockpile of medicines and vaccines to be ready for a future outbreak, although Swann noted it is important to make the right bets about what will be in the stockpile.
"When you're dealing with rare events, you're going to get it wrong sometimes, so it's also partly about having a portfolio of products and working with partners all along that supply chain to have products in stock," Swann said.
Investment in the care economy
The American Jobs Plan also calls for funds for improving the infrastructure of hospitals, particularly veterans' hospitals. Biden is calling for $50 billion to be spent on safeguarding hospitals and other critical infrastructures that could be negatively impacted by extreme weather events.
Under Biden’s plan, $18 billion will be allocated for the modernization of Department of Veterans Affairs hospitals and clinics. According to the White House, the median age of private sector hospitals is 11 years whereas the median age of VA hospitals is 58 years.
American Hospital Association CEO Richard Pollack urged Biden in a letter to prioritize healthcare as hospitals, which saw huge drops in patient volumes during the pandemic, often serve as the largest employer in communities.
"We urge your support for funding for hospital infrastructure as these investments will be critical to ensuring the long-term viability of hospitals; maintaining access to high quality, safe and equitable health care; and sustaining the millions of health care jobs that hospitals and health systems provide," Pollack wrote in the March 31 letter.
Pollack also encouraged Biden to work with Congress to provide adequate funding for the Hospital Preparedness Program to support hospitals' responses to emergencies.
The plan also seeks to improve the livelihoods of patients who need long-term help and the workers who care for them.
Biden is asking Congress to put $400 billion toward expanding access to home and community-based services under the government's Medicaid insurance program, enabling them to receive long-term care at home. Biden will also be extending the Money Follows the Person Program, which supports states' efforts to offer people a choice of where they receive long-term care services.
The expansion will also provide more money for home care workers and give them the opportunity to organize or join a union in order to collectively bargain for better wages and stronger benefits. These measures, according to the White House, will also ultimately improve patient care.
Digital infrastructure plays a part of the Biden infrastructure plan with an expansion of broadband internet connections nationwide.
'The new electricity' and data collection
Digital infrastructure is also addressed in Biden's plan. The president wants to ensure 100% coverage of high-speed broadband internet through a $100 billion investment.
"Broadband internet is the new electricity," the White House wrote in a March 31 statement. "It is necessary for Americans to do their jobs, to participate equally in school learning, healthcare, and to stay connected. Yet, by one definition, more than 30 million Americans live in areas where there is no broadband infrastructure that provides minimally acceptable speeds."
As part of the expansion of broadband, AHA's Pollack wrote that Congress should establish funding programs to offset the costs of implementing telehealth programs and ensure fair reimbursement to clinicians for these programs.
Usage of telehealth has skyrocketed during the COVID-19 pandemic. A recent report from the Medicare Payment Advisory Commission recommended that policymakers continue to expand telehealth coverage for one or two years after the public health emergency.
But one of the potential shortcomings of the infrastructure plan is a lack of data collection initiatives, Swann said. Data from the ongoing pandemic was vastly underutilized by government agencies, Swann said, noting potential sources like mobile phones, wastewater testing and hospitalizations.
"Some of the best data sets came out of media organizations and universities, who were collecting the data from disparate locations and scaling them and making them publicly available to clients," Swann said. "I would like to see more of that leadership come out of the governmental agencies, and I think that before the next pandemic, and really even immediately, we need to start thinking about the many different kinds of data that can provide information."
Pollack wrote that Congress should work to modernize the nation's data infrastructure by funding upgrades to hospitals' reporting mechanisms and through an investment in public health data system modernization. Through this investment, Pollack said, healthcare organizations can more effectively track and respond to issues of health equity, healthcare delivery and resources.