Biden Touts 4-Step Pandemic Plan, Other Health Initiatives in SOTU

In his first State of the Union address, President Joe Biden urged Americans to not let their guard down against COVID-19, touting a four-step pandemic plan that pledged to make more tests and treatments available, while also promising action on other health inititatives such as the opioid epidemic and mental health challenges for children.

Biden did mention COVID-19 at the outset of his speech, noting that "last year, COVID-19 kept us apart. This year we're finally together again."

But Biden did not mention the pandemic again until 36 minutes into his speech, after addressing the Russian invasion of Ukraine, inflation, and the infrastructure law. He said that while the virus "need no longer control our lives," he stated "we will never just accept living with COVID-19."

Biden revealed four steps his administration will take as part of a roadmap to "move forward safely" with the pandemic. Among the steps, a new "test to treat" program in which people who test positive at a pharmacy will be offered Pfizer's anti-viral Paxlovid, for free, "on the spot." The pill reduces the chance of hospitalization by 90%, said the president, promising that Pfizer will provide the US government with 1 million pills in March and more than 2 million in April.

Biden mentioned three other "common sense steps": Preparing for a potentially dangerous new variant, preventing more economic and school shutdowns, and expanding vaccinations worldwide to fight the pandemic on all fronts.

He also said that starting next week, a new batch of COVID tests will be made available for Americans to order for home delivery, through covidtests.gov, and that he would be asking Congress for more money to keep funding free vaccines, tests, masks, and treatments.

In 2021, the president did not give a traditional State of the Union, but instead made an address to a joint session of Congress almost 100 days after he took office. The audience was limited because of COVID-related social distancing restrictions.

For this year's address, attendees were required to take a COVID-19 test before entering the House of Representatives chambers. But, given new Centers for Disease Control and Prevention guidance issued February 25 relaxing mask rules, the invited 535 members of Congress, guests, and dignitaries were not required to wear masks.

Even so, some Republicans refused to attend over the COVID testing requirement. Florida Rep. Greg Steube tweeted, "I'm NOT permitted on the House floor tonight despite the fact that the 17th District of Florida voted me to represent them in the People's House because I didn't go through all of Dictator Pelosi's medical protocol and COVID testing."

Meanwhile, Senator Ed Markey (D-MA), tweeted, "I'm wearing a mask tonight at the #SOTU because we all need to remember that the immunocompromised and those over 60 remain at higher risk of severe illness and hospitalization from COVID-19."

Divisions over COVID-related restrictions and COVID vaccines are also readily apparent in polling. Although 62% of adults in a Kaiser Family Foundation poll said they think the worst of the pandemic "is behind us," more Democrats and independents than Republicans said that lifting restrictions could increase the number of deaths and leave immunocompromised people behind.

Biden indicated that he would lean into lifting more restrictions, saying that it's "time for Americans to get back to work," and that "our kids need to be in school."

He also urged an end to divisions. "Let's stop looking at COVID-19 as a partisan dividing line and see it for what it is: A God-awful disease," said Biden. "Let's stop seeing each other as enemies, and start seeing each other for who we really are: Fellow Americans."

Other Health Priorities

The president hit on several of his other healthcare priorities in his speech, including warning that the administration would scrutinize private investor ownership of nursing homes and noting that Medicare was going to "set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect."

He pledged to protect access to healthcare, to preserve a "woman's right to choose," to advance maternal healthcare, and to protect younger transgender Americans, calling a spate of state laws targeting them "wrong."

And Biden said he was doubling down on the Cancer Moonshot program's promise "to end cancer as we know it," asking Congress to fund his proposed Advanced Research Projects Agency for Health, which would be tasked with finding breakthroughs for cancer, Alzheimer's disease, diabetes, and other diseases.

Biden said he would take action to "get rid of outdated rules that stop doctors from prescribing treatments" for opioid addiction, adding, "I believe in recovery, and I celebrate the 23 million Americans in recovery."

The administration earlier in the day announced a new effort on improving Americans' mental health, with agenda items including working with Congress to expand telehealth and integrating mental health with primary care. Biden's fiscal 2023 budget will double funding for primary and behavioral health integration programs.

Acknowledging State of the Union guest Frances Haugen, a former Facebook (now Meta) employee who exposed the company's algorithms targeting children, Biden said, "We must hold social media platforms accountable for the national experiment they're conducting on our children for profit."

He added, "It's time to strengthen privacy protections, ban targeted advertising to children, demand tech companies stop collecting personal data on our children."

That hit a positive note for the American Academy of Pediatrics (AAP), whose president, Moira Szilagyi, MD, said in a statement that the group was happy the administration was proposing to "protect the digital privacy and well-being of children and adolescents."

The AAP last fall made a National Emergency Declaration on children's mental health because of the pandemic's exacerbation of underlying mental health concerns. Szilagyi and said AAP "welcomes tonight's recognition of children's mental health as a national priority and looks forward to what comes next."

The American Psychological Association (APA) and the American Medical Association (AMA) also applauded Biden's mental health proposals, especially for elevating children's needs.

"COVID-19 has had a devastating impact on mental health, especially for school-aged children and for communities that have been historically marginalized or minoritized, said AMA President Gerald E. Harmon, MD, in a statement.

"Psychological science has demonstrated the harm that social media can inflict on young people, so we are heartened that the plan calls for stronger online protections for young people and an end to algorithmically enhanced systems targeting kids, among other measures," said APA President Frank C. Worrell, PhD, in a statement.

Worrell also noted that the Biden administration's plan addresses key elements on the mental health clinicians' wish lists, including increasing the workforce, expanding evidence-based community mental health services, and support for telehealth.

The star of the evening, however, seemed to be Joshua Davis, a bespectacled, blazer-and-tie-clad seventh-grader with type 1 diabetes who beamed from the First Lady's box as Biden said, "For Joshua, and for the 200,000 other young people with type 1 diabetes, let's cap the cost of insulin at $35 a month so everyone can afford it."

Added Biden, "Drug companies will still do very well," and that he believed Medicare should be allowed to negotiate lower prices for prescription drugs.

The insulin cap proposal — only for those with private insurance — is contained in Biden's Build Back Better plan, which has been stymied in the Senate.

The Endocrine Society praised Biden for saying he will take on drug costs, in particular insulin, noting in a statement that more than 37 million Americans have diabetes, with 3 million starting on insulin within a year of being diagnosed.

Those with type 1 rely on insulin to survive, said the Endocrine Society. "We urge Congress to come together and pass legislation to make insulin affordable as soon as possible," said the statement.

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including JAMA, Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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