The demise of Roe v. Wade would make the need for effective birth control more urgent than ever. Yet many American women still have a hard time obtaining it.ROLLA, Mo. — For more than half a century, Tri-Rivers Family Planning has operated on a shoestring budget, providing contraceptives, pregnancy testing, treatment for sexually transmitted diseases and other reproductive health care to a mostly low-income and female clientele here in the Ozark Mountains.The clinic has never performed abortions. But with the Supreme Court widely expected to revoke the constitutional right to abortion that it established in Roe v. Wade, its work has never been more essential — and its nurse practitioners and patients have never felt more threatened.Last year, the Republican-led Missouri Senate voted to ban taxpayer funding for two common methods of preventing pregnancy: intrauterine devices and emergency contraception — the so-called morning-after pill, also known as Plan B — which many abortion opponents regard as “abortifacients” because they can prevent a fertilized egg from implanting in a woman’s uterus. Lawmakers later abandoned the effort, but some have indicated that if Roe falls, they may try again.“The attacks are relentless — any little angle they can chip away at what we do, they are doing it,” said Lisa Ecsi Davis, the clinic’s director of operations, who has worked at Tri-Rivers for 30 years. “It’s exhausting.”The demise of Roe would make the need for effective birth control more urgent than ever. Yet nearly six decades after the Supreme Court guaranteed the right to use contraception, and more than 10 years after the Affordable Care Act mandated that private insurers cover it, many American women still have a hard time getting access.Lisa Ecsi Davis, the director of operations, has worked at the clinic for 30 years.Whitney Curtis for The New York TimesFunding for Title X, the federal safety net program that helps finance family planning clinics like Tri-Rivers, has been flat for more than a decade. Private insurers do not always cover the full cost of contraception, despite the A.C.A. requirement. Six states allow pharmacists to refuse to fill birth control prescriptions for religious or moral reasons, without taking steps to help patients get them filled elsewhere.“This is our daily life,” lamented Rachel Goss, the executive director of the Family Planning Council of Iowa, which administers Title X grants in that state. “You’re fighting this constant uphill battle just to provide safe — and right now, legal — care.”Congressional Democrats, sensing a potent political issue in the upcoming midterm elections, are pushing to expand access to birth control.Last week, they introduced legislation to require insurers to fully cover any F.D.A.-approved birth control pills, including emergency contraception, which costs as much as $50 over the counter — far too much for those struggling financially. Read More on the U.S. Abortion DebateEvolving Language: As they fight for abortion rights, progressive groups and organizations are adopting more inclusive terms, such as “pregnant people” and “cheastfeeding.”Sports: The end of Roe v. Wade could have far-reaching implications for college athletes across the nation — and Oklahoma’s mainstay softball championships in particular.Without Exception: While most of the population supports carve-outs allowing abortions in cases like rape or incest, many of the bans that would go into effect after Roe do away with them.Mental Health: Anti-abortion groups argue that having an abortion can affect a woman’s mental health. But a new study shows that being denied one can be more harmful.But some Republicans on the far right have sought to broadly limit access to emergency contraception, which prevents pregnancy when taken within several days of unprotected sex.“The idea that we might now be facing fights on contraception is something that is very hard to wrap your head around,” said Elizabeth Nash, an expert in state policy at the Guttmacher Institute, a research group that supports abortion rights. If abortion opponents persuade lawmakers to define pregnancy as starting at fertilization, she said, it “could cause complications in being able to provide contraceptive care.”Texas already bars its state family planning programs from paying for emergency contraception. Missouri, one of 13 states with “trigger laws” that would immediately ban abortion if Roe is overturned, is becoming another front in the battle over birth control — and may foreshadow what is to come in a post-Roe world.In February, it became the fourth state — after Arkansas, Mississippi and Texas — to eject Planned Parenthood, a major provider of birth control nationally, from its Medicaid program. Planned Parenthood has asked the Biden administration to intervene, saying the move violated federal law. A spokeswoman for the federal Centers for Medicare and Medicaid Services said the agency was “considering the policy options within its authority.”Pamphlets for family planning were displayed at the clinic.Whitney Curtis for The New York TimesIn the meantime, Medicaid patients must find care elsewhere — and often endure long waits for appointments, said Michelle Trupiano, the executive director of the Missouri Family Health Council, the nonprofit that administers Title X grants in the state.Here in Rolla, a small city of about 20,000 people that sits along historic Route 66, Hailey Kramer, the chief nurse practitioner at Tri-Rivers, said her patients make clear that birth control is a deeply personal decision.Kaitlyn Ball, 24, became pregnant while taking birth control pills and now has a 3-year-old; she does not want to get pregnant again. After consulting with Ms. Kramer, she got an I.U.D.Taylor Gresham, a 25-year-old dancer, has been a patient at Tri-Rivers since the summer before her senior year in high school, when she discovered she was pregnant. After she got an abortion, the clinic provided her with Depo-Provera. Her mother thought it was a good idea, she said, because “a high school kid is probably not going to take a pill every day.”After she graduated, Ms. Gresham opted for an I.U.D.; more recently, she started taking birth control pills again. “I’m on a better routine with my life,” she explained.In 1965, in a case that provided the legal blueprint for Roe, the Supreme Court declared that married couples had a constitutional right to use contraception. Its decision in the case, Griswold v. Connecticut, established a right to privacy that the court said was implied, if not delineated, in the “penumbras” of the Constitution — the same rationale it invoked eight years later in Roe.Kaitlyn Ball, 24, became pregnant while taking birth control pills. After consultation she got an I.U.D.Whitney Curtis for The New York TimesGriswold put contraception at the forefront of the national conversation at a time when policymakers were focused on ending poverty; in 1969, President Richard M. Nixon declared that “no American woman should be denied access to family planning assistance because of her economic condition.” Title X was established by Congress the next year to help pay for the care that so-called family planning clinics provide to low-income patients, who are charged fees based on family size and income.Old newspaper clippings show that Rolla’s mayor came to the ribbon-cutting when Tri-Rivers — initially an affiliate of Planned Parenthood — was founded in 1971, and more than 100 Rolla merchants made donations to get the clinic going.Last year, Tri-Rivers cared for more than 1,800 patients, more than half of whom were uninsured. The clinic gets $250,000 a year, just under half its total budget, in Title X dollars — an amount that has “stayed the same for many years,” said Toni Stubblefield, its president and chief executive.The clinic, which serves roughly a 10-county area and sits halfway between St. Louis and Springfield, once had two satellites. One closed years ago, the other last year, a victim of tight budgets and Covid-19.The State of Roe v. WadeCard 1 of 4What is Roe v. Wade?

WASHINGTON — President Biden and other leaders issued an urgent call on Thursday for the world to step up its fight against Covid-19, and countries including Germany, Canada and Japan pledged large sums to finance tests, therapeutics and vaccines — a commitment Mr. Biden could not make because Congress has refused to authorize new pandemic aid.As the United States approached a harrowing milestone — one million American lives lost to the virus — fear of another deadly variant loomed large over the president’s second global Covid-19 summit, a virtual gathering co-hosted by Belize, Germany, Indonesia and Senegal. But some countries were notably absent. China, in the thick of its own Covid crisis, did not attend. Russia, waging war against Ukraine, was not invited.Senior Biden administration officials said the summit produced more than $3 billion in commitments toward the global response and toward efforts to prevent future pandemics. That is far short of the $15 billion that the World Health Organization says is needed. But the summit did lay the groundwork for a new global preparedness fund.The gathering on Thursday unfolded in a very different climate compared with that of the first Covid summit in September. The war in Ukraine is sapping energy and money from donor nations. The global vaccination campaign has stalled. Testing has plummeted around the globe. Covid antiviral pills, available in the United States, are scarce in many low- and middle-income nations. Many attendees said Covid fatigue had become as big a danger as Covid itself.“There’s still so much left to do; this pandemic isn’t over,” Mr. Biden said in his opening remarks, adding, “We have to prevent complacency.”Global coronavirus cases by regionThis chart shows how reported cases per capita have changed in different parts of the world.

A group of former heads of state and Nobel laureates are calling on the United States to immediately commit $5 billion to combat the global coronavirus pandemic, and activists are pressing President Biden to take a more forceful leadership role in the response as he convenes world leaders for a Covid-19 summit on Thursday.“I want America to recognize that the disease is not over anywhere until it’s over everywhere,” Gordon Brown, the former British prime minister, who is leading the push for funding, said in an interview Monday, adding, “We must not sleepwalk into the next variant.”But Mr. Biden conceded Monday afternoon that “much needed funding” for the Covid-19 response is not coming anytime soon. In a statement issued by the White House, the president said he had been informed by congressional leaders in both parties that including the funding in a new aid package for Ukraine would “slow down action on the urgently needed Ukrainian aid,” and that he was resigned to having the two packages move separately.“However let me be clear: As vital as it is to help Ukraine combat Russian aggression, it is equally vital to help Americans combat Covid,” Mr. Biden wrote, adding that both the domestic and the global response would suffer if the funding is not approved.Mr. Biden has asked Congress to authorize $22.5 billion in emergency coronavirus aid, including $5 billion for the global pandemic, but the request has stalled on Capitol Hill. A compromise proposal for $10 billion in emergency aid includes no money for the global response, meaning Mr. Biden will almost certainly arrive at his own summit empty-handed. Mr. Brown said in the interview that his appeal is intended to place pressure on Congress to release the funds.The White House said Monday that Mr. Biden will address the summit, and that Vice President Kamala Harris and Dr. Ashish K. Jha, the coronavirus response coordinator will also participate. Both Dr. Jha and Mr. Biden have been working behind the scenes to press lawmakers to authorize the funding, officials said.The summit, a virtual gathering that will be co-hosted by Belize, Germany, Indonesia and Senegal, is aimed at reinvigorating the global response. The need is urgent: The drive to vaccinate the world is losing steam; testing has plummeted around the globe and efforts to bring tests and Covid antiviral pills to low- and middle- income nations are stalled, running into obstacles that recall battles fought 20 years ago around H.I.V.Mr. Brown, now the World Health Organization’s ambassador for global health financing, said he is also encouraging leaders of other wealthy nations to make funding commitments. He is the lead author on a letter to the president whose signatories also include Mary Robinson, a former president of Ireland; Helen Clark, a former prime minister of New Zealand; and Joseph Stiglitz, the Nobel Prize-winning economist.“Mr. President — your leadership can revive the global Covid-19 response,” they wrote, adding that “our wholehearted hope is that your administration will step up to provide leadership on financing the global response, encouraging other countries to follow you, as is both urgent and necessary to help save lives across the world.”Global health officials are increasingly concerned about what many are calling “Covid fatigue,” as world leaders deal with crises like the war in Ukraine, or turn to other pressing health concerns.“Donors are predominantly saying, ‘Oh, we want to get back to, you know, whatever it was that they prefer funding like maternal child health, H.I.V., T.B., whatever it is, and they’re saying that there’s a reduced appetite for Covid,” said Dr. Fifa A. Rahman, an adviser to ACT-Accelerator, the consortium backed by the W.H.O. that is leading the global response.The summit is a follow-up to one Mr. Biden convened in September; he will use the gathering to ask wealthy nations to step up their financial contributions for vaccines, tests and treatments. Specifically, he will call on developed nations to donate $2 billion to purchase Covid treatments and $1 billion to purchase oxygen supplies for low- and middle-income countries, according to a senior administration official involved with the planning.The United States, working with international organizations, has donated more vaccine doses than any other nation to the global vaccination effort. Mr. Biden has pledged 1.2 billion doses to other nations; as of Monday, more than 539 million had been shipped, according to the State Department. But countries receiving the doses have had difficulty getting those shots into arms.Activists and advocacy groups are increasingly impatient. Organizations including Public Citizen, the consumer health and safety nonprofit; Prep4All, an AIDS advocacy group; and HealthGAP, a global health advocacy group that operates in Uganda, are circulating a petition that blasts the United States government — though not Mr. Biden personally — for a “lack of leadership” that “is alarming and shortsighted.”The petition urges the president to “act with reinvigorated urgency” and lays out specific demands, including working with international institutions and donor countries to “mobilize $48 billion this year to get the global response on track” and pressing drugmakers to share their intellectual property and technological know-how, not only for vaccines but also for Covid antivirals, which are plentiful in the United States, but not widely available in low- and middle-income countries.“The administration is not spending political capital to demand that Congress act,” Asia Russell, the executive director of Health GAP, said in an interview, adding, “What we know from the global AIDS response is that decades were wasted dithering. Those wasted years translated into human lives lost. President Biden and his Covid chiefs, they have the power to change history.”The administration wants international intellectual property rules to be waived to facilitate the generic manufacture of vaccines. But the waiver request is stalled at the World Trade Organization and does not extend to treatments, drawing objections from a coalition of 170 groups led by Trade Justice Education Fund, a nonprofit that works to advance equitable trade policy.“Americans and people around the world continue to suffer not only preventable deaths and long-term health consequences, but also disruptions to economic activity and global supply chains,” the groups wrote in a letter addressed to Mr. Biden’s trade representative, Katherine Tai, adding “We need every possible tool to overcome barriers and improve equitable access to Covid-19 medical products.”

The antiviral pills, plentiful in the United States, are scarce overseas. Health groups and the White House want to expand access but face obstacles that evoke the H.I.V. epidemic.WASHINGTON — A devastating virus was laying waste to nations that lacked medicines available to Americans. The pills were patented and pricey. Poor countries lacked refrigeration to store them, the thinking went, and patients would not be able to follow the complex dosing regimen.The year was 2002, the virus was H.I.V., and the president, George W. Bush, secretly sent his top health advisers to Africa to investigate what activists were calling “medical apartheid.” In the 20 years since, the United States has led the way in building a global infrastructure for H.I.V. testing and treatment, saving an estimated 21 million lives.Now, with that history in mind, global health agencies and the Biden administration are working to bring coronavirus tests and expensive antiviral pills to low- and middle-income nations. This week, President Biden will emphasize “global test to treat” at his second international Covid-19 summit, a virtual gathering of world leaders aimed at injecting new energy into the international pandemic response.Until now, the response has been focused largely on vaccinations, which remain a high priority. But Mr. Biden will also use the summit to call on wealthy nations to donate $2 billion to purchase Covid treatments and $1 billion to purchase oxygen supplies for low- and middle-income countries, according to a senior administration official involved with the planning.In the United States, where antiviral pills to combat Covid are widely available, Mr. Biden’s “test to treat” initiative lets many patients go to pharmacies, get tested for Covid and receive a free prescription on the spot if they test positive. In low- and middle-income nations, such efforts will most likely be much more limited until generic pills arrive, probably in 2023.But the global effort faces some of the same obstacles and inequities that existed two decades ago.Rich nations, including the United States, have gobbled up much of the supply. Global health agencies do not have the money to buy the antivirals or tests, which are crucial because the medication needs to be started early in the course of infection. Drug companies, trying to protect their patents, are limiting the supply of generic alternatives in many middle-income countries, including an entire swath of Latin America.All of this is playing out against the infectious disease equivalent of a ticking time bomb.“We all expect a major new surge from Omicron or a new variant in the global south from June to September, and if that happens, we are not going to be ready with test and treat,” said Dr. Bill Rodriguez, who runs the testing arm of the ACT Accelerator, the Geneva-based consortium coordinating the global response. “It feels extremely similar — painfully, ironically, tragically similar — to what happened with H.I.V.”On Monday, ahead of the summit, the consortium, which is backed by the World Health Organization, is set to convene a discussion of global health experts and declare access to testing and treatment an “equity issue,” officials said.Mr. Biden may well show up at his own summit empty-handed. The White House has asked Congress for an additional $22.5 billion in emergency coronavirus aid, including $5 billion for the global response, but Senate Republicans are refusing to authorize any funding unless it is offset by cuts to other programs. A $10 billion compromise proposal includes no money for the global response, and it is unclear when or whether that plan will come up for a vote.“Here we are with another virus that’s creating havoc all over the world,” said Gayle Smith, who ran the State Department’s global Covid response under Mr. Biden and is now chief executive of the One Campaign, an advocacy organization. “Maybe it’s not as lethal as H.I.V., but it’s still pretty bad. And we’ve got therapeutics. How are we going to think about this? Are we going to take the lessons learned and have a plan?”One of the biggest hurdles is the rapid decline of Covid testing around the world. The W.H.O.-backed consortium recently reported that just 20 percent of the 5.7 billion tests conducted globally have been in low- and middle-income nations. Low-income countries accounted for less than 1 percent of the testing. The reasons are twofold: Countries lack money to buy the tests, and demand has dropped in regions where Covid rates are now low.“What really worries me is the testing part of this,” said Dr. Bruce Aylward, a top W.H.O. official and the consortium’s coordinator. “If you’re not testing, you can’t sequence, you can’t isolate, you can’t treat. Everything else unravels.”Paxlovid, the more powerful of the two Covid antiviral pills approved by the Food and Drug Administration, is so plentiful in the United States that pharmacies are struggling to use up their supplies. The Biden administration has committed to purchasing 20 million treatment courses for Americans.The W.H.O. recently issued a “strong recommendation” that Paxlovid, which is made by Pfizer, be given to patients at high risk of hospitalization and called for its “wide geographic distribution.” The W.H.O. has given a far weaker “conditional recommendation” to the other drug, molnupiravir, which is made by Merck and is not nearly as in demand.Paxlovid is so plentiful in the United States that pharmacies are struggling to use up their supplies.Alex Welsh for The New York TimesGlobal health experts say both companies have absorbed the lessons of AIDS — but only to a point.They have each agreed to allocate several million courses of treatment — a total of seven million courses in all — to UNICEF for distribution in most low- and middle-income countries, which account for more than half the world’s population. But UNICEF will not be able to buy the drugs unless it can raise the money to do so or countries supply the funds. And seven million courses is hardly enough to address the need, experts say.The cost to UNICEF of Paxlovid — including Pfizer’s insistence that UNICEF keep how much it pays confidential — remains a sticking point, said Dr. Philippe Duneton, who runs the therapeutics arm of the W.H.O. consortium. In announcing its “strong recommendation” for Paxlovid, the W.H.O. took the highly unusual step of publicly scolding Pfizer for a “lack of transparency,” which makes it difficult to know which countries have the drug and what they are paying.“We need to have better visibility in terms of price,” Dr. Duneton said.Manufacturers often prefer that the details of their sales agreements be secret so as not to weaken their hand with other potential buyers. Pfizer’s chief executive, Albert Bourla, reported last week that Paxlovid had been a “key growth driver” for the company, which is using a “tiered pricing approach” in which low- and lower-middle-income countries will get Paxlovid at a not-for-profit price.In response to an inquiry from The New York Times, Pfizer issued a statement saying that it was “deeply disappointed by the sentiment expressed by our partners,” adding, “We have in good faith heard and responded to many of their concerns.”Both Pfizer and Merck have also taken steps to make inexpensive generic versions of their pills available, signing licensing agreements with the Medicines Patent Pool, which was created during the global AIDS crisis to bring drugs to low- and middle-income nations at low cost. It took years, and bitter fights between activists and companies, to reach such agreements for H.I.V. drugs.But the agreements for Covid antivirals do not apply to many middle-income nations, including much of Latin America and parts of northern Africa and Asia. The result, experts say, is that both poor and rich nations will have access, but countries in the middle will have to negotiate with the companies — or force the drugmakers to turn over their intellectual property.So far, 36 companies from 12 countries have signed up to make generic Paxlovid. Companies in India are already making generic versions of both Paxlovid and molnupiravir. The expectation is that both drugs will ultimately be available in about 100 low- and middle-income countries, covering about half the world’s population. The companies will not receive royalties from the sales while the W.H.O.’s declaration of the pandemic as a global health emergency remains in effect.“Given the severity of the pandemic and given the fact that vaccines had a very uneven penetration rate, we felt that this was a very important contribution the company could make,” said Paul Schaper, executive director for global public policy at Merck.But those generics will not be available until next year. In the meantime, doctors and activists around the world say vulnerable patients are dying as antiviral pills, monoclonal antibodies and even oxygen remain out of reach. In countries with low vaccination rates, the need is especially urgent.In Uganda, Dr. Sabrina Kitaka, a pediatrician who also advises the government on Covid-19 vaccination, said many children with underlying conditions — sickle cell disease, diabetes, advanced H.I.V. disease — have had complications from Covid-19. She has lost young patients who would have been eligible for Paxlovid, which is approved in the United States for children 12 and older who weigh at least 40 kilograms, or about 88 pounds.“Paxlovid will be the game changer,” Dr. Kitaka said. That is especially true “for patients who become critically ill and end up in the I.C.U.,” she added.In the Dominican Republic, Pfizer is fighting a petition for the government to compel the company to share its patents for Paxlovid with generic makers. Similar petitions have been filed in Colombia, Chile and Peru.“Both Merck and Pfizer have reserved for themselves all the high-income countries and virtually all of the upper-middle-income countries and even some lower-middle-income countries,” said Brook Baker, a law professor at Northeastern University who has submitted a legal brief in support of the Dominican Republic petition.Receiving a Covid vaccine in Kathantha Yimbo, Sierra Leone, in February. In countries with low vaccination rates, the need for antiviral pills and tests is especially urgent.Finbarr O’Reilly for The New York TimesIn Brazil, regulators have authorized both Paxlovid and molnupiravir. The country and Pfizer are negotiating a purchase agreement so Paxlovid can be offered for free through Brazil’s public health system.But a quarter of Brazilians have private insurance and may already have access to the drug, said Felipe Carvalho, coordinator of the Doctors Without Borders Access Campaign in Latin America.“We have a world divided between treatment for the rich and treatment for the poor, still today,” Mr. Carvalho said, adding, “We are still struggling 20 years, 30 years after the H.I.V.-AIDS crisis to convince companies to do the right thing.”In 2003, after he sent top government health experts, including Dr. Anthony S. Fauci, to Africa, Mr. Bush created PEPFAR, the President’s Emergency Plan for AIDS Relief, which supports clinics, medical personnel and community health workers.Dr. Deborah L. Birx, who ran PEPFAR for seven years and also served as President Donald J. Trump’s coronavirus response coordinator, said that Covid vaccination campaigns relied on the program’s infrastructure and networks and that a “test to treat” effort could too. Delivering drugs in Africa can be easier than in the rural United States, she said.“Unlike the United States,” Dr. Birx said, “we have shown that we can deliver drugs to the far end of the road, no matter where people live.”Leaders of the ACT Accelerator consortium are eager to get started. They have plans to expand rapid testing in 20 “priority countries,” mostly in Africa, and to run pilot “test to treat” programs in 10 nations. But both initiatives are in limbo because of a lack of money and a separate reason that officials find even more troubling: a sense of pandemic fatigue in nations whose leaders have other pressing priorities.“We have never been more ready to roll out global testing and treatment for any disease than we are for Covid right now,” said Dr. Rodriguez, who runs the consortium’s testing arm. But the halting pace saddens him: “It’s painful. It’s really painful.”

The strategy is supposed to help the nation transition to what some are calling a “new normal,” but it will require funding from Congress.WASHINGTON — The White House unveiled its long-awaited new coronavirus response strategy on Wednesday, aimed at turning the corner on the worst public health crisis in a century while also preparing for the next threat.The plan, meant to help the United States transition to what some are calling a “new normal,” has four main goals: protecting against and treating Covid-19; preparing for new variants; avoiding shutdowns; and fighting the virus abroad.But there is a big hitch: Much of the plan requires funding from Congress. The administration recently told congressional officials it could need as much as $30 billion to sustain the pandemic response. One outside adviser to the White House, Dr. Ezekiel Emanuel, said in an interview that the United States needed to spend much more — on the order of $100 billion over the next year, and billions more after that — to be fully prepared.“Congress has to think of this as an investment in biosecurity for the country,” said Dr. Emanuel, who led a team of experts in developing a far-reaching coronavirus response plan that it shared with the White House. “We should not be penny-wise and dollar-foolish.”The strategy comes on the heels of the president’s State of the Union address on Tuesday night and as new U.S. cases decline, though deaths remain high. President Biden used the speech to spotlight a key component: a new “test to treat” initiative that he said would allow Americans to get tested at a pharmacy and, if they are positive, “receive antiviral pills on the spot at no cost.”Many of the other initiatives in the strategy — including a plan to accelerate research so that vaccines can be developed and deployed within 100 days of variants arising, which was announced in November — are not new. But taken together, they amount to a blueprint for the next phase of the response.“Make no mistake, President Biden will not accept just ‘living with Covid’ any more than we accept ‘living with’ cancer, Alzheimer’s or AIDS,” the plan declares. “We will continue our work to stop the spread of the virus, blunt its impact on those who get infected, and deploy new treatments to dramatically reduce the occurrence of severe Covid-19 disease and deaths.”The health secretary, Xavier Becerra, who has been criticized for keeping too low of a profile, made a rare appearance on Wednesday alongside the health officials who hold the weekly White House briefings.Mr. Becerra highlighted another element of the plan: boosting research into long Covid, the long-term symptoms some people experience after infection. He pledged to open “new centers of excellence” around the country to provide high-quality care to long-Covid patients — which will also require congressional buy-in.A bipartisan group, led by two former governors, has been pressing Mr. Biden to do more for tens of thousands of children in the United States who have lost parents or caregivers to Covid-19, and the White House apparently listened. The plan says the president will direct federal agencies to review their programs to formulate a more coordinated “bereavement response” for such children, who now number around 200,000.“This is all part of our commitment to be there for Americans who have long-term physical and mental health needs caused by Covid,” Mr. Becerra said.The idea behind the strategy is to get the nation out of crisis mode and to a place, Mr. Biden has said, where the virus will no longer disrupt everyday life. It includes a pledge for the administration to work with Congress to “give schools and businesses guidance, tests and supplies to stay open, including tools to improve ventilation and air filtration.”In interviews, experts generally praised the plan as a good step forward. Dr. Rick Bright, the chief executive of the Rockefeller Foundation’s Pandemic Prevention Institute, called it a “great start,” adding that the plan should “serve as a firm foundation to build upon, to extend our preparedness posture beyond Covid.”But Jay A. Winsten, the director of the Harvard Initiative on Media Strategies for Public Health, said the 100-day timeline for vaccine development might not be fast enough for a highly transmissible variant like Omicron. The first Omicron sample was collected in South Africa on Nov. 8, he said; the United States reached the peak of the Omicron wave just 67 days later, on Jan. 14.Mr. Biden came into office more than a year ago with a 200-page plan to combat the pandemic, which was the most pressing challenge in his nascent presidency. But a lot has changed since then.The Coronavirus Pandemic: Key Things to KnowCard 1 of 3A new U.S. strategy.

The White House, intensifying its efforts to develop a new coronavirus strategy, is evaluating a blueprint by outside experts whose recommendations include stronger air filtration systems in public buildings, billions of dollars in research and a major upgrade to the nation’s public health system.The team of more than two dozen experts was led by Dr. Ezekiel Emanuel, a University of Pennsylvania bioethicist who advised President Biden’s transition team. The group includes former federal officials who have served presidents of both parties. They have spent much of this week meeting behind closed doors with government scientists and top health officials.The New York Times obtained a draft copy of their 136-page plan from a person involved in the sessions, who said the White House has asked the Emanuel team to provide cost estimates for some of its recommendations.Entitled “Getting to and Sustaining the Next Normal: A Roadmap for Living With Covid,” the plan strikes the same “Things are getting better but we’re not out of the woods yet” tone that the president himself has adopted in recent weeks. It provides a guide for bringing the nation out of crisis mode at a time when, the authors write, the United States is still “far from a normal situation.”“The mood of the American public, the demands of the economy and society, and the challenges posed by a virus that constantly surprises the experts pose new and unique challenges,” the authors wrote. “Trying to eliminate Covid is not realistic. Instead, the nation must plan to mitigate its effects, prepare for variants, and build towards a next normal.”White House officials emphasized that Mr. Biden’s coronavirus response team has been engaged for weeks in discussions with governors, business leaders and health experts on how to revise its strategy for the next phase of the pandemic.Dr. Emanuel’s team settled on 10 broad recommendations. Its report assumes that there will be fewer deaths from Covid-19 in 2022 than in 2021 and calls for the federal government to develop key indicators that community health officials can use to decide when to impose or ease emergency measures like masking and social distancing.“Economists determine the health of the economy using multiple indicators, primarily unemployment, inflation, and GDP growth,” the authors write. “Similarly, a dashboard for respiratory viral illnesses will be composed of several critical metrics.”The authors also call on the government to start a new research initiative, modeled on the Trump Administration’s Operation Warp Speed, to develop new and more effective therapeutics and vaccines that might work against all coronavirus variants.They want the Environmental Protection Agency to develop new air quality standards to prevent viral transmission indoors, a stronger scientific response to “long Covid,” new regulations to make it easier for health care providers to conduct virtual visits, and initiatives to improve safety in schools and workplaces.“From now on, the nation must do far more to avoid closing schools,” the authors wrote.

President Biden has made “harm reduction” a central pillar of his plan to fight a record number of drug-related deaths, but a conservative backlash is threatening the effort.WASHINGTON — President Biden came into office vowing to make “harm reduction” — a public health approach geared toward helping drug users stay safe rather than abstain — a central pillar of his drug policy agenda, at a time when illicit fentanyl has driven a surge in overdose deaths.Instead, his strategy is in danger of being derailed by a Washington drama over “crack pipes” that is more about political gamesmanship than public health. The clash is a revival of decades-old fights over clean needle exchange programs that addiction experts hoped had finally been laid to rest.Lawmakers of both parties introduced legislation last week to bar federal funding for “drug paraphernalia” in response to a story in the Washington Free Beacon, a conservative website, asserting that federally funded addiction treatment programs would distribute pipes for smoking crack cocaine as part of “safe smoking kits.” In response, the White House said tax dollars would not be spent on pipes.But with the Beacon story ricocheting around the conservative ecosystem — amplified by Republican including Senators Tom Cotton of Arkansas and Ted Cruz of Texas — Congress is pursuing plans not only to bar federal funding for “crack pipes,” but to impose restrictions on a new program that would have, for the first time, allowed federal funds to be spent on sterile needles for “syringe services” programs.Multiple studies have shown that distributing new syringes to drug users reduces the spread of blood borne diseases among drug users, including H.I.V., hepatitis C and lethal heart infections. The programs also provide naloxone, the overdose-reversing drug, and connect drug users to treatment and other resources.Some harm reduction programs do include sterile pipes — which are used for smoking methamphetamine and fentanyl as well as crack cocaine — in such kits, with the intent of preventing infectious disease or injury in drug users who might otherwise rely on contaminated paraphernalia. Harm reduction workers often try to steer users toward smoking rather than injecting, which poses a higher risk of infection and overdose.But there is no evidence that the Biden administration intended to pay for distribution of pipes. Nonpartisan fact checkers have debunked the claim.“This is tragic — we’ve gone full circle,” said Donna E. Shalala, who fought — and lost — a battle to get federal funding for needle exchange programs in the 1990s, when she was President Bill Clinton’s health secretary. Harm reduction, she added, “is a respectable, important strategy.”Yet even now, decades into a pervasive opioid epidemic that has led to hundreds of thousands of overdose deaths from prescription painkillers, heroin and synthetic fentanyl, which now also frequently turns up in stimulants like methamphetamine and cocaine — and many more from infectious diseases stemming from drug use — addiction experts say the backlash is not entirely surprising.As Regina LaBelle, an addiction policy expert at Georgetown University and the architect of Mr. Biden’s harm reduction policy, said in an interview: “We knew it wasn’t going to be easy.”Roughly 100,000 Americans died last year from drug overdoses, according to preliminary data from the Centers for Disease Control and Prevention — a record number that has more than doubled since 2015.Emergency personnel responded to a call in 2020 for a drug overdose in Paterson, N.J.Chang W. Lee/The New York TimesThe crack pipe fracas arrived just as experts thought they were making progress in getting politicians, including conservative Republicans, to accept harm reduction as a valid strategy. A case in point is former Vice President Mike Pence.In 2015, when Mr. Pence was the governor of Indiana, H.I.V. was spreading with terrifying speed among intravenous drug users in Scott County, a rural pocket of the state. Local, state and federal health officials were urging Mr. Pence to allow clean needles to be distributed to slow the outbreak, but Indiana law made it illegal to possess a syringe without a prescription.Mr. Pence, a steadfast conservative, was morally opposed to syringe exchanges on the grounds that they enabled drug abuse. But when the county sheriff urged him to allow the programs, Mr. Pence prayed about it — then signed an executive order doing so. It helped slow the H.I.V. outbreak to a trickle.Nearly two decades earlier, in 1998, Mr. Clinton blocked federal funding for clean needle programs, despite a personal appeal from Ms. Shalala. In an interview, she said Mr. Clinton had buckled under pressure from Democrats in Congress, who worried they would lose elections by being portrayed as soft on crime.Undeterred, Ms. Shalala encouraged philanthropies to finance needle exchange programs, and instructed National Institutes of Health experts to conduct trainings on needle exchange. Mr. Clinton later said he regretted his decision.When Mr. Biden was elected, addiction experts were elated. The American Rescue Plan, the coronavirus relief package he signed into law last year, set aside $30 million for a new Harm Reduction Grant Program to “support community-based overdose prevention programs, syringe services programs, and other harm reduction services.”It was the first time Congress had created a specific grant for harm reduction programs — which often run on shoestring budgets — and the grant program was exempt from a longstanding ban, renewed annually in spending measures, on using tax dollars to purchase clean needles. Some experts thought the ban might be lifted for good.“We finally got to a place where that ban was going to be lifted, we would see sustainability, we would see a massive shift in our current state of infectious disease,” said Chad Sabora, vice president of government and public relations at the Indiana Center for Recovery, a treatment center. He called the new controversy “heartbreaking.”Safe smoking kits are often distributed by syringe service programs, and often include glass stems, which function as pipes, as well as lip balm, alcohol swabs, rubber tips and other items to protect against mouth sores and cuts that can spread disease. The guidelines for the new federal grant program are not specific about it about whether the kits can include pipes.The law is murky; a 1986 law classifies crack pipes (but not needles) as drug paraphernalia and makes it illegal to sell or ship them. Ms. LaBelle said that law, and similar state laws, arguably could preclude the government from funding the glass stems that serve as pipes.After the uproar over the Free Beacon article, the White House Press Secretary, Jen Psaki, said glass pipes were “never a part of the kit,” insisting the story was untrue.Conservatives accused the White House of reversing itself.“The Biden administration is in cleanup mode because they got caught funding crack pipe distribution,” Mr. Cotton wrote on Twitter.Many addiction experts saw the political blowup over crack pipes as having racist undertones. Dahlia Heller, an addiction policy expert at Vital Strategies, a global nonprofit organization that supports harm reduction, said the Beacon story was “calling up a racist trope, very clearly, of Black people smoking crack. It was dog whistling a 1980s war on drugs.”Mr. Cotton, who leads a bipartisan commission to combat the trafficking of synthetic opioids — particularly fentanyl — was among those who responded by introducing legislation to ban funding for drug paraphernalia. Yet even as he expressed his outrage over crack pipes, he issued a commission report citing needle exchange programs as a well-documented way to get people struggling with drug abuse into treatment.Drug treatment programs funded by the federal government also include the use of naloxone, or Narcan, which can save drug users who overdose.Whitney Curtis for The New York TimesMr. Cotton’s spokeswoman, Caroline Tabler, said the commission did not suggest expanding needle exchange programs. Mr. Cotton opposes syringe services programs, which he believes “would enable drug use, empower drug suppliers, and harm Americans,” she said. Mr. Cotton is not the only lawmaker parsing his words. Senator Joe Manchin III, Democrat of West Virginia, reacted to the Beacon story by joining with Senator Marco Rubio, Republican of Florida, to introduce the PIPES Act, which would bar federal funds from being used to purchase “drug paraphernalia, such as crack pipes or needles.” The initials stand for Preventing Illicit Paraphernalia for Exchange Systems.Mr. Manchin’s home state is West Virginia, a longtime epicenter of the opioid crisis. The state capital, Charleston shuttered its harm reduction program in 2018; by the end of the year Charleston was leading the state in overdose deaths. West Virginia is among a number of states that have recently passed laws making it more difficult for syringe services to operate, as state lawmakers continue to oppose them on the grounds that they enable drug use and draw community complaints.“Manchin was never going to save us, but now it looks like he is going to bury us,” said Joe Solomon, a founder of Solutions Oriented Addiction Response, or SOAR, a which ran a syringe exchange program in Charleston until last year, when the City Council imposed restrictions that effectively forced its closure.Yet in 2016, Mr. Manchin praised President Barack Obama for an initiative that included needle exchange programs. That program was the result of a compromise: after nearly 30 years of an outright ban on any funding for needle exchange programs, Congress agreed to pay for program operations — but not the needles themselves — so long as state and local authorities, in consultation with the C.D.C., determined that a community was in danger of an infectious disease outbreak.The Manchin-Rubio bill would retain the current language about the C.D.C., but would extend the ban on purchasing needles to the American Rescue Plan funding. Its fate, and the fate of bills like it, is uncertain. Mr. Rubio tried unsuccessfully to force senators to vote on the measure before passing a spending resolution last week, and Congress is now on recess until the end of the month.In the meantime, Ms. LaBelle said, she and other experts have some work to do.“We have a lot of ingrained ideas about substance use and people are working hard to make sure that the general public understands what addiction is, what a substance use disorder is — that it’s not a moral failing,” she said. “But we’re still not at that point.”

President Biden came into office vowing to respect science, but openings in crucial jobs could hamper progress on medical and technological research.WASHINGTON — President Biden, who came into office vowing to “reinvigorate our national science and technology strategy,” is now facing a leadership vacuum that may threaten his ambitious research agenda, which stretches well beyond fighting the coronavirus pandemic.Both the Food and Drug Administration and the National Institutes of Health lack permanent leaders. Mr. Biden’s health secretary, Xavier Becerra, has been criticized for his low profile. And on Monday, his science adviser, Dr. Eric S. Lander — the first such adviser to serve in the cabinet — resigned after acknowledging that he had bullied his colleagues.Dr. Lander’s departure leaves a particularly big hole. He was in charge of the “cancer moonshot,” an initiative to cut death rates from cancer in half over the next 25 years, and was behind a new pandemic preparedness plan that the White House has likened to the Apollo mission.Dr. Lander was also a driving force behind Mr. Biden’s proposal to create a new agency to propel innovation in medical research. Modeled after the Defense Advanced Research Projects Agency, the proposed agency, known as ARPA-H, was the subject of a House committee hearing on Tuesday. Dr. Lander, who was supposed to be the key witness, was not there.Dr. Eric S. Lander resigned on Monday after acknowledging that he had bullied his colleagues.Oliver Contreras for The New York Times“This was an administration that really committed to the primacy of science for the pandemic and also aspirations for well beyond the pandemic,” said Dr. Eric Topol, the founder and director of the Scripps Research Translational Institute. “And what it has been on is a self-inflicting harm mission.”Administration officials say the work will carry on. Kevin Munoz, a White House spokesman, said the administration has “exceptional leadership” at the Department of Health and Human Services, and “strong acting leadership” at the F.D.A. and the health institutes.The F.D.A. is being run by an acting commissioner, Dr. Janet Woodcock, and Dr. Lawrence Tabak is the acting director of the N.I.H. after its longtime leader, Dr. Francis S. Collins, stepped down late last year. Both Dr. Woodcock and Dr. Tabak are longtime officials at their respective agencies, regarded as steady hands.But Sudip Parikh, the chief executive of the American Association for the Advancement of Science, said he was deeply concerned that, without permanent leaders, it would be difficult for federal agencies to carry out Mr. Biden’s agenda with imagination and vision.In addition to considering whether to create and fund ARPA-H, the House and the Senate are working to reconcile their versions of legislation authorizing an increase in funding for the National Science Foundation, which would expand research in a range of science and technology fields, like quantum computing and artificial intelligence.“I am excited about what we have accomplished so far, but I am really worried about this next set of steps,” Dr. Parikh said. “We are on the cusp of some of the biggest changes to the way we do science in this country in 74 years, so we want Senate-confirmed scientific leaders that can put forth a vision.”Ellen Sigal, the chairwoman and founder of Friends of Cancer Research, an advocacy group in Washington, shares that concern.“They promptly need to have an F.D.A. commissioner confirmed, they have to have an announcement on who will direct the N.I.H. and then they are going to have to replace Dr. Lander and figure out who has the stature to bring these various initiatives together,” she said.After the administration of former President Donald J. Trump, who routinely spread misinformation about the coronavirus, scientists were thrilled and relieved when Mr. Biden was elected.“Our long national nightmare is over,” R. Alta Charo, professor emerita of law and bioethics at the University of Wisconsin, told Scientific American at the time.In an interview on Thursday, Ms. Charo said Mr. Biden had fulfilled his pledge of respecting scientific integrity, and his response to the pandemic, while not perfect, had been a big improvement. Still, she said, “I think it’s appalling that we have such a vacuum of leadership.”Others have been less charitable. Holden Thorp, a former chancellor of the University of North Carolina at Chapel Hill who is now the editor in chief of Science, published an editorial on Tuesday calling Dr. Lander’s departure “the latest disappointment from an administration that has been struggling to guide the nation with sound science and science leadership.”Some critics of the administration say Mr. Biden brought some of the problems on himself with the people he chose to put in various leadership positions.The Coronavirus Pandemic: Key Things to KnowCard 1 of 3Some mask mandates ending.

The Biden administration said federal masking guidance would not change for now, but was seeking advice from public health experts on the way forward.WASHINGTON — The White House has been meeting with outside health experts to plan a pandemic exit strategy and a transition to a “new normal,” but the behind-the-scenes effort is crashing into a very public reality: A string of blue-state governors have gotten ahead of President Biden by suddenly abandoning their mask mandates.The director of the Centers for Disease Control and Prevention, Dr. Rochelle P. Walensky, said pointedly on Wednesday that while Covid-19 caseloads are dropping overall and her agency is working on new guidance for the states, it is too soon for all Americans to take off their masks in indoor public places.Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said her agency was working on new guidance for the states, but that it was not yet time to lift mask mandates across the nation.Susan Walsh/Associated Press“Our hospitalizations are still high, our death rates are still high,” she said during a news briefing by the White House Covid response team. “So, as we work toward that and as we are encouraged by the current trends, we are not there yet.”The gubernatorial frenzy to drop mask mandates comes as the White House Covid response coordinator, Jeffrey D. Zients, and the government’s top doctors are soliciting advice from a wide array of public health experts, including some former Biden advisers who have very publicly urged the president to shift course. Mr. Zients referenced the sessions briefly on Wednesday, saying the White House is also reaching out to governors and local public health officials to talk about “steps we should be taking to keep the country moving forward.”The talks, according to numerous participants, are aimed at drafting a fresh playbook for the delicate next phase of the pandemic, when the coronavirus threat is likely to recede but the possibility of a new variant and another deadly surge remains very real. They are addressing a range of issues beyond masking and mitigation, from how to get new antivirals to people who test positive for the virus to whether to upgrade ventilation systems in schools.But the slow deliberations, within both the C.D.C. and Mr. Zients’ team, are putting the White House in a tough spot. As officials examine the science and chart a careful course, they run the risk of making the Biden administration look irrelevant as governors forge ahead on their own.New York is among the blue states that are dropping their mask mandates.Gabby Jones for The New York Times“The administration needs to read the room and see that nearly all elected leaders are moving on without them,” said Dr. Leana Wen, a former Baltimore health commissioner who has often been critical of the administration, adding, “No one is expecting the C.D.C. to say that everyone should go maskless right now. What they are looking for are clear metrics on when restrictions can be lifted and when they may need to return.”Governors have said so themselves. Last week, after a bipartisan group of governors met with Mr. Biden, Gov. Asa Hutchinson of Arkansas, a Republican, told reporters he had emphasized to the president that the nation needs to “move away from the pandemic” and asked him for “clear guidelines on how we can return to a greater state of normality.”Today’s 3 Key Reads About Covid1. School Mask Mandates: Health experts agree masks should come off in schools. But they differ on when.2. The Next Vaccine Debate: Should the F.D.A. authorize a vaccine for young children despite incomplete data, or wait?3. Canada’s Trucker Protests: With no end in sight, the demonstrations in Ottawa are reverberating beyond Canada’s borders.It is now clear the states have decided not to wait. On Wednesday, the governors of New York, Rhode Island, Massachusetts and Illinois joined a growing list of Democrats who have dropped either a general statewide mask mandate or one that applies to schools.Asked about the moves, Jen Psaki, the White House press secretary, said the president was committed to fulfilling his campaign promise to listen to scientists and follow the data.“That doesn’t move at the speed of politics,” she added. “It moves at the speed of data.”The internal debate comes as the latest Covid-19 surge, fueled by the highly infectious Omicron variant, abates in much of the country. The seven-day average of new cases was about 253,000 on Wednesday, down from an average 800,000 in mid-January, according to a New York Times database. Hospitalizations are also declining, although deaths, a lagging indicator, continue to rise.If the drop in cases and hospitalizations continues, as many experts expect, Mr. Biden himself will soon have some tough decisions to make: Should he declare an end to the national emergency that his predecessor, President Donald J. Trump, declared in March 2020? Should Mr. Biden lift the mask mandate that he imposed for travel on airplanes, trains and buses?If the drop in Covid-19 cases and hospitalizations continues, President Joe Biden will face some tough decisions, such as whether to drop the mask mandate for travel.Al Drago for The New York TimesMr. Biden must be careful to avoid a “mission accomplished” moment. In June of last year, with cases dropping, his advisers began predicting a “summer of joy,” and Mr. Biden himself declared on July 4 that the United States was “closer than ever to declaring our independence from a deadly virus.” Then the Delta variant surged across the country. In late fall, the emergence of the even more contagious Omicron variant also caught the administration off guard.Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said any new strategy must take that into account.“It has to acknowledge that we are entering a new phase of virus transmission in our communities, being forever mindful that we were in exactly the same place one year ago today, where cases were decreasing from a January peak, vaccines were flowing,” he said. “And look what that got us.”The C.D.C.’s masking decisions are especially fraught: It is difficult, experts say, to issue a one-size-fits-all prescription for a country as sprawling and varied as the United States.“It’s a challenging situation, because of course people are really anxious to get back to some sense of normalcy,” said Dr. Celine Gounder, an infectious disease specialist who recently joined Kaiser Health News as an editor at large. “It’s highly variable across the country — how much transmission there is, what vaccination uptake has been — but the C.D.C. produces guidance for the entire country, so it makes sense for them to be cautious.”Masking has been one of the most contentious issues of the pandemic. Many Republican governors cast aside their mask mandates long ago. Some, like Gov. Ron DeSantis of Florida, even banned mask mandates and threatened to penalize school officials who defied them. The actions drew fierce criticism from Mr. Biden, who directed his education secretary to bring federal civil rights actions to deter states from barring masking in classrooms.The Coronavirus Pandemic: Key Things to KnowCard 1 of 3Some mask mandates ending.

A broad, bipartisan group of senators is coalescing around a plan for an independent panel to investigate the origins of the coronavirus and the U.S. response.WASHINGTON — A broad and bipartisan group of senators is coalescing around legislation to create a high-level independent commission, modeled after the one that examined the Sept. 11 attacks, with broad powers to investigate the origins of the coronavirus pandemic and the response across the Trump and Biden administrations.Under a plan proposed by the top Democrat and Republican on the Senate Health Committee — Senators Patty Murray of Washington and Richard M. Burr of North Carolina — a 12-member panel would have subpoena power to “get a full accounting of what went wrong during this pandemic,” Ms. Murray said in an interview, and make recommendations for the future.The legislation, being circulated as a draft, is still in its early stages; Ms. Murray said she hopes to get feedback from colleagues within a month, followed by a hearing and a markup. In this highly polarized environment, both she and Mr. Burr acknowledged that politics could derail it.And even if the measure passes both houses of Congress and is signed into law, the panel itself could become bogged down in bitter partisanship, depending on who is appointed to it.But in interviews this week, more than a dozen senators from both parties embraced the idea, and none raised any substantive objections. More than half a dozen senators have similar proposals of their own that have produced some strange partnerships.“I’m all for it,” declared Senator Roger Marshall, Republican of Kansas, a medical doctor who is working with Senator Kirsten Gillibrand, Democrat of New York, and others on a similar bill. “As a doctor, if a patient dies and we don’t know why, we do an autopsy. In the military, when we have a major event we go back and figure out what we did right and what we did wrong.”The favorable reception from members of both parties is rare in a divided Capitol, and marks a significant turnabout. Bills introduced last year in both the House and the Senate, including one by Senators Susan Collins, Republican of Maine, and Bob Menendez, Democrat of New Jersey, have stalled, in part because Republicans feared they would target President Donald J. Trump’s early failures.But now President Biden has been in office long enough to have had failures of his own. And by explicitly stating that the origin of the pandemic must be investigated, the Murray-Burr bill appeals both to Republicans, some of whom theorize the virus emerged from a lab leak in China, and Democrats who want to put that theory to rest.“This is a crisis that has been shockingly polarizing,” said Philip D. Zelikow, the lawyer who led the 9/11 Commission and has been laying the groundwork for a pandemic inquiry. “This is the first signal that maybe leading Democrats and Republicans are now ready to come together. I think that’s really heartening. A lot of people would not have predicted it.”The Murray-Burr bill is carefully drafted to avoid partisan divisions. The panel would be made up of 12 “highly qualified citizens” — preferably, but not necessarily, nonpartisan subject matter experts in relevant fields like public health, manufacturing of medical products, supply chain issues and national security. They may not be government employees.Democrats and Republicans in Congress would each appoint half the members, who would name their own chairman and vice chairman. The White House would not make any appointments. The panel would hold hearings and take testimony, as the Sept. 11 panel did, and would be expected to produce a report within a year, with a possible six-month extension.“I think it’s a splendid idea,” said Senator John Kennedy, Republican of Louisiana. “I think we need to know what worked and what didn’t work. I think we need to be prepared for the next one. I would particularly like to know whether the lockdowns and the shutdowns we saw, whether the flame was worth the candle.”The measure avoids the use of the word “commission,” which acquired negative connotations in Washington after a bitter partisan debate doomed an effort to create a commission to investigate the Jan. 6 Capitol attack. Instead, the panel is called a “task force,” though Ms. Murray used the words “commission” and “task force” interchangeably.“We tried to structure it in a way that would make a partisan approach difficult,” Mr. Burr said.The proposal is part of a broader measure, the Prepare for and Respond to Existing Viruses, Emerging New Threats and Pandemics Act — or PREVENT Pandemics Act. It would require certain changes even before an inquiry has concluded, including making the director of the Centers for Disease Control and Prevention a Senate-confirmed position instead of serving at the will of the president.People familiar with the authors’ thinking say they want to put the measure on a fast track, possibly by attaching it to another must-pass piece of legislation.The Biden White House has been noncommittal. Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, said this week that the administration was focused on the current crisis, but “over time we do look forward to engaging with Congress and reviewing lessons learned.”But Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, said it was important to investigate the origins of the pandemic. He said it took years after the coronavirus that caused SARS emerged in 2002 to determine that it had almost certainly jumped from bats or civets to humans at a wet market in China. That led to greater regulation of wet markets, he said.The 9/11 Commission, signed into law at the end of 2002 by an initially reluctant President George W. Bush, was an independent, bipartisan panel that spent a year and a half investigating the attacks and the country’s preparedness for them, holding public hearings in what amounted to a national reckoning.It produced an extensive report in book form — both a detailed analysis and a gripping narrative that was a surprise best seller and changed Americans’ understanding of the attacks, which killed nearly 3,000, and the terrorist threat. The report led to structural changes in government and in the way intelligence is evaluated and shared, as well as new cooperation among federal, state and local agencies.“We have prevented dozens of terrorist attacks in our city, because they work together,” Ms. Gillibrand said, referring to New York. “And so the same approach of a joint effort across government is necessary to stop the next pandemic.”Mr. Zelikow, who led the Sept. 11 panel, has laid the foundation for a commission to investigate the pandemic, with financial backing from four foundations and a paid staff that has already interviewed hundreds of public health experts, business leaders, elected officials, victims and their families.Mr. Zelikow, who has been consulting with Senators Burr and Murray, said he would be willing to turn his work over to a commission created by Congress. The pandemic has fundamentally challenged Americans’ trust in government, he said, and a thorough inquiry would be an important “bridge to trying to rebuild that confidence and that trust.”Covid-19 victims and their families, many of whom support the idea of a commission, are also eager for the kind of airing of grievances that the Sept. 11 panel provided the victims of the terrorist attacks two decades ago. And, they say, a nonpartisan, serious inquiry might be something the country could rally around.“I would like to see a narrative of what people have gone through to really help bring the data to life and to give a little bit of an on-ramp to healing for families and others,” said Kristin Urquiza, the founder of Marked by Covid, a victims group. “Right now we are so divided, but I firmly believe that through our loss and pain and grief, it’s actually an avenue toward seeing one another as humans and Americans.”