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It Is Time to Separate Food Safety from the FDA?

Between the baby formula debacle and longer-than-expected review periods for COVID-19 vaccines, it’s been a rough year for the Food and Drug Administration (FDA).  The extent of the FDA’s problems is reflective of all the different responsibilities the vast agency has, ranging from control and supervision of food safety and tobacco products to pharmaceutical drugs and medical devices.  With the FDA’s plate so full, some policymakers feel splitting off food safety into its own agency is the best way forward.

The latest proposal to split up the FDA is the Food Safety Administration Act.  Introduced by Sen. Dick Durbin (D-IL) and Rep. Rose DeLauro (D-CT), the bill would spin-off the FDA’s food-related responsibilities into a separate Food Safety Administration.  DeLauro has referred to food safety as a “second-class citizen” at the FDA, and both she and Durbin have said creating a separate agency led by a Senate-confirmed food expert would lead to better outcomes for consumers.

They argue that establishing a separate Food Safety Administration would improve food safety and benefit consumers by applying “focused leadership” from a food safety expert capable of providing more accountability.  Additionally, the newly formed agency’s unified structure and direct oversight capabilities would ensure constant attention to food safety issues and more bandwidth to stay on top of foodborne illnesses.

Indeed, policymakers have been discussing the separation of food safety from other FDA-regulated industries for years, or at least instituting reforms that would bolster the agency’s food safety responsibilities.  Here are some key examples from the past 15 years.

  • Some critics called for the FDA to be split into two agencies – one that handles drugs/medical devices and another than handles food safety and cosmetics – in the wake of a salmonella outbreak in 2008.
  • Other approaches have attempted to provide more resources and authorities for the FDA’s food safety arm as a way to bring about change from within.  In 2011, Congress enacted new measures that provided new regulatory programs for food importers, foreign producers, and fresh produce growers.
  • In 2010, the Obama administration established the new position of a deputy commissioner for foods and veterinary medicine to provide direct oversight on food issues.  However, the Trump administration later took away the deputy commissioner’s authority over the agency’s respective policymaking units on food and veterinary medicine.  Notably, neither administration gave the deputy commissioner oversight authority on the agency’s food inspection and import activities.
  • In June 2018, the Trump administration proposed a plan to consolidate the FDA’s food safety functions into a new agency within the US Department of Agriculture (USDA) known as the Federal Food Safety Agency.  The FDA would have been renamed the Federal Drug Administration, but Congress would not extend him the power to reorganize the government. This similarly happened during the Obama administration where the administration put together a similar proposal to fold the FDA’s food inspection and enforcement services into the USDA Food Safety and Inspection Service in 2015.

The FDA is also focusing on ways to improve.  Scrutiny over the agency’s regulation of electronic cigarettes and baby formula prompted the agency to order an external review of its activities on tobacco regulation and food safety.  The review will focus on the agency’s Human Foods Program, which Commissioner Robert Califf said has been stressed from the COVID-19 pandemic.

The Reagan-Udall Foundation, which has been tasked with reviewing the agency, is set to complete its report by the end of September.  While it remains to be seen what the foundation will recommend, breaking up the agency into a separate entity focused on food might be the best move for consumers.  Former Deputy Commissioner for Food Michael Taylor recently wrote that food has been a “low priority” at the agency for decades.  One reason for this is the fact that most FDA commissioners are physicians whose expertise pertains to drugs, meaning they have little time or bandwidth set aside for food.

Another reason for FDA’s second-class status is a lack of sufficient funding.  Over the past 10 years, FDA’s food funding has grown by 42%, while funding for the agency’s drug and device-related programs has increased 122%.

But does the FDA even have to wait for Congress to split it up?   As Taylor argued, the FDA commissioner and the secretary of health and human services (HHS) could use their own authority to unite all the FDA’s food offices under a single deputy commissioner with strong oversight powers.  But until any serious reforms are made, the agency will likely struggle to find a way to give the proper time and attention to its long list of priorities.

What Happened, What You Missed: July 4-8

FDA Allows Pharmacists to Prescribe Paxlovid

Authorized state-licensed pharmacists can now prescribe the COVID-19 antiviral Paxlovid to eligible patients, according to a revised emergency use authorization (EUA) from the Food and Drug Administration (FDA).  The revision will increase access to the medication, which has been a priority of the Biden administration for the past few weeks.  While Paxlovid has shown to be 89% effective in reducing the risk of hospitalization, use of the drug has been lower than expected due to complex eligibility requirements and reduced testing.  The FDA has recommended that pharmacists refer patients for clinical evaluation if not enough information is available to assess possible drug interactions or renal and hepatic function.

BA.5 Becomes Dominant Omicron Subvariant in US

Omicron subvariant BA.5 comprises 53.6% of COVID-19 cases in the US, making it the nation’s dominant strain according to data from the Centers for Disease Control and Prevention (CDC).  A similar subvariant, BA.4, makes up 17% of cases.  Scientists estimate that BA.4 and BA.5 are about three times less sensitive to neutralizing antibodies from existing COVID-19 vaccines than the original Omicron subvariant BA.1, although current vaccines still offer strong protection against hospitalization and death from BA.4/5 infection.  Due to waning vaccine protection, the FDA has recommended that vaccine manufacturers update their shots to specifically target BA.4/5 ahead of a fall booster campaign.

Senate Dems Release Updated Drug Pricing Proposal

On Wednesday, Senate Democrats released legislative text for an updated drug pricing proposal as part of an attempt to revive the reconciliation bill, Build Back Better that failed to move forward last year.  While the text overall matches last year’s initial agreement, key changes include moving the implementation date for drug price negotiations from 2025 to 2026 and requiring Medicare to negotiate prices on as many drugs as possible in order to prevent future Republican administrations from interfering with negotiations.  While there are no agreements on a broader reconciliation package, Senate Majority Leader Chuck Schumer (D-NY) has said that if a deal can be made, a bill could be considered on the Senate floor before August recess.

FDA Weighing Vin Gupta as New Advisor

According to reports, the FDA is considering tapping Dr. Vin Gupta, a pulmonologist and medical analyst for NBC, as a senior advisor to lead the agency’s communications strategy.  The FDA’s decision to consider onboarding a communications expert is likely a response to the criticism over the agency’s messaging on baby formula and COVID-19 vaccines.  Currently a chief medical officer at Amazon, Gupta his risen in prominence as a health commentator over the last two years of the COVID-19 pandemic and helped advise the Biden campaign and transition team on the pandemic response.  If hired, Gupta would be responsible for reforming the FDA’s image as well as guiding the agency’s messaging on vaping and nicotine.

ICYMI: The Reflecting Pool Isn’t a Swimming Pool

Earlier this week, people were spotted taking a dip in the Reflecting Pool on the National Mall in Washington, DC, probably as a respite to the brutal humidity that’s been lingering around the region.  Yesterday, the National Park Service erected a fence around most of the Reflecting Pool – seemingly as a way to keep swimmers out.  This week’s escapades weren’t the first time people have used the Reflecting Pool for something other than its intended purpose – in 2018, some people took to ice skating on the pool during a particularly cold winter.

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What Happened, What You Missed: June 20-24

Moderna Says Updated Vaccine Effective against Omicron Subvariants

Moderna announced on Wednesday that an updated version of its COVID-19 vaccine provides strong protection against a symptomatic infection of the Omicron subvariants BA.4 and BA.5, which are rapidly spreading worldwide.  The updated vaccine candidate is bivalent, meaning it targets both the original version of COVID-19 and the Omicron variant.  The World Health Organization (WHO) labeled BA.4 and BA.5 as “variants of concern” as they are better able to evade immune defenses from previous infections and the current available vaccines.  Moderna is currently manufacturing the bivalent vaccine doses with the hope that they could be employed as a booster in the fall and winter, when experts say COVID-19 cases could spike.

Administration Approves Waiver to Expand Insurance Options in Colorado

Up to 10,000 people in Colorado will soon have access to lower health insurance premiums, according to the Section 1332 Innovation Waiver that the Biden administration approved on Thursday.  The Department of Health and Human Services (HHS) estimates that a combination of additional federal funding and more competition between insurers will allow the Colorado Option to lower premiums by 15% for individuals, families, and small businesses by 2025.  Colorado is also working to establish premium reduction targets for insurers as a way of attracting new consumers to the state’s individual marketplace.  Of note, Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urged Congress to pass legislation that  extends the Affordable Care Act (ACA) premium tax subsidies during a press call on the waiver’s approval.

House Passes Bill to Authorize New Biomedical Research Agency

The House passed (336-85an amended bill to establish the Advanced Research Projects Agency for Health (ARPA-H) as a new biomedical research agency on Wednesday evening.  While the Fiscal Year (FY) 2022 omnibus provided $1 billion in funding for the new agency, separate authorizing legislation is required to fill in key details on the structure and organization of ARPA-H.  Notably, the legislation establishes ARPA-H as an independent agency within HHS, which differs from the administration’s preference of housing the new agency within the National Institutes of Health (NIH).  To ensure bipartisan support, key amendments to the original legislation include capping administrative costs at 15%, limiting the number of program offices to six in order to address concerns over “mission creep,” and the removal of the requirement that the ARPA-H director be confirmed by the Senate.  While members of both parties are eager to make ARPA-H a reality, it remains unclear when the Senate will vote on authorizing legislation.

Senate Passes Gun Safety Legislation

On Thursday night, the Senate approved bipartisan gun safety legislation by a 65-33 vote, clearing the way for a vote in the House later today.  Known as the Bipartisan Safer Communities Act, the bill expands background checks on gun buyers 21 and younger to include their mental health and juvenile justice records.  It would also expand current law to prevent people from buying guys if they have previously abused a current or former romantic partner and incentivize states to create laws to seize guns from people who are deemed a danger to the community.   Additionally, the measure includes millions of dollars for mental health, school safety, and crisis intervention programs.

ICYMI: Smithsonian Selects 4 Possible Sites for New Museums

The Smithsonian has narrowed down its choices to four possible locations for the future National Museum of the American Latino and the Smithsonian American Women’s History Museum. These four site locations include the Arts and Industries Building, a section of undeveloped land north of the Reflecting Pool, an undeveloped lot next to the National Museum of African American History and Culture, and an undeveloped section of land along Maine Avenue SW and the Tidal Basin.  To decide on a final location for each museum, all four sites will go through an evaluation process to determine environmental impact, accessibility, and other factors.

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What Happened, What You Missed: May 23-27

Pfizer’s COVID-19 Vaccine Is 80% Effective in Kids under 5

This week, Pfizer finished submitting clinical trial data to the Food and Drug Administration (FDA) to seek emergency approval of its three-dose COVID-19 vaccine for children ages six months to five years.  On Monday, the company announced that its vaccine is 80.3% effective in preventing against symptomatic COVID-19 in young children.  The FDA is expected to complete its review of both Pfizer and Moderna’s emergency use authorization (EUA) applications within days of each other, and an advisory committee is scheduled to meet on June 15 to review data on both companies’ vaccines.  If the independent committee recommends one or both vaccines, young kids could get their first shots as soon as late June.

Senators Release Bipartisan Telehealth Proposal Aimed at Improving Mental Health

On Thursday, a bipartisan group of Senate Finance Committee members released a discussion draft on telehealth politics intended to improve mental health care.  The discussion draft includes policies that would direct Medicare and Medicaid to promote and support provider use of telehealth, remove Medicare’s in-person visit requirement for mental health services, and preserve access to audio-only mental health coverage in Medicare under certain circumstances.  The Senate Finance Committee is among four congressional committees that have so far committed to advancing legislation to improve mental health care.  Lawmakers behind the mental health legislation were initially hoping to combine their respective measures into a package that can be enacted this summer, but staffers and lobbyists say unfinished work on Fiscal Year (FY) 2023 appropriations and a busy campaign season means a comprehensive mental health package probably won’t be signed into law until the end of the year.

Becerra Taps Adam Russell as Acting Deputy Director of ARPA-H

Health and Human Services (HHS) Secretary Xavier Becerra on Wednesday appointed Adam H. Russell, DPhil, to be acting deputy director of the Advanced Research Project Agency for Health (ARPA-H).  Set to start his new role in June, Russell will be tasked with building out the administrative structure of the new agency and hiring initial staff until President Joe Biden appoints an ARPA-H Director.  Currently the chief scientist at the University of Maryland’s Applied Research Laboratory for Intelligence and Security, Russell gained experience managing research projects at both the Intelligence Advanced Research Projects Activity (IARPA) and the Defense Advanced Research Projects Agency (DARPA) – two agencies focused on breakthrough technologies that served as an inspiration for creating ARPA-H.

Of note, Becerra also formally established ARPA-H on Wednesday as a separate agency within the National Institutes of Health (NIH).  Many lawmakers have disputed the administration’s decision to place ARPA-H within NIH because they say it will prevent the new agency from fostering an independent culture that’s necessary for innovation.  Last week, a House committee advanced an authorization bill that would establish ARPA-H as an independent agency within HHS.

Lawmakers Take Another Swing at Gun Control Reform

In the wake of the mass shooting at a Texas elementary school, members of Congress are making another attempt at reaching a deal on gun control legislation.  Instead of starting out with a House-passed background check bill that faces no chance of being considered in the Senate, bicameral, bipartisan leaders are starting fresh.  Senate Majority Leader Chuck Schumer (D-NY) and Majority Leader Dick Durbin (D-IL) are tapping Sens. Chris Murphy (D-CT) and Kyrsten Sinema (D-AZ) to reach out to Republicans, while Senate Republican Leader Mitch McConnell (R-KY) has asked Sen. John Cornyn (R-TX) to have conversations with Democrats.  However, it remains unlikely that both parties will make a breakthrough on gun legislation in the 50-50 Senate, especially in the months leading up to a contentious midterm election.

ICYMI: New Graphic Novel Tells Story of Former Congressman

This month marks the release of Smahtguy, a graphic novel that details the life of former Rep. Barney Frank (D-MA).  The graphic novel’s author is a Disney cartoonist-turned-staffer who chronicled his time working for Frank in a sketchbook for nearly two decades.  Among the first members of Congress to publicly identify as gay, Frank was a leading progressive who was best known for leading the Dodd-Frank financial reform package in the wake of the 2008 financial crisis.

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What Happened, What You Missed: May 16-20

FDA Authorizes Pfizer COVID-19 Booster Shots for Kids Ages 5-11

On Tuesday, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for a third “booster” dose of Pfizer’s COVID-19 vaccine for children ages 5 to 11 at least five months after their most recent shot.  The FDA decided to authorize a third dose because data increasingly shows that a booster can improve protection for children in this age group and that the benefits of a booster outweigh the risks.  While COVID-19 tends to be less severe in children than adults, a top FDA official noted in a press release that the Omicron variant has caused more kids to be infected and subsequently hospitalized, justifying the need for additional protection.  Two days later, a Centers for Disease Control and Prevention (CDC) advisory panel voted to recommend a third dose of Pfizer’s vaccine to children ages 5 to 11.

House Committee Advances Legislation on FDA User Fees, ARPH-A

The House Energy and Commerce Committee advanced legislation to reauthorize the FDA medical product user fee programs Wednesday alongside five other health care bills.  The current statutory authority for the FDA to collect user fees expires on September 30, 2022, and it remains unknown as to when the full House will vote on the user fee bill.  Of note, a Senate panel on Wednesday unveiled its own legislation to reauthorize FDA user fee collection.  Among the other bills the House committee advanced on Wednesday was legislation to authorize the Advanced Research Projects Agency for Health (ARPA-H).  Notably, this legislation goes against the Biden administration’s wishes of making ARPA-H a part of the National Institutes of Health (NIH), instead making it an independent agency within the Department of Health and Human Services (HHS).

Administration Offers Third Round of Free COVID-19 Tests

The White House announced on Tuesday that households can now order a third round of free at-home rapid COVID-19 tests at COVIDTests.gov.  Unlike the first two rounds that limited households to four test per order, the third round will provide eight tests per household.  To date, the administration has delivered 350 million tests to more than 70 million households across the nation.  The administration’s announcement comes as the nation sees a rise in case numbers driven by the BA.2.12.1 subvariant.

Administration Poised to Renew Public Health Emergency in July

The current COVID-19 public health emergency (PHE) is set to expire on July 16, 2022.  In recent weeks, HHS Secretary Xavier Becerra reiterated the administration’s commitment on multiple occasions to provide 60 days’ notice before letting the PHE expire.  However, the 60-day mark came and went earlier this week, meaning the administration is all but certain to renew the PHE come mid-July.  Numerous waivers are tied to the end of the PHE, including telehealth flexibilities under Medicare as well as a prohibition against states disenrolling people from Medicaid.

ICYMI: Lawmakers Hold First Hearing on UFOs in 50 Years

On Tuesday, top Pentagon officials testified before a House Intelligence Subcommittee on unidentified aerial phenomena (UAPs) – the military’s parlance for unidentified flying objects (UFOs) – marking the first public hearing on the subject in over a half-century.  During the hearing, top Defense Department officials promised to bring transparency to an ongoing investigation of reports of UAPs by military pilots and other personnel at the urging of lawmakers who were disappointed by the secrecy and confusion that have consistently plagued the investigation into UAPs thus far.  The Pentagon officials also testified under oath that the government had not collected materials from any extraterrestrial landings on Earth.

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