WASHINGTON — Top Trump officials actively lobbied Congress to deny state governments any extra funding for the Covid-19 vaccine rollout last fall — despite frantic warnings from state officials that they didn’t have the money they needed to ramp up a massive vaccination operation.
The push, described to STAT by congressional aides in both parties and openly acknowledged by one of the Trump officials, came from multiple high-ranking Trump health officials in repeated meetings with legislators.
Without the extra money, states spent last October and November rationing the small pot of federal dollars they had been given. And when vaccines began shipping in December, states seemed woefully underprepared.
The previously unreported lobbying efforts underscore that even after the Trump administration spent billions helping drug makers develop Covid-19 vaccines, it not only dismissed states’ concerns about the help they would need to roll them out, but actively undermined their efforts to press Congress to get the funding they needed.
Much of the lobbying push came from Paul Mango, the former deputy chief of staff for policy at the Department of Health and Human Services. He argued, repeatedly, that states hadn’t demonstrated they needed additional funding because, at least as of last October, they hadn’t spent the $200 million that the Centers for Disease Control and Prevention sent to states in September.
Far from denying his efforts, Mango doubled down in an interview with STAT — and even accused states of pressing for the money to bolster their empty tax coffers.
“A lot of them had shut down their economies and they weren’t getting tax revenue,” he said.
“I’m sure they could use money — that’s not in dispute — what’s in dispute is whether they needed money given all they hadn’t used to actually administer vaccines,” Mango added, suggesting that his lobbying efforts were an attempt to protect taxpayers from wasteful government spending.
Mango and other Trump officials started lobbying Congress to deny states the money last fall. At the time, states were working with the Trump administration and the CDC to craft plans to administer the first Covid-19 vaccines, which were expected to be authorized in November. Meanwhile, Congress was busy negotiating a Covid-19 response package that was almost guaranteed to include some funding for the vaccination effort. On Oct. 15, states formally asked congressional leadership for $8.4 billion in funding.
On Oct. 27, Mango told congressional staff, including those working for the House Appropriations Committee, that states did not need more federal funding because they had not yet spent the $200 million provided by the government earlier that year, a Democratic aide told STAT.
Mango also said that HHS had asked states for detailed financial plans for how they planned to spend the extra money, but that their plans were “vague.” STAT was unable to obtain those plans: The Association for State and Territorial Health Officials told STAT it did not have access to them.
“Every time we got on our biweekly update with the Hill, they said, ‘Don’t you guys need more money for distribution?’ and we said the same thing we told you: ‘We’ve already allocated $200 million. They haven’t drawn anything down, they haven’t drawn down their testing [funding], and we are looking for business plans. If we get those things, we will be the first to let you know and we will be happy to give them more money,” Mango told STAT.
It’s true that the states hadn’t spent most of the money by October. State health departments, for their part, say there are several good reasons why. For one, they hadn’t begun vaccinating anyone yet. States were also drawing down other sources of funding that were set to expire. And they were reluctant to immediately spend the new funding because they were unsure when new funding would be appropriated by Congress.
STAT was unable to independently confirm how much of the $200 million has since been spent by states. Mango insisted that as of Dec. 31, states had only “drawn down 1% of the $200 million.” ASTHO has claimed that the metric Mango has referenced is not a real-time metric and may take weeks or months to be reported to the federal government.
Mango also made a similar argument, repeatedly, about the CDC, according to a second Democratic aide. At the time, Trump’s CDC Director, Robert Redfield, was requesting $6 billion for states’ efforts on the vaccine rollout. Mango said the money Redfield requested wasn’t needed, according to the aide.
Mango told STAT this week that Redfield’s 2020 request was “lobbying Congress for money behind our back,” referring to the Trump administration.
“I call it the mutual-admiration society — they were trying to help their friends at the state public health offices even though they didn’t have any real plan to spend the money,” Mango said.
Mango wasn’t the only one using the argument. Russ Vought, the head of the White House budget office, likewise argued that states did not need additional funding because they had not already spent the $200 million allocated to them, a Republican Senate aide said. The Republican aide called Vought “obsessed” with the fact that states hadn’t spent the money.
The Republican aide also emphasized that even staunch fiscal conservatives knew that states needed more than $200 million to vaccinate the majority of Americans.
Trump staffers were so reluctant to acknowledge that states needed additional funding that staffers negotiating the relief packages eventually gave up on asking the Trump administration how much money states needed. Instead, they went directly to associations representing state and local health departments, a second Republican aide confirmed.
The lobbying from the Trump administration prompted a flurry of defensive action from state health officials.
In a sharply worded letter on Dec. 4, ASTHO and the Association of Immunization Managers wrote to Surgeon General Jerome Adams that, “Recent communications by senior Administration officials to Congress … indicate that this Administration and some members of Congress do not support our request for substantial additional resources for vaccine administration and infrastructure.”
“This is extremely unfortunate,” ASTHO wrote. “We believe that it is neither a partisan nor political statement to share the very obvious fact that the vaccination of 330,000,000 Americans safely and effectively will take far more than the $340 million currently allocated to local, state, and territorial governmental public health agencies.”
In addition to the missive, ASTHO requested a meeting with its members and HHS Secretary Alex Azar to discuss the situation. The meeting request, which was made on Oct. 20, was denied, according to the group’s executive director Michael Fraser.
A former senior adviser to Adams told STAT that the question of whether the Trump administration should advocate for more funding to states generated a schism between political appointees, like Azar and Mango, who argued states didn’t need more funding, and doctors on the coronavirus task force, like Adams, White House coronavirus coordinator Deborah Birx and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
“The political people very much believed that it wasn’t their responsibility and it should be left up to the states,” the former adviser said. “The majority of the people running the Trump response at a high political level had zero medical experience or response experience and there was a disconnect between saying, ‘I’ve already given them supplies, it shouldn’t cost anything after that,’ versus understanding that there are costs that have to do with the planning, with the spaces, with all of the PPE, with the training, security.”
State public health officials weren’t the only ones sounding the alarm over the lack of funding.
The National Governors Association had also directly warned the Trump administration that additional funding was needed.
“Without additional state and local funding to implement COVID-19 vaccine plans, we will be hampered in what we can accomplish. When can we expect more definitive information about resources related to this response?” NGA wrote to HHS on Oct 18.
HHS’ response: The agency reiterated that $200 million had already been allocated to states and that “states should recognize that most of the major costs of a vaccine campaign are already being covered.”
Congress eventually did allocate $4.5 billion to state governments, but the money only began to flow to states earlier this month. In the meantime, the Trump administration administered dramatically fewer vaccines than it had originally promised.
It’s impossible to say definitively how the Trump administration’s full-throated advocacy for state funding would have changed the course of the early vaccine rollout.
Mango told STAT that the early hiccups with the vaccine rollout were caused by states too closely following CDC recommendations for who to vaccinate first and by natural vaccine supply constraints, not lack of funding.
But independent public health officials weren’t so sure.
“A lot of that could have been avoided or smoothed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, regarding the scramble from states to begin vaccinating in December. “Having more money would have allowed them to devote more resources to planning for the vaccine, making sure they had enough vaccinators … and get in place venues to do mass vaccinations.”