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    Troubled Vaccine Maker and Its Founder Gave $2 Million in Political Donations

    Emergent BioSolutions faces scrutiny in Congress for ruining Covid-19 vaccines and securing lucrative federal contracts. Executives will appear before some lawmakers who benefited from the company’s spending.WASHINGTON — When Fuad El-Hibri, founder and executive chairman of Emergent BioSolutions, appears Wednesday before a House subcommittee to explain how the company’s Baltimore plant ruined millions of doses of coronavirus vaccine, he will be questioned by lawmakers he and his employees spent tens of thousands of dollars helping to elect.Since 2018, federal campaign records show, Mr. El-Hibri and his wife, Nancy, have donated at least $150,000 to groups affiliated with the top Republican on the panel, Representative Steve Scalise of Louisiana, as well as Mr. Scalise’s campaigns. At least two other members of the subcommittee received donations during the 2020 election cycle from the company’s political action committee, which has given about $1.4 million over the past 10 years to members of both parties.Mr. El-Hibri and his wife have made additional donations totaling more than $800,000 over the same period, with the majority going to Republican candidates and organizations.Political giving is nothing new in Washington. But with the federal government as Emergent’s prime customer, Mr. El-Hibri and the company he founded have spent years cultivating ties on Capitol Hill, helping Emergent carve out a lucrative niche market as a government contractor under both Democratic and Republican administrations.Now Emergent and its top executives find themselves under scrutiny from some of the very elected officials they have sought to influence.Members of Congress are demanding answers from the company, which was awarded a $628 million contract last year to manufacture Covid-19 vaccines but has yet to produce a single dose deemed usable by federal regulators. Along with Mr. El-Hibri, Emergent’s chief executive, Robert G. Kramer, will testify beginning at 10:30 a.m. before the House Select Subcommittee on the Coronavirus Crisis, which has opened a sprawling inquiry.Like nearly everything else about the coronavirus pandemic, the hearing is bound to be colored by politics.Democrats, led by Representative Jim Clyburn of South Carolina, the panel’s chairman, are expected to use the session to put a spotlight on the company’s relationship with Trump administration officials, including Robert Kadlec, the former assistant secretary of health and human services for preparedness and response, who had previously consulted for Emergent. Dr. Kadlec has said that he was not involved in negotiating the company’s coronavirus contract but that he did sign off on it.Democrats have also signaled that they will zero in on the executives’ stock trades. Emergent’s stock performed so well in 2020 that Mr. El-Hibri cashed in shares and options worth over $42 million, The New York Times reported in March. Mr. Kramer sold slightly more than $10 million in stock this year, according to filings with the Securities and Exchange Commission reported earlier by The Washington Post.“They all made millions in stock transactions while they seem to be hiding stuff from the public,” Mr. Clyburn said in a recent interview with CNN.Republicans, led by Mr. Scalise, who as the No. 2 Republican holds the title of whip, are likely to point out that the company’s contracts date at least to the Obama administration, which designated its Baltimore facility a center for innovation in advanced development and manufacturing — meaning it would be ready to make vaccines and other needed treatments in the event of a crisis.Representative Steve Scalise of Louisiana received campaign donations from Mr. El-Hibri and his wife, Nancy.Anna Moneymaker for The New York TimesA spokeswoman for Mr. Scalise said that Mr. El-Hibri would receive no special treatment at the hearing. “The Democrats invited him as a witness, and Whip Scalise will treat him as he would any other witness that has been invited before the committee,” the spokeswoman said.Until recently, Emergent was an obscure player in Washington, but a dominant force in the highly specialized market for drugs and vaccines aimed at countering a biological attack. The company burst into the limelight earlier this spring after The Times reported that workers at its Bayview plant in Baltimore had accidentally conflated the ingredients of two vaccines that rely on live viruses, forcing Emergent to discard up to 15 million doses of the Johnson & Johnson vaccine.Food and Drug Administration inspectors subsequently raised concerns about possible further contamination, and the company has recently submitted a quality improvement plan to regulators. The equivalent of about 70 million more doses of Johnson & Johnson’s vaccine, mostly for domestic use, are on hold and may never be cleared for use in the United States.“The collaboration with BARDA was designed to create a higher probability of success but was not without risk,” an Emergent spokesman, Matt Hartwig, said in a statement to The Times, using the acronym for the Biomedical Advanced Research and Development Authority, the federal agency that awarded the contract. “Our motivation in collaborating with BARDA was to help play a role in bringing the pandemic to an end and we are proud of the work of Emergent’s employees.”Mr. Kramer, the chief executive, is likely to use the hearing to outline the company’s corrective action plan and to cast Emergent as a company committed to helping the country in crisis. During a recent earnings call with investors, Mr. Kramer announced a management shake-up and took “full responsibility” for the problems in Baltimore.But he also cast some blame on the government, saying that federal officials had asked Emergent to manufacture the two live-virus vaccines — one developed by Johnson & Johnson and the other by AstraZeneca — despite the risk of contamination. He said that the company had taken precautions but that the contamination had most likely occurred when “one or more of these precautions did not function as anticipated.”Emergent’s chief executive, Robert G. Kramer, sold slightly more than $10 million in stock this year, according to filings with the Securities and Exchange Commission.Joe Andrucyk/Office of Governor Larry HoganThrough Mr. Hartwig, the Emergent spokesman, the El-Hibris declined to comment.The company is a longtime partner to the federal government. Then known as BioPort, it was founded by Mr. El-Hibri in 1998 after he and some investors paid the state of Michigan $25 million to buy the license for a government-developed anthrax vaccine and an aging manufacturing plant. In the two decades since, the company built its business largely around selling products to the Strategic National Stockpile, the nation’s emergency medical reserve.An investigation by The Times, published in March, found that the company’s anthrax vaccine had in some years accounted for roughly half of the stockpile’s budget and that the company’s aggressive tactics, broad political connections and penchant for undercutting competitors had given it remarkable sway over the government’s purchasing decisions related to the vaccines.The company’s board is stocked with former federal officials, and its lobbyists include former members of Congress and aides from both parties. The company’s government relations shop is similarly stocked with partisans; Chris Frech, its top in-house lobbyist, worked for former President George W. Bush, and Grant Barbosa, a senior director for government affairs, was a legislative assistant to Vice President Kamala Harris when she was a senator.Senate lobbying disclosures show that the company has spent an average of $3 million a year on lobbying over the past decade — much more than similarly sized biotech firms but about the same as two pharmaceutical giants, AstraZeneca and Bristol Myers Squibb, whose annual revenues are at least 17 times higher.During the first three months of this year, Emergent reported spending $1.47 million on lobbying, enlisting the services of more than two dozen lobbyists from 10 firms.Federal campaign disclosure records show that donations to the Emergent BioSolutions Inc. Employees PAC run the gamut. Board members and executives like Mr. El-Hibri give as much as $5,000, the maximum allowable amount per year under federal election rules. Some employees have contributed on a biweekly basis in amounts as small as $3.47. Three former employees said the company offered a payroll deduction program to make giving easier.The employee group tends to spend in small dollar amounts, typically $1,000 to $2,500 on incumbents, including lawmakers representing states where it operates, like Maryland and Michigan. Representative Steny Hoyer, Democrat of Maryland and the No. 2 Democrat in the House, was a top beneficiary in the 2020 election cycle; he and an affiliated organization received a total of $10,000.Two members of the House panel conducting Wednesday’s hearing — Representative Jim Jordan, Republican of Ohio, and Representative Jamie Raskin, Democrat of Maryland — each received $1,000 contributions over the same election cycle.In an interview, Mr. Raskin said that he had been unaware of the donation until he was contacted by a Times reporter and that he had returned the money. A spokesman for Mr. Jordan said that the congressman had raised more than $18 million during the 2020 election cycle and that contributions had no bearing on his work as a legislator.Mr. Hartwig, the Emergent spokesman, said in an email message that the PAC “supports incumbent Members of Congress of both chambers and from both parties who represent our employees and our facilities, and who are committed to preparedness and response for the next biological, chemical, or public health threat.”Sharon LaFraniere contributed reporting. More

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    Pfizer Nears Deal to Provide More Vaccine Doses

    #masthead-section-label, #masthead-bar-one { display: none }Covid-19 VaccinesVaccine QuestionsDoses Per StateAfter Your VaccineHow the Moderna Vaccine WorksWhy You’ll Still Need a MaskAdvertisementContinue reading the main storySupported byContinue reading the main storyPfizer Nears Deal With Trump Administration to Provide More Vaccine DosesThe company could provide at least tens of millions of additional doses of a coronavirus vaccine under an agreement that would give it better access to the supplies it needs to expand manufacturing.A health worker receiving the Pfizer vaccine in Arlington, Va., on Wednesday. The Trump administration is nearing a deal with Pfizer to provide tens of millions of additional doses in the second quarter of next year, helping to address a looming shortage.Credit…Michael A. McCoy for The New York TimesSharon LaFraniere and Dec. 22, 2020Updated 6:17 p.m. ETThe Trump administration and Pfizer are close to a deal under which the pharmaceutical company would bolster supply of its coronavirus vaccine for the United States by at least tens of millions of doses next year in exchange for a government directive giving it better access to manufacturing supplies, people familiar with the discussions said.An agreement, which could be announced as early as Wednesday, would help the United States at least partly offset a looming vaccine shortage that could leave as many as 110 million adult Americans uncovered in the first half of 2021.So far, only two pharmaceutical companies — Pfizer and Moderna — have won federal authorization for emergency distribution of Covid-19 vaccines, and most of what they are capable of producing for the next six months has already been allocated through contracts with the United States and other governments.In the negotiations, the government is asking for 100 million additional doses from Pfizer from April through June. The company has signaled that it should be able to produce at least 70 million, and perhaps more, if it can get more access to supplies and raw materials.To help Pfizer, the deal calls for the government to invoke the Defense Production Act to give the company better access to roughly nine specialized products it needs to make the vaccine. One person familiar with the list said it included lipids, the oily molecules in which the genetic material that is used in both the Moderna and Pfizer vaccines is encased.Pfizer first started asking for the government’s help in obtaining supplies as early as September and has been unhappy about the lack of response, according to documents reviewed by The New York Times.Moderna and other companies that worked more closely than Pfizer with the administration through its Operation Warp Speed to develop their vaccines already receive favored treatment from suppliers, putting Pfizer at a disadvantage. That includes two companies — Sanofi and Novavax — that have yet to begin large-scale clinical trials in the United States.Pfizer and the administration have been negotiating for more doses from Pfizer for more than a month. But a host of other issues have stood in the way of a deal, including Pfizer’s commitments to other nations that moved faster than the United States to lock in a big supply, according to people familiar with the situation.Pfizer already has a federal contract, signed in July, to deliver 100 million doses of its vaccine by the end of March. Moderna has the same agreement, and has also pledged to sell the government 100 million more doses in the second quarter of the year, from the start of April to the end of June.Because the Pfizer and the Moderna vaccine both require two doses, that supply would cover only 150 million Americans out of the roughly 260 million who are eligible at the moment to be vaccinated. (Moderna’s vaccine is now restricted to those 18 and over, and Pfizer’s is limited to those 16 and over.)If Pfizer provides another 100 million doses, that would leave about 60 million eligible Americans uncovered in the first half of the year. Other producers could also cover the shortfall should their vaccines prove successful.It is not clear how many more doses Pfizer can quickly produce even if the administration uses the Defense Production Act to clear away supply obstacles. One person familiar with the situation said the firm may only be able to deliver 70 million by the end of June, even with better access to supplies. Had the government agreed to prioritize its supply needs earlier, one person familiar with Pfizer’s situation said, the company might be better positioned now to fully meet the demands. Documents reviewed by The Times showed that Pfizer officials began asking Gen. Gustave F. Perna, the chief operating officer of Operation Warp Speed, in September for help with supplies and brought up the issue repeatedly in weekly meetings.A senior Trump administration official said the government was unwilling to intervene because Pfizer refused to promise that it would use those materials to produce vaccines solely for Americans..css-fk3g7a{font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:0.875rem;line-height:1.125rem;color:#121212 !important;}@media (min-width:740px){.css-fk3g7a{font-size:0.9375rem;line-height:1.25rem;}}.css-1sjr751{-webkit-text-decoration:none;text-decoration:none;}.css-1sjr751 a:hover{border-bottom:1px solid #dcdcdc;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-zs9392{margin:10px auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-zs9392{font-size:1.25rem;line-height:1.4375rem;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.75rem;margin-bottom:20px;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-zs9392{font-size:1.5rem;line-height:1.875rem;}}.css-121grtr{margin:0 auto 10px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-qmg6q8{background-color:white;margin:1.5rem auto 1.9rem;max-width:600px;}#NYT_BELOW_MAIN_CONTENT_REGION .css-qmg6q8{padding:0;width:calc(100% – 40px);max-width:600px;margin-right:auto;margin-left:auto;}.css-qmg6q8 strong{font-weight:700;}.css-qmg6q8 em{font-style:italic;}@media (min-width:740px){.css-qmg6q8{margin:40px auto;}}.css-qmg6q8:focus{outline:1px solid #e2e2e2;}.css-qmg6q8 a{color:#326891;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ccd9e3;}.css-qmg6q8 a:visited{color:#333;-webkit-text-decoration:none;text-decoration:none;border-bottom:1px solid #ddd;}.css-qmg6q8 a:hover{border-bottom:none;}.css-qmg6q8[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-qmg6q8[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-qmg6q8[data-truncated] .css-5gimkt:after{content:’See more’;}.css-qmg6q8[data-truncated] .css-6mllg9{opacity:1;}.css-11uwurf{border:1px solid #e2e2e2;padding:15px;border-radius:0;margin:0 auto;overflow:hidden;}@media (min-width:600px){.css-11uwurf{padding:20px;}}#NYT_BELOW_MAIN_CONTENT_REGION .css-11uwurf{border-top:1px solid #121212;border-bottom:none;}Covid-19 Vaccines ›Answers to Your Vaccine QuestionsWith distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.“It’s our obligation under that type of priority rating to make sure that assets are used only for U.S. sales or production,” the official said, “and they weren’t willing to do that.”People knowledgeable about the talks said General Perna had raised a different concern with Pfizer, saying the government wanted to protect its investment in the other companies under Warp Speed’s umbrella, so it did not want to grant Pfizer the same priority with supplies.According to a report last month by the Government Accountability Office, the Defense Production Act gives the federal government vast authority over private companies, including the power to prevent supplies from being diverted to a different purpose or products from being sold overseas. The administration has granted the kind of status that Pfizer has been seeking to multiple contractors for medical supplies since the pandemic began, including companies that produce ventilators and N-95 respirators, the report states.Because the Pfizer vaccine, developed with the German company BioNTech, is one of only two that the Food and Drug Administration has approved for emergency use, the company has had leverage in negotiating the new contract.That advantage could erode if other vaccines are authorized. A third firm, Johnson & Johnson, is expected to announce results from its clinical trials next month. A fourth, AstraZeneca, has announced some interim results, but it has yet to fully enroll its trial in the United States.With infections, hospitalizations and deaths surging to record levels from a pandemic that has already killed more than 320,000 Americans, the pressure on Pfizer and the government to come to terms is growing.“The last thing we want is for this to turn acrimonious,” said Dr. Walid F. Gellad, who leads the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. “This kind of corrosive back-and-forth is not helping the public feel any better about what’s going to happen in the future.”Pfizer’s relationship with the administration has been tense for months. After he lost the election in November, President Trump accused Pfizer of deliberately slow-walking federal approval of its vaccine to hurt him politically.Alex M. Azar II, the secretary of health and human services, and his aides have complained that Pfizer has kept the government at arm’s length, has faced production problems and has sometimes been uncooperative in negotiations.Another snag in the relationship surfaced Friday when a European official released on Twitter — and then quickly deleted — a price list that showing that vaccine shipments to the U.S. government cost a third more per dose than shipments to European customers.Pfizer completed a deal last month to sell the European Union 200 million doses at a cost of $14.50 each. The contract signed by the Trump administration with Pfizer in July for the original 100 million doses put the price at $19.50.It is unclear how much the United States would pay if Pfizer and the federal government struck a new deal. In a statement, Pfizer said only that the European Union’s order was its largest to date, and that Pfizer and BioNTech “are using a tiered pricing formula based on volume and delivery dates.” It declined to disclose further details of the agreement.Pfizer executives have been frustrated because, according to people familiar with the negotiations, they repeatedly urged the federal government this summer and fall to lock in more doses early, before other nations snapped them up. Administration officials declined, later saying that Pfizer refused to commit to specific dates when it would deliver them.The pharmaceutical firm has struggled to navigate the politics of the situation. Pfizer’s chief executive, Dr. Albert Bourla, repeatedly suggested that the firm would know if its vaccine worked by October. Mr. Trump, who saw a vaccine breakthrough as crucial to his re-election chances, initially praised Dr. Bourla as a “great guy” — then blamed the firm for his loss when the results were released after Election Day.At the same time, the president and his top aides have claimed credit for Pfizer’s success, even though, unlike the other five vaccine makers in the Operation Warp Speed program, Pfizer did not take federal subsidies for the vaccine development or manufacturing, assuming all of the risk itself.Pfizer is insisting that in order to bolster production, the Trump administration must direct suppliers to prioritize the company’s purchases of raw materials.Credit…Benjamin Rasmussen for The New York TimesPfizer has also vacillated in describing its relationship with the federal government. A top Pfizer official at one point stated that “we were never part of Operation Warp Speed,” then the company backtracked and acknowledged the firm was.Mr. Azar alluded to the friction with Pfizer in an interview last week with CNBC, saying the federal government was willing to help Pfizer manufacture more “if they are willing to take our help.” He added, “I do wish we would just stop talking about this Pfizer thing.”He denied that there was any threat of a vaccine shortage, saying the government had commitments for three times as many doses as it has now ordered for the first half of next year. Mr. Azar’s total appears to include either doses of vaccines that have not yet been shown to work or doses described in contract options that are not set in stone and include no firm date of delivery, or both.AdvertisementContinue reading the main story More

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    After 4 Years of Trump, Medicare and Medicaid Badly Need Attention

    President-elect Joe Biden has pledged to “marshal the forces of science” in his administration. Undoubtedly he needs to start by bolstering the credibility of the Food and Drug Administration and the Centers for Disease Control and Prevention.But a third health agency, central to the lives of older Americans, low-income families and the disabled, is sorely in need of his attention. Science has also been under assault at the Centers for Medicare & Medicaid Services, which provides federal health insurance to more than 130 million Americans at a cost of more than $1 trillion, nearly twice the Pentagon’s budget.C.M.S. does more than just write checks for medical care. Its scientists and analysts determine which treatments should be offered — I am the chairman of the committee that advises Medicare on those decisions — and how best to care for the patients it serves.Unfortunately, the Trump White House has steadily eviscerated the agency’s dispassionate approaches to making those determinations.Recently, for instance, the Trump administration set in motion a plan to strip C.M.S. of its ability to assess for itself whether new medical devices approved by the F.D.A. are appropriate for the older patients it covers. This is important because the benefits and risks of such devices and procedures, which range from implantable hips and cardiac stents to digital apps and laboratory tests, can vary widely based on patient age and disability.The proposed rule requires Medicare to pay for any new device so long as the F.D.A. labels it a “breakthrough.” And that word does not mean what you think it does.The F.D.A. calls a device a “breakthrough” when it is expected — though not yet proved — to be helpful to patients with serious conditions. The designation has nothing to do with how the device works in older patients, or even if it was studied in that population at all. The proposed rule would also require Medicare to cover any new drug or device if at least one commercial insurer covers it for its members, even if its members are young and healthy.Already, companies seldom generate enough data on their products for C.M.S. to assess their value for its patients. In 2019, for instance, data was insufficient in just under half of new F.D.A. drug approvals to assess benefits or side effects in older patients. The proposed rule would drain the last remaining motivation that companies have to study their treatments in the patients who are likely to ultimately receive them.C.M.S. scientists and analysts do more than evaluate new treatments. They also test alternative ways to organize and pay for patient care. The agency has found, for example, that enrolling people at risk of diabetes in gym sessions reduced how often they were hospitalized. But some seemingly obvious ways to improve health care don’t work: C.M.S. also found it could not reduce hospitalizations for cancer patients by paying their doctors to actively manage their patients’ care.The fact that so many promising ideas don’t work as expected is the reason C.M.S. needs to double down on evaluations of how medical care is delivered to its patients.This administration has gone in the other direction. Just before the election, the White House conjured up a plan to send older people a $200 prescription drug discount card in the mail. Research has already demonstrated that if you give people money to buy prescription drugs, they will buy more of them. The pharmaceutical industry knows this, too. That’s why it hands out coupons worth billions of dollars.These same studies also show that when people are indiscriminately given cash for medicines — instead of only those who need that money the most — it costs much more overall than it saves. No wonder the discount card giveaway would have cost around $8 billion. Fortunately, the president has yet to follow through with it.In another troubling development, the administration announced on Nov. 20 that it would run an experiment in which reimbursements to physicians will be cut for dozens of high-cost drugs they administer in the office, such as chemotherapies and treatments for inflammatory diseases.C.M.S. financial analysts warned that the cuts will lead many Medicare patients to lose access to these important treatments. Scientists should evaluate this prediction by including a comparison group of patients whose doctors would not receive a cut in payment. But the agency administrator made it clear that she didn’t believe the warning. No comparison group is planned. That is no way to evaluate whether our nation’s vulnerable would be helped or hurt by this significant policy change.Another example of a poorly designed experiment involved taking Medicaid coverage away from able-bodied people who are not working or going to school, under an ill-founded theory that doing so would inspire them to seek employment. Such a study is best done narrowly, so that any harms are minimized. Instead, the administration invited multiple states in 2018 to test the outcome.A Harvard study found that a work requirement in Arkansas led to a rise in the number of uninsured people and no significant changes in employment. Thousands of Medicaid beneficiaries in Michigan and New Hampshire were set to lose their coverage before work requirements in those states were ended. Given those results, the overall program should have been canceled. The administration broadened it.Through its reliance on scientific evaluation of what it should pay for, and how, C.M.S. has remained financially viable for more than half a century. As the new president plans to fix the damage done by the current president, this vital agency demands his attention.Peter B. Bach is a physician at Memorial Sloan Kettering Cancer Center. He served as a senior adviser to the administrator of the Centers for Medicare and Medicaid Services in 2005 and 2006.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More