Full text
FY2022 COVID-19 Supplemental
Appropriations for the Department of Health
and Human Services (HHS): In Brief
September 2, 2022
Congressional Research Service
https://crsreports.congress.gov
R47232
FY2022 COVID-19 Supplemental Appropriations for HHS
Contents
President’s Request and Selected Congressional Proposals ............................................................ 1
Selected Considerations................................................................................................................... 5
Public Availability of Data on COVID-19 Public Health Spending ......................................... 5
Policy Considerations................................................................................................................ 6
Tables
Table 1. HHS FY2022 Emergency Supplemental Appropriations for
COVID-19 Response.................................................................................................................... 3
Table 2. HHS FY2022 Emergency Supplemental Appropriations for COVID-19
Response: Summary and Comparison of Provisions.................................................................... 3
Contacts
Author Information.......................................................................................................................... 8
FY2022 COVID-19 Supplemental Appropriations for HHS
ince March 2020, more than $400 billion has been appropriated for domestic Coronavirus
S Disease 2019 (COVID-19) public health response to Department of Health and Human
Services (HHS) agencies, mostly as emergency-designated supplemental discretionary
appropriations.1 Much of this funding is available for multiple years or until expended. HHS has
allocated funding for vaccines, therapeutics, tests, and health care supports, among other
activities.2 Congress is currently considering additional FY2022 supplemental appropriations for
HHS to support continued COVID-19 response activities. In addition, with the recent public
health emergency declared for the monkeypox outbreak, more recent legislative proposals would
provide supplemental appropriations for other emerging diseases in addition to COVID-19.3 This
report summarizes the President’s request for additional funding, selected congressional
proposals in response to that request, and selected policy considerations.
President’s Request and Selected
Congressional Proposals
On March 2, 2022, the White House submitted an FY2022 supplemental appropriations request
of $22.5 billion for HHS and other agencies to support ongoing COVID-19 response efforts.4 The
HHS portion of the request would provide $18.3 billion, as summarized in Table 1. According to
the request, much of the funding would support procurement of oral antivirals, monoclonal
antibodies, booster and pediatric vaccines, and rapid and lab-based tests. The funding would also
support preparedness for new variants, including research and development for “pan-COVID”
next-generation vaccines and surveillance of new variants.5 In addition, the Centers for Disease
Control and Prevention (CDC) would allocate $750 million for global COVID-19 vaccine
assistance (in addition to Department of State, Foreign Operations, and Related Programs
appropriations for global assistance).
COVID-19 supplemental appropriations were included in an early version of the FY2022
omnibus appropriations package (see Rules Committee print in Table 1).6 However, these
1 CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress,
coordinated by Kavya Sekar, and CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health,
Medical Supply Chain, Health Services, and Related Provisions, coordinated by Johnathan H. Duff and Kavya Sekar.
2 See U.S. Government Accountability Office, Appendix 4: COVID-19: Current and Future Federal Preparedness
Requires Fixes to Improve Health Data and Address Improper Payments, GAO-22-105397, April 27, 2022, at
https://files.gao.gov/reports/GAO-22-105397/index.html#appendix4; CRS In Focus IF11951, Domestic Funding for
COVID-19 Vaccines: An Overview, by Kavya Sekar; CRS In Focus IF12050, Federal Support for Domestic COVID-19
Test Availability, by Kavya Sekar, Taylor R. Wyatt, and Erica A. Lee; and CRS Report R46897, The Provider Relief
Fund: Frequently Asked Questions, by Elayne J. Heisler.
3 See CRS In Focus IF12186, U.S. Domestic Response to the 2022 Monkeypox Outbreak, by Taylor R. Wyatt, Kavya
Sekar, and Hassan Z. Sheikh.
4 Letter from Shalanda D. Young, Acting Director of OMB, to Nancy Pelosi, March 2, 2022, at
https://www.whitehouse.gov/wp-content/uploads/2022/03/COVID-and-Ukraine-Supplemental-Funding-Request-
Pelosi.pdf.
5 Pan-covid vaccines are vaccines designed to target multiple coronavirus types and variants. See, for example,
National Institutes of Health, “NIAID Issues New Awards to Fund ‘Pan-Coronavirus’ Vaccines,” press release,
September 28, 2021, at https://www.nih.gov/news-events/news-releases/niaid-issues-new-awards-fund-pan-
coronavirus-vaccines, and CRS In Focus IF11789, COVID-19 Variants: Vaccines, Diagnostics, and Therapeutics, by
Amanda K. Sarata, Agata Bodie, and Kavya Sekar.
6 See Division M of U.S. Congress, House Committee on Rules, Rules Committee Print 117-35: Consolidated
Appropriations Act, 2022, committee print, 117th Cong., March 8, 2022, at https://rules.house.gov/sites/
democrats.rules.house.gov/files/BILLS-117HR2471SA-RCP-117-35.pdf.
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FY2022 COVID-19 Supplemental Appropriations for HHS
appropriations were ultimately excluded from the enacted Consolidated Appropriations Act, 2022
(H.R. 2471; P.L. 117-103, March 15, 2022), reportedly after some Members objected to
rescinding certain previously appropriated funding in the American Rescue Plan Act (P.L. 117-2)
to offset the proposed supplemental COVID-19 appropriations.7
On April 4, 2022, a group of Senators announced a bipartisan agreement on COVID-19
supplemental funding.8 However, on April 5, 2022, the Senate voted not to invoke cloture on the
motion to proceed to consider the proposal (using H.R. 4373 as the legislative vehicle).9 No
subsequent action has occurred as of the date of this report. Several Senators reportedly voted
against cloture because they sought an agreement on amendments that would be considered to the
bill.
On June 8, 2022, the Administration reportedly repurposed $10 billion in existing funding,
originally allocated for testing and other purposes, to purchase vaccines and therapeutics.10
As the FY2023 appropriations cycle has progressed, congressional debate has continued over
potential FY2022 COVID-19 funding. COVID-19 supplemental appropriations were not included
in the bill reported on July 5, 2022, by the House Labor, HHS, Education and Related Agencies
(LHHS) Appropriations Subcommittee.11 The Senate Appropriations Committee Chair released
draft FY2023 appropriations bills on July 28, 2022.12 The LHHS draft bill includes a title with
$16 billion in HHS FY2022 emergency-designated supplemental appropriations for COVID-19 or
“any disease with potential for creating a pandemic.”13 According to a press release from Senate
Appropriations Committee leaders, proposed funding is for the “the next phase of the COVID-19
pandemic and to address other emerging diseases that pose a significant threat to public health.”14
Table 1 compares appropriations amounts across the proposals, and Table 2 summarizes and
compares key provisions.
7 Laura Weiss, David Lerman, Lindsey McPherson, and Paul M. Krawzak, “Pandemic Aid Bill Pulled as House Aims
to Wrap Up Omnibus,” Roll Call, March 9, 2016, at https://rollcall.com/2022/03/09/covid-19-aid-to-be-stripped-from-
omnibus-package/. See legislative history for H.Res. 972 and H.Res. 973.
8 Senate Democrats, “Schumer Statement on $10 Billion COVID Preparedness Funding Agreement,” press release,
April 4, 2022, at https://www.democrats.senate.gov/newsroom/press-releases/schumer-statement-on-10-billion-covid-
preparedness-funding-agreement.
9 Lindsey McPherson, Laura W., and Caroline Simon, “Odds Dimming for Quick Passage of $10B Virus Aid
Package,” Roll Call, April 5, 2022, at https://rollcall.com/2022/04/05/immigration-timing-issues-slow-pandemic-relief-
bill-in-senate/. See also H.Res. 972, H.Res. 973, and Senate Roll Call vote number 129 at https://www.senate.gov/
legislative/LIS/roll_call_votes/vote1172/vote_117_2_00129.htm. For discussion of the cloture process, see CRS Report
98-425, Invoking Cloture in the Senate, by Christopher M. Davis.
10 Tony Rumm, “White House Shifts Pandemic Money to Vaccines, Cutting Other Programs,” Washington Post, June
8, 2022, at https://www.washingtonpost.com/us-policy/2022/06/08/coronavirus-aid-white-house-vaccines/.
11 H.R. 8295.
12 U.S. Senate Committee on Appropriations, “Chairman Leahy Releases Fiscal Year 2023 Senate Appropriations
Bills,” press release, July 28, 2022, https://www.appropriations.senate.gov/news/majority/breaking-chairman-leahy-
releases-fiscal-year-2023-senate-appropriations-bills.
13 U.S. Congress, Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies, FY2023 LHHS Appropriations, committee print, 117th Cong., 2nd sess., July 2022,
https://www.appropriations.senate.gov/imo/media/doc/LHHSFY2023.PDF.
14 U.S. Senate Committee on Appropriations, press release, July 28, 2022, “Leahy, Murray, Coons Introduce $21
Billion Emergency Supplemental To Address The Ongoing COVID Crisis And Other Emerging Diseases,”
https://www.appropriations.senate.gov/news/leahy-murray-coons-introduce-21-billion-emergency-supplemental-to-
address-the-ongoing-covid-crisis-and-other-emerging-diseases.
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FY2022 COVID-19 Supplemental Appropriations for HHS
Table 1. HHS FY2022 Emergency Supplemental Appropriations for
COVID-19 Response
Dollars in Millions
July 28
Rules Senate
Committee Approp.
March 2 Print 117-35 April 4 Cmte. Maj.
HHS Appropriations Account Request (Division M) Senate Draft Draft
HRSA Program Management- 1,500 — — —
Uninsured Fund
CDC Wide Activities and Program 1,050 — — —
Support
PHSSEF: R&D, manufacturing, purchase, 15,700 10,600 10,000 16,000
distribution of vaccines, therapeutics,
diagnostics, and other medical supplies.
NMT for BARDA (13,700) (9,850) (9,250) (9,000)
NLT for therapeutics — (5,000) (5,000) —
NLT for vaccines for emerging — (750) (750) (750)
variants and vaccine manufacturing
NMT for testing (2,000) — — —
Total $18,250 $10,600 $10,000 $16,000
Source: The amounts for March 2 request are from Letter from Shalanda D. Young, Acting Director of OMB,
to Nancy Pelosi, March 2, 2022 at https://www.whitehouse.gov/wp-content/uploads/2022/03/COVID-and-
Ukraine-Supplemental-Funding-Request-Pelosi.pdf; the amounts for Rules Committee Print 117-35 are from U.S.
Congress, House Committee on Rules, Rules Committee Print 117-35, Consolidated Appropriations Act 2022,
committee print, 117th Cong., 2nd sess., March 8, 2022; the amounts for April 4 Senate draft are from Senate
Democrats, “Schumer Statement On $10 Billion COVID Preparedness Funding Agreement,” press release, April
4, 2022, at https://www.democrats.senate.gov/newsroom/press-releases/schumer-statement-on-10-billion-covid-
preparedness-funding-agreement; and the amounts for July 28 Senate Appropriations Committee majority draft
are from the draft FY2023 LHHS text linked at https://www.appropriations.senate.gov/news/majority/breaking-
chairman-leahy-releases-fiscal-year-2023-senate-appropriations-bills.
Notes: Non-adds shown in italics and parentheses. Abbreviations: HRSA: Health Resources and Services
Administration; CDC: Centers for Disease Control and Prevention; PHSSEF: Public Health and Social Services
Emergency Fund Account; R&D: Research and Development; BARDA: Biomedical Advanced Research and
Development Authority; NMT: not more than; NLT: not less than; LHHS: Departments of Labor, Health and
Human Services, Education, and Related Agencies.
Table 2. HHS FY2022 Emergency Supplemental Appropriations for COVID-19
Response: Summary and Comparison of Provisions
July 28
Rules Senate
Committee Approp.
March 2 Print 117-35 April 4 Cmte. Maj.
Provision Request (Division M) Senate Draft Draft
Provisions tied to PHSSEF appropriation
Products purchased with funds √ √ √ √
may be deposited in the SNS.
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FY2022 COVID-19 Supplemental Appropriations for HHS
July 28
Rules Senate
Committee Approp.
March 2 Print 117-35 April 4 Cmte. Maj.
Provision Request (Division M) Senate Draft Draft
Funds may be used for √ √ √ √
construction, alteration, or
renovation of nonfederally
owned facilities for vaccine,
therapeutic, and diagnostic
production.
Funds may be transferred to and √ √ √ √
merged with the Covered
Countermeasure Process Fund.a
HHS Secretary may reallocate or √ — — —
transfer funds to other HHS
appropriations for the purposes
specified.
Secretary must notify ACs of — √ √ √
any obligation in excess of
$50,000,000 at least two days in
advance.
Report to ACs every 30 days — √ √ √
detailing obligations in excess of
$20,000,000 and current
inventory and distribution of
COVID-19 vaccines,
therapeutics, and diagnostics.
Other provisions: transfer and reporting
Funds may be transferred √ — — —
between PHSSEF, CDC, HRSA,
and NIH for specified purposes
with prior notification to ACs.
Funds may restore obligations √ — — —
incurred prior to enactment.
Funds may be transferred — √ √ √
between PHSSEF and NIH for
specified purposes with prior
notification to ACs.
HHS Secretary must provide a — √ √ √
detailed spend plan, which must
be updated and submitted to the
ACs every 60 days.
HHS Secretary must provide — √ √ √
biweekly obligation reports to
the ACs not later than 60 days
after enactment.
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FY2022 COVID-19 Supplemental Appropriations for HHS
July 28
Rules Senate
Committee Approp.
March 2 Print 117-35 April 4 Cmte. Maj.
Provision Request (Division M) Senate Draft Draft
HHS Secretary must provide — √ √ √
monthly reports on obligations
for research, advanced
development, procurement, and
administration activities, and
supply needs projections to
designated committees.
Source: The amounts for March 2 request are from Letter from Shalanda D. Young, Acting Director of OMB,
to Nancy Pelosi, March 2, 2022, at https://www.whitehouse.gov/wp-content/uploads/2022/03/COVID-and-
Ukraine-Supplemental-Funding-Request-Pelosi.pdf; the amounts for Rules Committee Print 117-35 are from U.S.
Congress, House Committee on Rules, Rules Committee Print 117-35, Consolidated Appropriations Act 2022,
committee print, 117th Cong., 2nd sess., March 8, 2022; the amounts for April 4 Senate draft are linked at Senate
Democrats, “Schumer Statement On $10 Billion COVID Preparedness Funding Agreement,” press release, April
4, 2022, https://www.democrats.senate.gov/newsroom/press-releases/schumer-statement-on-10-billion-covid-
preparedness-funding-agreement; and the amounts for July 28 Senate Appropriations Committee majority draft
are from the draft FY2023 LHHS text linked at https://www.appropriations.senate.gov/news/majority/breaking-
chairman-leahy-releases-fiscal-year-2023-senate-appropriations-bills.
Notes: Acronyms (in addition to those noted in Table 1): SNS = Strategic National Stockpile; HHS = Health
and Human Services; NIH = National Institutes of Health; ACs = Appropriations Committees; LHHS:
Departments of Labor, Health and Human Services, Education, and Related Agencies.
a. The Covered Countermeasures Process Fund is the account that funds claims under the Countermeasures
Injury Compensation Program (CICP).
Selected Considerations
Public Availability of Data on COVID-19 Public Health Spending
Throughout the pandemic, real-time publicly available information on COVID-19 public health
spending by appropriated purpose has been limited—due in part to how Congress and the
President appropriated the funding. A large portion of COVID-19 relief funding was appropriated
to the Public Health and Social Services Emergency Fund (PHSSEF) account, including funding
for the Provider Relief Fund, testing, vaccines, and therapeutics, among other purposes.15 The
laws that provided COVID-19 relief funding also included transfer authorities that allow HHS to
shift funds between accounts.16 Providing emergency appropriations to the PHSSEF account
under the Office of the Secretary, in addition to transfer authorities, has allowed HHS some
flexibility to allocate funds to meet emerging needs. At the same time, this practice has
diminished public transparency regarding how much funding has been spent for what purpose.
Official federal spending trackers such as USASpending.gov track spending by agency and
account. When several different appropriations are provided to an account, or when funds are
15 See section on PHSSEF account in CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental
Appropriations in the 116th Congress, and table on American Rescue Plan Act appropriations assigned to the PHSSEF
account at HHS Budget in Brief: FY2022, p. 22, at https://www.hhs.gov/sites/default/files/fy-2022-budget-in-brief.pdf.
16 See “Understanding PHS COVID-19 Supplemental Appropriations” in CRS Report R46711, U.S. Public Health
Service: COVID-19 Supplemental Appropriations in the 116th Congress, coordinated by Kavya Sekar.
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FY2022 COVID-19 Supplemental Appropriations for HHS
shifted between accounts, it is challenging for observers to assess what amount of the
appropriations have been spent for specific purposes as appropriated.
The Government Accountability Office has separately published detailed tables on HHS COVID-
19 funding by agency and activity (e.g., vaccines, testing) in its quarterly CARES Act reports, but
these tables are not current—they reflect data from several months earlier.17 Though not official,
media organizations have published what are reportedly more detailed White House documents
on COVID-19 spending transmitted to Congress.18
It is unclear whether current congressional proposals would improve publicly available
information. Such proposals would continue the practice of providing all of the supplemental
appropriations to the PHSSEF account. Although the proposals would require regular reports to
congressional committees, it is unclear if the reports would be made publicly available. Congress
could also propose long-term solutions to better track HHS public health emergency spending and
require that spending data be made publicly available in useful categories and formats for
analysis.
Policy Considerations
In determining whether and how much funding to appropriate toward public health, Congress
may consider the following issues:
Supply availability and demand: Data regarding ordered and administered
COVID-19 therapeutics and vaccines do not indicate a supply shortage relative to
demand, but this situation may not continue.19 Earlier Biden Administration
projections and some other analyses indicated that already purchased supplies
may not meet projected needs in the fall and winter.20 The Biden Administration
has since announced additional purchases of updated vaccines for early fall, and
supplies of the recently authorized Novavax vaccine have become available.21 A
fall booster campaign with the updated vaccines is expected to begin in
17 See Coronavirus Oversight Reports at https://www.gao.gov/coronavirus.
18 Rachel Cohrs, “White House Documents Detail a Looming Squeeze on Covid-19 Boosters,” STAT, May 6, 2022, at
https://www.statnews.com/2022/05/06/white-house-documents-detail-a-looming-squeeze-on-covid-19-boosters/.
19 For data on therapeutics, see Administration for Strategic Preparedness and Response (ASPR), Cumulative COVID-
19 Therapeutics Ordered and Administered Amounts by Jurisdiction, August 21, 2022, at https://aspr.hhs.gov/COVID-
19/Therapeutics/Orders/Documents/state-data.pdf. For current data on vaccination, see CDC, COVID Data Tracker,
COVID-19 Vaccinations in the United States, at https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-
admin-rate-total.
20 See letter from Biden Administration to Senate Committee on Health, Education, Labor, and Pensions (HELP)
Minority staff, at https://s3.documentcloud.org/documents/21884318/vaccine-projections.pdf, and Jennifer Kates, Josh
Michaud, and Larry Levitt, “Are There Enough COVID-19 Vaccines for America without More Funding?,” Kaiser
Family Foundation, March 25, 2022, at https://www.kff.org/coronavirus-covid-19/issue-brief/are-there-enough-covid-
19-vaccines-for-america-without-more-funding/.
21 HHS, “Biden-Harris Administration Secures 105 Million Doses of Pfizer’s Latest COVID-19 Vaccine for Fall
Vaccination Campaign,” press release, June 29, 2022, at https://www.hhs.gov/about/news/2022/06/29/biden-harris-
administration-secures-105-million-doses-of-pfizers-latest-covid-19-vaccine-for-fall-vaccination-campaign.html, HHS,
“Biden-Harris Administration Secures 66 Million Doses of Moderna’s Variant-Specific COVID-19 Vaccine Booster
for Potential Use in Fall and Winter 2022,” press release, July 29, 2022 at https://www.hhs.gov/about/news/2022/07/
29/biden-harris-administration-secures-66-million-doses-modernas-variant-specific-covid-19-vaccine-booster-for-
potential-use-in-fall-winter-2022.html, and FDA, “Coronavirus (COVID-19) Update: FDA Authorizes Emergency Use
of Novavax COVID-19 Vaccine, Adjuvanted,” press release, July 13, 2022, at https://www.fda.gov/news-events/press-
announcements/coronavirus-covid-19-update-fda-authorizes-emergency-use-novavax-covid-19-vaccine-adjuvanted.
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FY2022 COVID-19 Supplemental Appropriations for HHS
September. Biden Administration operational guidance for the campaign notes
that there will be a “sufficient but finite supply” of vaccines.22 In addition,
several COVID-19 therapeutic products are in late-stage clinical trials and may
become available for purchase later this year.23
Variants: The evolution of SARS-CoV-2 is unknown, which adds uncertainty to
any supply needs projection. Some currently available vaccines and therapeutics
might be ineffective against future variants.24 Some of the proposed funding in
the FY2022 supplemental appropriations proposals would support pan-COVID
vaccine research, which is already supported by the Department of Defense and
NIH.25
Commercialization: To date, the federal government has purchased much of the
U.S. COVID-19 vaccine and therapeutics supply. Congress could consider
whether and when it would be appropriate to stop appropriating specific funds for
federal purchase and distribution, and therefore transition COVID-19 products to
routine health care financing systems. On August 30, 2022, the Administration
for Strategic Preparedness and Response (ASPR) announced plans to
commercialize COVID-19 products, with vaccines and therapeutics transitioning
to the commercial market by early 2023. According to the announcement, the
commercialization plans were “accelerated” given the lack of additional funding
from Congress. The announcement also states that additional funding would
assist with winding down federal procurement and distribution programs.26
Monkeypox outbreak: The public health emergency for monkeypox raises new
questions as supplemental appropriations are considered. As noted, the July 28
proposal from the Senate Appropriations Committee Chair would provide
funding that would be available for both COVID-19 and other emerging threats.
As a separate consideration, many states and other jurisdictions have remaining
funding balances on COVID-19-specific public health grants that they received
from the prior relief laws.27 Congress could consider legislative changes to
expand the possible uses of existing grant funds to other threats.
22 CDC, CDC Fall Vaccination Operational Planning Guide - Information for the Fall Vaccine Campaign, Including
Upcoming Bivalent COVID-19 Vaccine Booster Doses, August 16, 2022, at https://www.cdc.gov/vaccines/covid-19/
downloads/CDC-Fall-Vaccination-Operational-Planning-Guide.pdf.
23 Heidi Ledford, “Hundreds of COVID Trials Could Provide a Deluge of New Drugs,” Science, March 1, 2022, and
BIO, “BIO COVID-19 Therapeutic Development Tracker,” last updated August 1, 2022, at https://www.bio.org/policy/
human-health/vaccines-biodefense/coronavirus/pipeline-tracker.
24 CRS In Focus IF11789, COVID-19 Variants: Vaccines, Diagnostics, and Therapeutics, by Amanda K. Sarata, Agata
Bodie, and Kavya Sekar.
25 Walter Reed Army Institutes of Research, “Preclinical Studies Support Army’s Pan-coronavirus Vaccine
Development Strategy,” press release, December 16, 2021, at https://www.army.mil/article/252890/
preclinical_studies_support_armys_pan_coronavirus_vaccine_development_strategy, and NIH, “NIAID Issues New
Awards to Fund ‘Pan-Coronavirus’ Vaccines,” press release, September 28, 2021, at https://www.nih.gov/news-events/
news-releases/niaid-issues-new-awards-fund-pan-coronavirus-vaccines.
26 ASPR, “COVID-19 Medical Countermeasures and the Commercial Marketplace,” August 30, 2022, at
https://aspr.hhs.gov/ASPRBlog/Pages/BlogDetailView.aspx?ItemID=440.
27 Data on state and local award spending available at Pandemic Oversight, “All Pandemic Awards,”
https://www.pandemicoversight.gov/data-interactive-tools/interactive-dashboards/all-pandemic-awards.
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FY2022 COVID-19 Supplemental Appropriations for HHS
Author Information
Kavya Sekar
Analyst in Health Policy
Acknowledgments
CRS Analyst in Public Health Emergency Management Taylor Wyatt and CRS Research Assistant Sylvia
Bryan assisted with aspects of this report.
Disclaimer
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