The president aims to revive the cancer “moonshot” program he headed as vice president.WASHINGTON — President Biden will unveil a plan on Wednesday to reduce the death rate from cancer by at least 50 percent over the next 25 years — an ambitious new goal, senior administration officials say, for the cancer “moonshot” program he initiated and presided over five years ago as vice president.Mr. Biden and his wife, Jill Biden, will also announce a campaign to urge Americans to undergo screenings that were missed during the coronavirus pandemic, according to the officials, who spoke on condition of anonymity Tuesday evening to preview the president’s announcement. Screening is important to reduce cancer deaths.The president has a deep personal interest in cancer research; in 2015, his son Beau died of glioblastoma, an aggressive brain cancer. The next year, President Barack Obama called on Mr. Biden in his State of the Union address to lead the moonshot program, with a goal of making “a decade’s worth of advances in cancer prevention, diagnosis and treatment” in five years.At the time, Congress authorized $1.8 billion over seven years; roughly $400 million of that money has yet to be allocated, and the National Cancer Institute, which oversees the initiative, says it has already spent $1 billion on more than 240 research projects. The senior officials said the White House would not be announcing any new funding commitments, but insisted that there would be “robust funding going forward.”Instead, the Bidens will set out broadly outlined goals in a showy White House ceremony to be attended by roughly 100 people, including Vice President Kamala Harris, patients, caregivers, family members, researchers and members of Congress.The White House is billing the event as a fresh push by the president to “reignite” the moonshot program and “end cancer as we know it.” Specifically, Mr. Biden will set a goal of cutting the age-adjusted death rate — a statistic that accounts for expectations that older people are more likely to grow ill and die — by more than half over the next 25 years. But there were few specifics about how that goal would be achieved.“These are audacious goals, and I have no doubt there will be mechanisms to achieve them,” said Ellen Sigal, founder of Friends of Cancer Research, which works to support cancer research and deliver new therapies to patients, who has been briefed on the plan.Mr. Biden has already named Danielle Carnival, who worked on the moonshot program during the Obama administration, to help oversee the new version of the effort. Now, the senior officials said, the president will create a “cancer cabinet” to coordinate the work of multiple government agencies.The White House says more than 9.5 million cancer screenings were missed in the United States as a result of the Covid-19 pandemic. Mr. Biden will call on the cancer institute, a branch of the National Institutes of Health, to coordinate with cancer treatment centers to offer screenings around the country, and to develop a program to fast-track the development of tests that can detect multiple types of cancer at once.Presidents since Richard M. Nixon have sought to tackle cancer, of which there are more than 100 types of disease that can vary in the way they grow, spread and respond to treatment. The cancer institute estimates that nearly 40 percent of men and women will be diagnosed with some type of cancer at some point during their lifetimes. The American Cancer Society estimates there will be 1.9 million new cases of cancer in the United States this year, and more than 609,000 cancer deaths.Most experts no longer talk of “curing” cancer; that language is far too simplistic, and the White House is not using it. But officials say it is possible to make substantial progress in the fight against cancer through early diagnosis and improved treatments.There have been great strides in cancer research, treatment and prevention in the five years since the original moonshot program was announced. Targeted therapies are helping cancer patients live longer. Doctors can now detect cancers through a simple blood draw. More refined colonoscopies are preventing more colon cancers.“The original moonshot demonstrated that it was possible to compress a decade’s worth of progress into a few short years,” Ms. Sigal said, adding, “We can’t afford to not make that opportunity a reality again.”

The masks will be distributed at pharmacies and community health centers, but some public health experts said the effort was coming too late.WASHINGTON — Two years into the coronavirus pandemic, Americans who have had a hard time getting their hands on masks and at-home tests are suddenly being showered with offers of freebies — courtesy of taxpayers and the Biden administration, which had come under sharp criticism for not acting sooner.On Wednesday, the administration announced that it would make 400 million nonsurgical N95 masks available free of charge at community health centers and retail pharmacies across the United States. The White House said that to “ensure broad access for all Americans,” there would be a limit of three masks per person.The news came a day after the administration rolled out covidtests.gov, its new website where Americans can order at-home coronavirus tests at no cost.Taken together, the moves represent a stepped-up effort by the White House to combat Omicron, the fast-moving coronavirus variant that first appeared in November and has fueled a spike in cases, hospitalizations and deaths across the country. But some public health experts said that while the efforts were welcome, they were too late.“It will not be as impactful as it would have been had we done it at the beginning of the Omicron surge or the beginning of the Delta surge,” said Julia Raifman, a health law and public policy expert at the Boston University School of Public Health.The White House called the distribution of masks the “largest deployment of personal protective equipment in U.S. history.” Wednesday’s announcement came days after the Centers for Disease Control and Prevention updated its mask guidance to acknowledge that cloth masks do not offer as much protection as surgical masks or respirators.The N95 masks will come from the Strategic National Stockpile, the nation’s emergency reserve of medical supplies. The stockpile was badly depleted at the outset of the pandemic, leaving health care workers without masks and other personal protective gear essential to fighting the coronavirus. As late as December 2020, the United States was still facing alarming shortages of personal protective gear.The decision to distribute masks from the stockpile to the public is a sharp departure from prior practice; in the past, they were reserved for health care workers.According to the C.D.C.’s new description of masks, well-fitting respirators, including N95s, offer the highest level of protection. Their name refers to their ability to filter out 95 percent of all airborne particles when used correctly.This month, in a series of opinion articles in the Journal of the American Medical Association, six former advisers to President Biden’s transition team called for a new pandemic strategy that would include making N95 masks free and easily available to all Americans, and vastly increasing the number of free coronavirus tests.But Mr. Biden faced challenges, particularly on the testing front. His administration had pledged to ramp up testing capacity but had not done so by the time the Omicron variant emerged. So while he announced shortly before Christmas that his administration would purchase 500 million rapid tests to distribute free to the public, Americans had to wait for them.“They talked a lot about substantially ramping up testing and it didn’t happen,” said Dr. Ashish K. Jha, the dean of the Brown University School of Public Health, adding, “I think that was a real failure of the administration, to not have more tests available by the time we got into the holidays.”N95 respirators, which can filter out 95 percent of all airborne particles when used correctly, were in short supply early in the pandemic.Brendan Mcdermid/ReutersLast week, Mr. Biden stepped up the testing initiative and announced that his administration would purchase another 500 million tests, bringing the total to one billion. Jeffrey D. Zients, the president’s coronavirus response coordinator, also told reporters last week that the administration was “actively exploring” ways to make high-quality masks available.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4Omicron in retreat.

In a striking critique, six prominent health experts who advised President Biden’s transition team called for an entirely new domestic coronavirus strategy.WASHINGTON — On the day President Biden was inaugurated, the advisory board of health experts who counseled him during his transition officially ceased to exist. But its members have quietly continued to meet regularly over Zoom, their conversations often turning to frustration with Mr. Biden’s coronavirus response.Now, six of these former advisers have gone public with an extraordinary, albeit polite, critique — and a plea to be heard. In three opinion articles published on Thursday in The Journal of the American Medical Association, they called for Mr. Biden to adopt an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely, not to wiping it out.The authors are all big names in American medicine. Several, including Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration, and Dr. David Michaels, a former head of the Occupational Safety and Health Administration now with George Washington University’s School of Public Health, have held high-ranking government positions. Dr. Ezekiel Emanuel, an oncologist, medical ethicist and University of Pennsylvania professor who advised former President Barack Obama, organized the effort.Like any White House, Mr. Biden’s prizes loyalty and prefers to keep its differences in house; in that regard, the articles are an unusual step. The authors say they wrote them partly because they have not made headway talking directly to White House officials.“From a macroperspective, it feels like we are always fighting yesterday’s crisis and not necessarily thinking what needs to be done today to prepare us for what comes next,” Dr. Borio said.The authors shared the articles with White House officials before they were published, but it was unclear whether the administration would adopt any of their suggestions. Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, declined to comment on the articles.The White House press secretary, Jen Psaki, told reporters she had not read the articles, and dismissed a question about whether the president “is coming around to accepting” that Covid-19 is here to stay, even though several recent media accounts suggested that the administration was beginning to operate under that assumption. Mr. Biden’s recent emphasis on keeping schools open and businesses running even when cases are soaring also suggests a recalibration, as does a recent decision by the Centers for Disease Control and Prevention to recommend that people with Covid isolate for five days instead of 10.“The president’s goal is to defeat the virus,” Ms. Psaki said, adding, “The president’s focus and objective now is to save as many lives as possible.”Outlining their ideas for the “new normal” strategy, Dr. Emanuel and two co-authors — Michael T. Osterholm, an epidemiologist at the University of Minnesota, and Dr. Celine Gounder, an infectious disease expert at New York University — pointedly noted that in July, Mr. Biden proclaimed that “we’ve gained the upper hand against this virus,” which in retrospect was clearly not the case.Now, with the Omicron variant fueling an enormous new surge, they wrote, the United States must avoid becoming stuck in “a perpetual state of emergency.” The first step, they wrote, is recognizing that the coronavirus is one of several respiratory viruses circulating, and developing policies to address all of them together.To be better prepared for inevitable outbreaks — including from new coronavirus variants — they suggested that the administration lay out goals and specific benchmarks, including what number of hospitalizations and deaths from respiratory viruses, including influenza and Covid-19, should prompt emergency mitigation and other measures.In addition to urging the administration to adopt a longer view, the authors took pointed issue with some of Mr. Biden’s current policies and stances — especially on political lightning rod issues. They called for more aggressive use of vaccine mandates, which have drawn fierce opposition from Republicans, and said the nation needed a digital verification system for vaccination — so-called vaccine passports — which Mr. Biden has resisted in the face of Republican attacks on the concept.“Relying on forgeable paper cards is unacceptable in the 21st century,” wrote Dr. Borio, Dr. Emanuel and Dr. Rick Bright, the chief executive of the Rockefeller Foundation’s Pandemic Prevention Institute.The most surprising thing about the articles is that they were written at all. Several of the authors said in interviews they were dismayed that the administration seemed caught off guard by the Delta and Omicron variants. Dr. Bright, who helped write two of the pieces, recalled the warning he issued when the advisory board had its last meeting on Jan. 20, 2021.“The last thing I said,” he recalled, “is that our vaccines are going to get weaker and eventually fail. We must now prepare for variants; we have to put a plan in place to continually update our vaccines, our diagnostics and our genomics so we can catch this early. Because the variants will come, and we should never be surprised and we should never underestimate this virus.”Mr. Biden published a pandemic strategy when he came into office, and Dr. Emanuel said the administration “executed very well on it through June,” until the Delta variant brought a new surge of cases. The president recently released a new winter strategy, just as the Omicron variant began spreading in the United States.Many of the steps the authors suggest — including faster development of vaccines and therapeutics; “comprehensive, digital, real-time” data collection by the C.D.C.; and a corps of “community public health workers” — are already part of Mr. Biden’s plans.He has taken steps to control the spread of Omicron and to ensure that hospital systems do not get overwhelmed. He has sent military troops to states including Wisconsin and Indiana to help out at hospitals, and has opened new testing sites in New York and elsewhere. He has insisted there will be no lockdowns, and has repeatedly pleaded with Americans to get vaccinated.“I honest to God believe it’s your patriotic duty,” Mr. Biden said recently.But Dr. Bright said such language was turning off Americans, including many Trump voters, who are resistant to vaccines.“The message continues to berate unvaccinated people and almost bully unvaccinated people,” said Dr. Bright, who led a federal biomedical agency during the Trump administration but quit the government after being demoted for complaining about political interference in science. “There are so many reasons people are unvaccinated; it’s not just because they follow Trump.”The authors say the administration needs to look past Omicron and acknowledge that it may not mark the end of the pandemic — and to plan for a future that they concede is unknowable. They also make clear that the current rate of Covid hospitalizations and deaths, an average of more than 1,300 lives lost each day in the United States, is unacceptably high.In the three articles — one proposing a new national plan, the others suggesting improvements to testing, surveillance, vaccines and therapeutics — the authors also make more specific suggestions.They call for next-generation Covid vaccines that would target new variants or perhaps take new forms, like nasal sprays or skin patches, that would be easier to distribute; for a “universal coronavirus vaccine” that would combat all known coronaviruses; and for major upgrades to public health infrastructure. And while they said the president’s pledge to buy 500 million rapid coronavirus tests and distribute them free was “an important step,” they wrote that “many more are needed.”The authors also said that vaccine mandates should be imposed more broadly, including for schoolchildren, and that N95 masks should be made free and readily available to all Americans, as should oral treatments for Covid. (Mr. Biden has imposed several vaccine mandates on workers, but they are tied up in court.)Dr. Gounder said she had been disappointed by the administration’s “single-minded focus on vaccines” and with its decreasing emphasis on mask-wearing. Dr. Borio said she had been “very frustrated” that there was no federal system linking testing to treatments, so that people who tested positive and were at high risk for Covid complications could get prescriptions on the spot for new antiviral medicines.Dr. Emanuel — brother to Rahm Emanuel, Mr. Obama’s first chief of staff and Mr. Biden’s ambassador to Japan — echoed that sentiment. If the distribution of new therapies is left to “the usual health care system,” he said, only “rich, well-connected people” would have access.The articles reflect both their frustrations and their desire to help, the authors said. They recognize that they have the luxury of taking a 30,000-foot view while administration experts are slogging it out in the trenches.“But at the same time,” Dr. Bright said, “we think a lot of work still needs to be done.”

The president is set to unveil his initiatives, which also include creating new federal testing sites and deploying federal vaccinators, in a speech on Tuesday.WASHINGTON — President Biden will announce new steps on Tuesday to confront a staggering surge in coronavirus cases, including readying 1,000 military medical professionals to help at overburdened hospitals, setting up new federal testing sites, deploying hundreds of federal vaccinators and buying 500 million rapid tests to distribute free to the public.The measures, outlined to reporters Monday night by two senior administration officials who spoke on condition of anonymity, come as coronavirus caseloads are rapidly rising around the country, particularly in the Northeast, fueled by the highly infectious new Omicron variant — just as Americans prepare to gather for Christmas.The 500 million tests that the administration intends to purchase will not be available until January, the senior officials said, adding that the government intends to create a website where people can request that tests be sent to their homes, free of charge. It was not immediately clear where the tests would come from.The plan for new federal testing sites will debut in New York City, where several new sites will be running before Christmas. And Mr. Biden intends to invoke the Defense Production Act, officials said, to accelerate production of tests.The plan has a more urgent tone than the winter pandemic strategy that Mr. Biden announced three weeks ago at the National Institutes of Health, just days after the new variant was discovered in South Africa. At the time, he promised that the 150 million Americans with private health insurance would be able to get reimbursed for at-home Covid-19 tests starting in mid-January, said his administration would improve access to booster shots and imposed new testing requirements for international travelers.But that plan — and Mr. Biden’s broader response to the Omicron variant — has drawn criticism from public health experts, who say the president has focused too heavily on vaccination as his central strategy. Many have called on him to be more aggressive about testing as a means of slowing the variant’s spread — including possibly sending rapid tests to the homes of every American, free of charge.Since Mr. Biden announced his winter strategy, the Omicron variant has exploded; the Centers for Disease Control and Prevention reported on Monday that it has raced ahead of other variants and is now the dominant version of the coronavirus in the United States, accounting for 73 percent of new infections last week.“We have to acknowledge the reality that unfortunately, with a heavy heart, the virus is in charge and we need to take back control, and the only way to do that as a society is to test and isolate, test and isolate, repeat, repeat, repeat,” said Mara Aspinall, an expert in medical diagnostics at Arizona State University.Mr. Biden was himself exposed to the coronavirus late last week but has tested negative, White House officials said on Monday. With Americans already jittery about their holiday plans, he will try to reassure the nation while reminding people, yet again, that their best defense against Covid-19 is to get vaccinated and, for those who are eligible, to get booster shots.The White House is trying to avoid talk of lockdowns at all costs, and, to the consternation of some, has stopped short of urging people to cancel travel plans, avoid public transportation and the like.“This is not a speech about locking the country down,” Jen Psaki, the White House press secretary, told reporters earlier on Monday. “This is a speech outlining and being directly clear with the American people about the benefits of being vaccinated, the steps we’re going to take to increase access, increase testing, and the risks posed to unvaccinated individuals.”But Mr. Biden will also acknowledge that the shape of the pandemic is shifting, the officials said. Breakthrough Omicron infections are common, though scientists believe that the vaccines will still provide protection against the worst outcomes. Many fully vaccinated and boosted people who are getting infected are experiencing mild symptoms or none at all.Mr. Biden will say that if people are vaccinated and follow other public health guidelines, including wearing masks in public places, “they should feel comfortable celebrating Christmas and the holidays” with their families, one of the officials said.But beneath those notes of assurance from the president is deep concern among his advisers — and public health experts — about the ability of the nation’s hospitals, which are already under great strain, to withstand an Omicron surge. Even if the variant ends up causing less severe disease and a relatively low percentage of those infected need to be hospitalized, experts say, the explosion in cases means it is still possible that hospitals will become overwhelmed.“That’s the big concern,” said Dr. Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials. “If there are a lot of people getting sick, even if only a small portion of them are getting severely ill, that could still be a huge number of people.”Mr. Biden intends to direct his defense secretary, Lloyd J. Austin III, to “ready an additional 1,000 service members — military doctors, nurses, paramedics and other medical personnel — to deploy to hospitals during January and February, as needed,” according to a fact sheet prepared by the White House.At the same time, Mr. Biden will announce that six federal emergency response teams, with more than 100 health professionals and paramedics, will deploy immediately to six states: Michigan, Indiana, Wisconsin, Arizona, New Hampshire and Vermont. Already, 300 federal medical workers have been deployed since Omicron was discovered in late November.A Federal Emergency Management Agency contractor administering a coronavirus booster shot on Monday in Federal Way, Wash. FEMA plans to stand up new pop-up vaccination clinics.Ted S. Warren/Associated PressMr. Biden will also direct the Federal Emergency Management Agency to work with hospitals across the country to make plans to expand capacity. FEMA will also stand up new pop-up vaccination clinics, the officials said, to handle hundreds of additional vaccinations per week.The Coronavirus Pandemic: Key Things to KnowCard 1 of 5The Omicron variant.

Xavier Becerra, the secretary of health and human services, hinted on Tuesday that the Biden administration may need to ask Congress for more money to fight the coronavirus pandemic, depending on the scope and severity of a potential new wave of infections fueled by the Omicron variant.During a round-table discussion with reporters that focused heavily on testing, Mr. Becerra noted that while the administration has some flexibility to move money around, of the $50 billion Congress has allocated for testing, about $10 billion is left. President Biden has made expanded testing a centerpiece of the winter pandemic strategy he announced last week.“Are we going to have more than $10 billion worth of needs and costs on Covid, especially in regards to testing?” Mr. Becerra said. “There’s a strong chance we will, depending on where Omicron takes us.” He added that his department’s experts were trying to make projections to determine whether additional funding would be necessary — before the need becomes urgent.“The president said we’ve got to stay ahead of this, so we don’t want to be asking Congress for money after we know we need it,” he said.With the pandemic heading into its third year, and Omicron on the horizon, much of the money that Congress has allocated for coronavirus response has been spent. The $2 trillion CARES Act was signed by former President Donald J. Trump in March 2020, and the $1.9 trillion American Rescue Plan was signed by Mr. Biden in March 2021. Both were aimed at boosting the economy, as well as addressing Americans’ health needs during the crisis.The rescue plan included $14 billion to speed up vaccine distribution, and $130 billion to help schools reopen safely, among other coronavirus-related provisions. But the plan, and the CARES Act before it, went into effect before the emergence of the Delta variant this summer, which caused hospitalizations and deaths to spike, adding strain to an already overburdened health care system. The Centers for Disease Control and Prevention has been tracking Omicron cases, which have now turned up in more than 20 states. “Even if most infections are mild, a highly transmissible variant could result in enough cases to overwhelm health systems,” agency officials wrote in a report last week.On Thursday, the Department of Health and Human Services announced it was releasing $9 billion in “provider relief fund” payments to bolster hospitals and other health care providers that have experienced revenue losses because of the pandemic. More than 69,000 providers in all 50 states, plus Washington, D.C., and eight territories, will receive payments.In September, the department announced that it would spend a total of $25.5 billion on the effort. That includes the $9 billion released on Thursday and $8.5 billion released last week to rural health care providers. The remainder of the funds will be disbursed in 2022.In announcing his winter strategy last week, Mr. Biden vowed to fight the pandemic with “science and speed.” He said that people who buy at-home rapid coronavirus tests would soon be eligible for reimbursement from their insurers, and that to ensure access for the uninsured, the federal government would distribute 25 million tests to community health centers and rural clinics.After the announcement, administration officials said people buying the tests would have to request reimbursement, rather than being reimbursed in the pharmacy as when filling prescriptions. Some public health experts and consumer advocates have balked at that. Mr. Becerra said Thursday that his department was still figuring out the particulars. A number of states have been distributing free at-home tests, including Massachusetts, New Hampshire, Maryland, Colorado and Ohio.Other countries have spent more heavily on rapid testing. In Britain, citizens can use a government website to order free rapid tests for home use. Germany invested hundreds of millions of dollars to create a network of 15,000 rapid testing sites. The United States has instead focused public purchasing on vaccines, and efforts to encourage their uptake.On Tuesday, Mr. Becerra pledged, “We are going to make sure that the American people have access to tests and they don’t have to pay out of pocket.”“How that exactly gets done, we work with our team to make it happen,” he added. “We’re hoping that it will be done in a way that is as smooth as possible.”

A bipartisan group led by two former governors is urging President Biden to help an estimated 167,000 children who have lost parents or caregivers.WASHINGTON — Courtney Grund, whose husband died of Covid-19 in August, got an alarming text message last week: Her 16-year-old son was “talking about self-harm,” according to the message, sent by his friend. She quickly signed him up for grief counseling, she said in a tearful interview, using her maiden name to protect his privacy.John Jackson, a disabled veteran on a fixed income, said he had struggled to find help for his 14-year-old daughter, whose mother died in the pandemic. “I can see it in her, where she’s suffering,” he said.Pamela Addison, a reading teacher whose husband died, said she felt fortunate that she could afford therapy — $200 a session out of pocket — for her grieving 3-year-old.Although Congress has allocated trillions of dollars to combat the pandemic, including more than $100 million for existing children’s mental health programs and $122 billion for schools, the Biden administration and lawmakers have not yet created initiatives specifically for the tens of thousands of children who have lost parents and primary caregivers to Covid-19.Behind the scenes, leaders of a bipartisan coalition of experts in education, the economy and health — backed by wealthy philanthropies and headed by two former governors, Dirk Kempthorne of Idaho, a Republican, and Deval Patrick of Massachusetts, a Democrat — have been meeting with White House officials, urging them to do more.On Thursday — just two days after the surgeon general warned that young people were facing “devastating” mental health issues related to the pandemic — that group, the Covid Collaborative, will release a report estimating that more than 167,000 children in the United States have lost parents or in-home caregivers to the disease.The collaborative is asking President Biden to initiate a national campaign to identify these children and, with help from the private sector, take steps to improve their emotional and economic well-being. Its recommendations include offering them mental health care and creating a “Covid Bereaved Children’s Fund,” similar to a fund established after the Sept. 11 attacks, to provide up to $10,000 to families in need.“The president is uniquely positioned to put an official imprimatur on the call in this report to coordinate all resources, public and private, at every level of government and every level of the private sector and philanthropy to help these children,” Mr. Patrick said in an interview.“It’s a tragedy not of their making,” he added, “but they’re our kids. They belong to us, and all we are saying is, ‘Let’s act like it.’”The report, titled “Hidden Pain,” estimates that more than 70 percent of the bereaved children are 13 or younger. It is based on federal data and a modeling study led by Dan Treglia, a social policy researcher at the University of Pennsylvania.Communities of color are disproportionately affected. Dr. Treglia, who is also part of the collaborative, said racial and ethnic disparities in caregiver loss from Covid-19 exceeded the already stark disparities in coronavirus deaths.Parents and young people left behind said the push by the Covid Collaborative was welcome news, if only to force officials in Washington to recognize this new cohort of bereaved children.Ms. Grund picked up her son from school last week after she got the text from his friend; he has not yet returned.He went to his first group therapy session Tuesday evening. In an interview, he said he was having mood swings and suicidal thoughts, and had not wanted to leave his room. He would like to see initiatives that better equip teachers and school officials to help grieving students.Ms. Grund with her son and Georgie, their therapy dog. Her son said he would like to see initiatives that better equip teachers and school officials to help grieving students.Adriana Zehbrauskas for The New York Times“No one knew how to deal with what I was going through, so it was hard for the teachers to communicate to me,” he said, adding that while he could talk to his friends, it had not helped much. “I can share with them, but it’s in one ear and out the other,” he said. “They don’t completely understand and, like, process the whole situation.”A spokeswoman for the Department of Health and Human Services, Kirsten Allen, said the administration “has made a number of investments and launched several initiatives covering a wide range of mental health priorities — including support for children who have lost parents.”She cited the surgeon general’s advisory and the expansion of several existing programs. In May, for example, the department announced it was releasing $14.2 million, allocated by Congress through the American Rescue Plan, to expand access to pediatric mental health care. The rescue plan also provided money for suicide prevention programs and a program to improve care and access to services for “traumatized children.”John Bridgeland, the collaborative’s founder and chief executive officer, said expanding existing programs was not enough. “We need a focused effort to help the unbearable loss of these 167,000 children,” he said.Losing a parent or a caregiver is hard for a child in ordinary times. But experts in grief counseling and school officials say the pandemic has exacted a particular toll.“The death of a parent is something that we deal with all the time — not just with Covid,” said Susan Gezon Morgan, a school nurse in Emmett, Idaho, a small city outside Boise. “But I think the fact that Covid is in the news and so sudden, and oftentimes it’s a young parent, that it seems so much more traumatizing.”In a small community like Emmett, where everyone knows everyone else, Ms. Morgan said, the grief cuts both ways. Grieving children lose their privacy, but they also have a tight-knit community to provide support. In big cities, it is another story.Mr. Jackson, of Reisterstown, Md., just outside Baltimore, is home-schooling his daughter, Akeerah, in part because he fears her peers will be insensitive, encouraging her to “just get over” her loss.When Akeerah’s mother, Cathy Fulcher, died, Mr. Jackson got a note from the Baltimore County school system saying she could delay turning in her grades, but little in the way of guidance. Soon afterward, he said, he started looking for a place for his daughter to get therapy.“One was $250; they didn’t take any type of insurance,” he said. “That was just for us to come in for an evaluation. That’s just not in the budget.”Akeerah Jackson, 14, with her father, John, and a photo of herself with her mother, Cathy Fulcher, who died of Covid-19. A grief support center in Baltimore has helped Akeerah cope with her loss.Alyssa Schukar for The New York TimesEventually he found Roberta’s House, a grief support center for Baltimore families. There, Akeerah said, she has learned how to cope with her grief by drawing and writing in a journal, and she is now a “peer ambassador,” leading sessions for other teens. She has also attended Camp Erin, a free camp for grieving children offered in cities across the country.Both are funded by the New York Life Foundation, which also backs the Covid Collaborative and has created a website, grievingstudents.org, to provide information for educators as part of its “grief-sensitive schools” initiative, which predates the pandemic. The vice president of the foundation, Maria Collins, says many of its programs have waiting lists.“It’s known in this field that the young person is the forgotten griever,” she said, adding that the foundation was open to working with the federal government and would be “eager to provide tangible support, financial and otherwise, for Covid-bereaved children.”The collaborative envisions $2 billion to $3 billion for the bereavement fund, possibly supplemented by money from private foundations. It would help parents struggling with everything from rent payments to their children’s academic performance to finding the right therapy at a reasonable cost.The report builds on similar research: The journal Pediatrics, relying on data through June 30, before the wave of infections caused by the Delta variant, reported in October that more than 120,000 American children had lost parents or caregivers from Covid-19.The researchers who conducted the collaborative’s study found that Black and Hispanic children were roughly two and a half times as likely as whites to be bereaved as a result of the pandemic, while Native American children were nearly four times as likely. Dr. Treglia, whose research focuses on vulnerable populations, said the number of bereaved children grew quickly during the Delta surge in part because it hit so many adults of childbearing age.“There is an extraordinary responsibility to care for those children,” he said. “So many of them were facing economic and other hardships even before the pandemic began, and certainly before they lost a caregiver. Now they are facing their darkest days.”Some parents whose spouses were frontline workers say they would like at least some recognition from Washington that their loved ones died while trying to protect others.Ms. Addison, whose husband was a hospital speech pathologist in Paterson, N.J., runs a support group called Young Widows and Widowers of Covid-19. She estimates that 95 percent of her 900 members have children.“You invite athletes to the White House because they’ve won a championship; why not invite families who lost their loved one because they went into a hospital, they went into a school that wasn’t really safe?” she said. “You see when a military person dies there is this big celebration of their life and the kids know their parent is a hero. Our kids need that.”

The Biden administration will spend billions of dollars on a new plan to combat the pandemic, investing in antiviral pills, rapid tests and manufacturing.WASHINGTON — The Biden administration, under pressure to increase the supply of coronavirus vaccines to poor nations, plans to spend billions of dollars to expand manufacturing capacity, with the goal of producing at least one billion additional doses a year beginning in the second half of 2022.The investment is part of a new plan, announced Wednesday by White House officials, for the government to partner with industry to address immediate vaccine needs in the United States and overseas and to prepare for future pandemics. It comes on top of recent decisions to buy enough of Pfizer’s new Covid-19 pill for about 10 million courses of treatment, and to spend $3 billion on rapid over-the-counter tests, which are needed to detect the virus early enough for the Pfizer drug to work.Taken together, the moves amount to an expansive new effort to control the pandemic at a time when Americans are desperate for normalcy and caseloads are creeping up with winter’s approach.In another development that the White House hopes will reassure the public, the Food and Drug Administration is likely to approve requests from Pfizer-BioNTech and Moderna to offer booster shots to everyone 18 and older.President Biden has pledged to fight the coronavirus pandemic by making the United States the “arsenal of vaccines” for the world. But national self-interest is also at work; as long as vaccination rates remain low in other parts of the world, allowing the virus to spread, dangerous new variants could arise and plunge the United States into crisis once again.The global need is great. Testifying on Capitol Hill on Wednesday, Loyce Pace, the director of global affairs at the Department of Health and Human Services, said that more than half of the world’s five million coronavirus deaths had occurred in low- and middle-income countries, and that vaccination rates in some of them “are in the single digits.”Less than 10 percent of Africa’s population is vaccinated, she said, compared with more than 50 percent in North America and Europe. In many poor nations, including those struggling to combat other diseases like tuberculosis, malaria and H.I.V., even health care workers on the front lines of the pandemic remain unvaccinated.Expanding vaccine manufacturing through public-private alliances is not without risks. Until recently, the federal government had a manufacturing partnership with Emergent BioSolutions, whose Baltimore facility ruined millions of doses of Johnson & Johnson’s coronavirus vaccine earlier this year. The Biden administration severed its relationship with Emergent earlier this month.Administration officials insist this plan will be different. In interviews, Jeff Zients, President Biden’s coronavirus response coordinator, and Dr. David Kessler, who oversees vaccine distribution as the chief science officer for the Covid-19 response, said the intent is to invest in companies with experience making mRNA vaccines, enabling those companies to expand production to meet the government’s needs.That could include building new plants or production lines, and it might require licensing technology from other vaccine manufacturers.“This is about assuring expanded capacity against Covid variants and also preparing for the next pandemic,” Dr. Kessler said in an interview. “The goal, in the case of a future pandemic, a future virus, is to have vaccine capability within six to nine months of identification of that pandemic pathogen, and to have enough vaccines for all Americans.”Dr. Kessler and Mr. Zients conceded the plan is not fully fleshed out; the Biomedical Advanced Research and Development Agency on Wednesday issued a request for ideas from industry. The price tag is unknown; Dr. Kessler estimated it at several billion, with the money coming from the American Rescue Plan, the $1.9 trillion coronavirus relief package Mr. Biden signed into law earlier this year.Mr. Zients said the government was looking to move quickly, and wanted responses from industry within 30 days. The potential partners appear to be limited; only two major vaccine makers — Pfizer and Moderna — are currently using mRNA technology, although those companies employ contract manufacturers to do the work for them.In a statement on Wednesday, Pfizer commended the administration and pledged to “come to the table with how we can best contribute” to the fight against Covid-19. Officials at Moderna did not respond to an email message seeking comment. But Steve Brozak, an investment banker whose company, WBB Securities, specializes in biotechnology, said engaging industry could prove difficult.“Without a specific commitment of money, without a specific time plan, companies may not be interested,” Mr. Brozak said. If the administration wants to ramp up vaccine manufacturing, he added, it will also have to increase production of resins and other vaccine components.Reaction to the plan was mixed, especially among activists who have been pushing the Biden administration to lean on Pfizer and Moderna to share their technology with manufacturers overseas. (The National Institutes of Health is in a patent dispute with Moderna, which received billions in taxpayer funding, over who deserves credit for inventing the central component of the company’s coronavirus vaccine.)“The idea of making a business plan with two companies rather than a public health plan is disturbing to us,” said Dr. Joia Mukherjee, chief medical officer of Partners In Health, a global public health nonprofit. “We believe that Biden has the power, particularly with Moderna because so much of it was taxpayer funded, to demand the sharing of patents and know-how.”Some activists, furious with what they regard as the administration’s slow progress, turned up at the home of Ron Klain, Mr. Biden’s chief of staff, in September and deposited a fake mountain of bones on the sidewalk in protest. Another group protested outside Mr. Zients’s home on Wednesday morning.Addressing criticism that the Biden plan is not focused on building capacity overseas, Dr. Kessler said that domestic manufacturing “is important not only for the U.S. supply, but for global supply.”At the same time, partnering with big drug makers offers no guarantees. Mr. Biden announced earlier this year that he had brokered a deal with Merck & Co., the pharmaceutical giant, to manufacture Johnson & Johnson’s vaccine, including for other countries. Officials hailed the partnership as historic, saying it fit in with the president’s vision of a manufacturing campaign like the one Franklin D. Roosevelt spearheaded to produce supplies for World War II.But the Merck deal has not panned out as expected. Administration officials initially hoped Merck would begin producing the vaccine’s key ingredient by the end of this year, but that will not happen until April, Dr. Kessler said.Congress put a total of $16.05 billion in the American Rescue Plan this year, in two separate tranches, that could be used to procure and manufacture treatments, vaccines and other tools for ending the pandemic.But in an analysis released this summer, the AIDS advocacy group Prep4All found that all told, the administration had spent $145 million — just $12 million of it from the American Rescue Plan — to expand vaccine manufacturing. Most went to retrofitting Merck’s production lines.James Krellenstein, a founder of Prep4All and the author of the study, pointed to the experience with Emergent and Merck to suggest that simply paying industry to build new production lines will not work. His group has called for the government to build its own vaccine manufacturing facility, and to hire a contract manufacturer to run it.“The Biden administration is at two forks in the road right now,” Mr. Krellenstein said. “We have to commend them in the first place for committing to address seriously the manufacturing and supply issues. But we do need the Biden administration to learn a little bit from history.”The advocacy group Public Citizen has called for a $25 billion government investment to make eight billion doses of mRNA in one year, enough to meet global need. Peter Maybarduk, Public Citizen’s access to medicines director, criticized the administration for not doing more to press Moderna and Pfizer to share their technology with manufacturers in developing nations.“Sharing doses is charity, and desperately needed,” he said. “But sharing knowledge is justice.”

The $1.85 trillion social policy bill would provide free private health insurance for more than two million adults locked out of coverage, but only for four years.ALBANY, Ga. — After giving up on their goal of creating a new Medicaid program to cover two million poor adults, Democrats are aiming to provide them with free private coverage as part of the party’s social policy bill. But there is a catch: The benefits would last only four years.Even with that expiration date, the legislation cannot come fast enough for people like Evelyn Davis, who suffered two heart attacks and has high blood pressure and diabetes. A former home health care aide, she lost coverage when she got divorced two years ago. She has chest pains and heart palpitations but said she cannot afford to see a cardiologist.“If I can’t get any medicine, I just get Tylenol PM when I sleep,” Ms. Davis, 63, said, “and just pray to God when I wake up that I won’t be in pain.”She is among an estimated 2.2 million American adults who lack insurance because they live in one of the 12 states where Republicans have refused to expand Medicaid, which is jointly financed by the federal government and states, under the Affordable Care Act. Too poor to qualify for subsidized private insurance through the Obamacare exchanges yet not poor enough for Medicaid, they navigate a byzantine system of charity care — and often skip care altogether.Now these patients may get what many have hoped for since the Affordable Care Act’s passage more than a decade ago — albeit with no guarantee that the new benefits are here to stay. The framework announced last week by President Biden for the $1.85 trillion social policy bill includes the biggest expansion of health care since the Obama-era health law, patching holes in the landmark law that had long seemed impossible to fix.Still, the framework is tenuous. On Monday, Senator Joe Manchin III, Democrat of West Virginia, dashed hopes for a quick Senate vote by refusing to endorse the measure, whose health care provisions had already been pared back under pressure from Mr. Manchin and other centrists to keep the price down.The “public option,” promoted by Mr. Biden during his presidential campaign as a way for people to buy into a Medicare-like plan, was never even considered. Language authorizing the government to negotiate prices with drug companies was scrapped. A plan to give dental, vision and hearing coverage to Medicare recipients has been whittled down to just hearing.And in the end, negotiators dropped the idea of a new Medicaid plan financed entirely by the federal government for people in the 12 holdout states, which would have been complicated to create, in favor of fully subsidized private coverage — but only through 2025.The free plans would be comparable to Medicaid coverage, with minimal fees for doctor visits and enhanced benefits like transportation to medical appointments. All told, an estimated 4.4 million people — including the uninsured and other low-income adults — would be able to take advantage of them.For Democrats, who took back the House in 2018 and this year gained control of the Senate in part by vowing to expand access to affordable heath care, the bill is a political necessity. And perhaps no Democrat needs it more than Senator Raphael Warnock, Georgia’s first Black senator, who won a special election in January on a promise of expanding Medicaid.Mr. Warnock will be on the ballot again in 2022, a year that is widely expected to be grim for his party, and the contest could determine control of the Senate. In Washington, closing the coverage gap remains Mr. Warnock’s signature issue.“I believe that health care is a human right, and if you believe it’s a human right, you don’t believe it’s a human right for 38 states,” Mr. Warnock said in an interview in September.But some Democrats, notably Mr. Manchin, view solving the problem solely with federal dollars as unfair to states that did expand Medicaid and continue to pay 10 percent of the cost; why, they ask, should Republicans be rewarded for resisting? Republicans oppose the social policy plan in its entirety, calling it a “tax and spending spree.”A rural hospital treating Covid-19 patients in Rio Grande City, Texas. The state accounts for more than a third of people in the Medicaid coverage gap.Christopher Lee for The New York TimesThe profile of those who fall in the gap is much the same as the profile of those hardest hit by the coronavirus pandemic: poor people of color. Most are in the South; Texas alone accounts for more than a third of people in the gap, according to the Kaiser Family Foundation.Della Young, 49, a kidney transplant patient with lupus, was doing fine when she lived in New York. As an end-stage renal disease patient, she is covered by Medicare, which paid 80 percent of her medical expenses. Medicaid picked up the rest.But when Ms. Young moved to McDonough, Ga., in 2015, she lost her Medicaid coverage and was unable to pay for drugs to prevent her body from rejecting her donated organ. Her transplant failed in 2016, and she has been waiting for a new kidney ever since, while undergoing dialysis three times a week. She sends the dialysis center a check for $5 a month — a small offering toward a much larger bill.Because out-of-pocket expenses associated with transplants are so high, Emory Transplant Center, where Ms. Young is a patient, advised her to raise money on her own. She started a GoFundMe account, hoping to raise $100,000. She has raised $5,077 so far.“This whole fund-raising thing is crazy,” she said. “Health care should be the same across the board, regardless of what state you live in.”In Albany, a small city about three hours south of Atlanta, patients like Ms. Davis are eager for any help they can get. She and about a dozen other uninsured people shared their stories in the bare-bones waiting room of the Samaritan Clinic, founded 15 years ago by the Rev. Daniel Simmons, the senior pastor of Mount Zion Baptist Church, who said he had followed the will of God.“People were suffering, dying right in our backyard,” he said. “I said, ‘Lord, what do you want me to do?’”Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap.Nicole Craine for The New York TimesStill, the clinic can only do so much. Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap. She gets blood pressure and cholesterol drugs through the clinic, which works with companies that offer free medicines.But when Ms. Jones sought care for Covid-19, she got a bill for $150. “That went to collections because I didn’t have the money to pay it,” she said.Volunteer doctors provide primary care at the clinic, but Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care. Georgia is one of a dozen states that have not expanded Medicaid under the Affordable Care Act. Addressing the coverage gap has been a priority for the state’s two Democratic senators, Raphael Warnock, center, and Jon Ossoff, right. J. Scott Applewhite/Associated PressSome patients, she said, can afford to go to the community health center, which has a low co-payment of $25. “But oftentimes, once they get in to see a provider and they have to run labs, the patient ends up having a bill,” Ms. Fortson said. “And once they can’t pay that bill, they are unable to get appointments, and so they come to us to get help.”The question of Medicaid expansion has percolated through Georgia politics for much of the past decade. The Affordable Care Act intended for states to expand Medicaid to cover adults with incomes up to 138 percent of the federal poverty line — currently about $17,800 a year for an individual. Republican states sued, and in 2012 the Supreme Court upheld the law but made Medicaid expansion optional.Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care.Nicole Craine for The New York TimesIn 2014, Georgia Republicans went one step further. Fearful that a Democrat would win the governorship, they passed a law requiring the legislature to approve any expansion plan. In 2018, Stacey Abrams, the Democratic candidate for governor, hit Republicans hard on health care. The next year, the state sought to partially expand Medicaid, with requirements for recipients to work.The Trump administration approved the plan, which would have covered only a fraction of the state’s uninsured low-income adults, just days before Mr. Trump lost the 2020 election. The Biden administration, opposed to work requirements, has put it on hold.In the meantime, people in the coverage gap are trying to make do — now with new hope that the social policy bill will become law. Ms. Davis, the former home health care aide, pays $90 out of pocket to see a primary care doctor once a year and gets annual mammograms from the county health department, where they are free. Her children help, but she does not like to accept it.The Democrats’ plan to fully subsidize four years of coverage would tide Ms. Davis over until she turns 65 in two years and becomes eligible for Medicare. She sought Social Security disability benefits, hoping to qualify for Medicare that way, but was unsuccessful.“I filed for disability and they denied me,” she said, “and I’m like, ‘Oh Lord, it ain’t so much about the check.’ If I could just get some insurance so I could see my doctors, that’s all I want.” She added, “If I could get four years, it would be great.”

The $1.85 trillion social policy bill would provide free private health insurance for more than two million adults locked out of coverage, but only for four years.ALBANY, Ga. — After giving up on their goal of creating a new Medicaid program to cover two million poor adults, Democrats are aiming to provide them with free private coverage as part of the party’s social policy bill. But there is a catch: The benefits would last only four years.Even with that expiration date, the legislation cannot come fast enough for people like Evelyn Davis, who suffered two heart attacks and has high blood pressure and diabetes. A former home health care aide, she lost coverage when she got divorced two years ago. She has chest pains and heart palpitations but said she cannot afford to see a cardiologist.“If I can’t get any medicine, I just get Tylenol PM when I sleep,” Ms. Davis, 63, said, “and just pray to God when I wake up that I won’t be in pain.”She is among an estimated 2.2 million American adults who lack insurance because they live in one of the 12 states where Republicans have refused to expand Medicaid, which is jointly financed by the federal government and states, under the Affordable Care Act. Too poor to qualify for subsidized private insurance through the Obamacare exchanges yet not poor enough for Medicaid, they navigate a byzantine system of charity care — and often skip care altogether.Now these patients may get what many have hoped for since the Affordable Care Act’s passage more than a decade ago — albeit with no guarantee that the new benefits are here to stay. The framework announced last week by President Biden for the $1.85 trillion social policy bill includes the biggest expansion of health care since the Obama-era health law, patching holes in the landmark law that had long seemed impossible to fix. Still, the framework is tenuous. On Monday, Senator Joe Manchin III, Democrat of West Virginia, dashed hopes for a quick Senate vote by refusing to endorse the measure, whose health care provisions had already been pared back under pressure from Mr. Manchin and other centriststo keep the price down. The “public option,” promoted by Mr. Biden during his presidential campaign as a way for people to buy into a Medicare-like plan, was never even considered. Language authorizing the government to negotiate prices with drug companies was scrapped. A plan to give dental, vision and hearing coverage to Medicare recipients has been whittled down to just hearing.And in the end, negotiators dropped the idea of a new Medicaid plan financed entirely by the federal government for people in the 12 holdout states, which would have been complicated to create, in favor of fully subsidized private coverage — but only through 2025. The free plans would be comparable to Medicaid coverage, with minimal fees for doctor visits and enhanced benefits like transportation to medical appointments. All told, an estimated 4.4 million people — including the uninsured and other low-income adults — would be able to take advantage of them.For Democrats, who took back the House in 2018 and this year gained control of the Senate in part by vowing to expand access to affordable heath care, the bill is a political necessity. And perhaps no Democrat needs it more than Senator Raphael Warnock, Georgia’s first Black senator, who won a special election in January on a promise of expanding Medicaid.Mr. Warnock will be on the ballot again in 2022, a year that is widely expected to be grim for his party, and the contest could determine control of the Senate. In Washington, closing the coverage gap remains Mr. Warnock’s signature issue.“I believe that health care is a human right, and if you believe it’s a human right, you don’t believe it’s a human right for 38 states,” Mr. Warnock said in an interview in September.But some Democrats, notably Mr. Manchin, view solving the problem solely with federal dollars as unfair to states that did expand Medicaid and continue to pay 10 percent of the cost; why, they ask, should Republicans be rewarded for resisting? Republicans oppose the social policy plan in its entirety, calling it a “tax and spending spree.” A rural hospital treating Covid-19 patients in Rio Grande City, Texas. The state accounts for more than a third of people in the Medicaid coverage gap.Christopher Lee for The New York TimesThe profile of those who fall in the gap is much the same as the profile of those hardest hit by the coronavirus pandemic: poor people of color. Most are in the South; Texas alone accounts for more than a third of people in the gap, according to the Kaiser Family Foundation.Della Young, 49, a kidney transplant patient with lupus, was doing fine when she lived in New York. As an end-stage renal disease patient, she is covered by Medicare, which paid 80 percent of her medical expenses. Medicaid picked up the rest.But when Ms. Young moved to McDonough, Ga., in 2015, she lost her Medicaid coverage and was unable to pay for drugs to prevent her body from rejecting her donated organ. Her transplant failed in 2016, and she has been waiting for a new kidney ever since, while undergoing dialysis three times a week. She sends the dialysis center a check for $5 a month — a small offering toward a much larger bill.Because out-of-pocket expenses associated with transplants are so high, Emory Transplant Center, where Ms. Young is a patient, advised her to raise money on her own. She started a GoFundMe account, hoping to raise $100,000. She has raised $5,077 so far.“This whole fund-raising thing is crazy,” she said. “Health care should be the same across the board, regardless of what state you live in.”In Albany, a small city about three hours south of Atlanta, patients like Ms. Davis are eager for any help they can get. She and about a dozen other uninsured people shared their stories in the bare-bones waiting room of the Samaritan Clinic, founded 15 years ago by the Rev. Daniel Simmons, the senior pastor of Mount Zion Baptist Church, who said he had followed the will of God.“People were suffering, dying right in our backyard,” he said. “I said, ‘Lord, what do you want me to do?’ ”Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap.Nicole Craine for The New York TimesStill, the clinic can only do so much. Lisa Jones, 59, lost her employer-sponsored insurance when she gave up her job at a chicken processing plant to care for her ailing husband. He put her on his plan, but when he died she fell into the coverage gap. She gets blood pressure and cholesterol drugs through the clinic, which works with companies that offer free medicines.But when Ms. Jones sought care for Covid-19, she got a bill for $150. “That went to collections because I didn’t have the money to pay it,” she said.Volunteer doctors provide primary care at the clinic, but Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care. Georgia is one of a dozen states that have not expanded Medicaid under the Affordable Care Act. Addressing the coverage gap has been a priority for the state’s two Democratic senators, Raphael Warnock, center, and Jon Ossoff, right. J. Scott Applewhite/Associated PressSome patients, she said, can afford to go to the community health center, which has a low co-payment of $25. “But oftentimes, once they get in to see a provider and they have to run labs, the patient ends up having a bill,” Ms. Fortson said. “And once they can’t pay that bill, they are unable to get appointments, and so they come to us to get help.”The question of Medicaid expansion has percolated through Georgia politics for much of the past decade. The Affordable Care Act intended for states to expand Medicaid to cover adults with incomes up to 138 percent of the federal poverty line — currently about $17,800 a year for an individual. Republican states sued, and in 2012 the Supreme Court upheld the law but made Medicaid expansion optional.Nedra Fortson, a nurse practitioner and the clinic’s executive director, said it was difficult to refer patients to specialists because so many refuse to offer free care.Nicole Craine for The New York TimesIn 2014, Georgia Republicans went one step further. Fearful that a Democrat would win the governorship, they passed a law requiring the legislature to approve any expansion plan. In 2018, Stacey Abrams, the Democratic candidate for governor, hit Republicans hard on health care. The next year, the state sought to partially expand Medicaid, with requirements for recipients to work.The Trump administration approved the plan, which would have covered only a fraction of the state’s uninsured low-income adults, just days before Mr. Trump lost the 2020 election. The Biden administration, opposed to work requirements, has put it on hold.In the meantime, people in the coverage gap are trying to make do — now with new hope that the social policy bill will become law. Ms. Davis, the former home health care aide, pays $90 out of pocket to see a primary care doctor once a year and gets annual mammograms from the county health department, where they are free. Her children help, but she does not like to accept it.The Democrats’ plan to fully subsidize four years of coverage would tide Ms. Davis over until she turns 65 in two years and becomes eligible for Medicare. She sought Social Security disability benefits, hoping to qualify for Medicare that way, but was unsuccessful.“I filed for disability and they denied me,” she said, “and I’m like, ‘Oh Lord, it ain’t so much about the check.’ If I could just get some insurance so I could see my doctors, that’s all I want.” She added, “If I could get four years, it would be great.”

But his plans face a tough road as pressure grows for big pharmaceutical companies to share their vaccine technologies with poorer nations.WASHINGTON — President Biden, declaring the coronavirus an “all-hands-on-deck crisis,” set out ambitious goals on Wednesday for ending the pandemic and urged world leaders, drug companies, philanthropies and nonprofit groups to embrace a target of vaccinating 70 percent of the world by next year.But the course that Mr. Biden charted, at a virtual Covid-19 summit meeting that he convened on the sidelines of the United Nations General Assembly in New York, may be difficult to turn into reality. And pressure is mounting on the president to lean harder on U.S. pharmaceutical manufacturers, which are resisting sharing their Covid-19 technology with poorer countries.The daylong meeting, the largest gathering of heads of state to address the pandemic, was a reflection of Mr. Biden’s determination to re-establish the United States as a leader in global health after President Donald J. Trump severed ties with the World Health Organization last year, at the outset of the coronavirus crisis.Mr. Biden announced a series of actions, including the purchase of an additional 500 million doses of Pfizer’s vaccine at a not-for-profit price to donate overseas and $370 million to administer the shots. Vice President Kamala Harris announced that the United States would donate $250 million to a new global fund that aims to raise $10 billion to prevent future pandemics.“We’re not going to solve this crisis with half-measures or middle-of-the-road ambitions. We need to go big,” the president said in televised remarks. “And we need to do our part: governments, the private sector, civil society leaders, philanthropists.”Still, Mr. Biden’s summit meeting spurred some resentment toward the United States from those who have criticized the administration for hoarding vaccines and not doing enough to help developing nations manufacture their own. Others said the administration was claiming credit for a plan that already existed.“It’s not really new, but the financial power of what they put on the table is new of course,” Dr. Marie-Paule Kieny, a French virologist and former top W.H.O. official, said in an interview. She noted that the organization had already set a target of vaccinating 70 percent of people in low- and middle-income countries by next September.“The U.S. wants to be engaged,” she added, “but they still don’t know exactly how to engage with the new world that has developed while they were away.”Mr. Biden also faces criticism for offering booster doses to fully vaccinated Americans when millions of people around the world, including health care workers, have yet to receive a first dose. In his speech at the United Nations on Wednesday, President Uhuru Kenyatta of Kenya said that such inequities were hindering efforts to rebuild the global economy, which requires confidence and investment.“The surest way to building that confidence is by making vaccines available to the world, in an equitable and accessible manner,” Mr. Kenyatta said. “That, sadly, is currently not the case. The asymmetry in the supply of vaccines reflects a multilateral system that is in urgent need for repair.”In his opening remarks, Mr. Biden cited two especially urgent challenges: vaccinating the world against Covid-19 and solving a global oxygen shortage, which is leading to unnecessary deaths among Covid-19 patients who might survive if oxygen were more available.But as soon as the president finished speaking and the television cameras were turned off, the director general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, called on countries and companies to immediately share doses, intellectual property and technical know-how for manufacturing vaccines, according to one person who attended the summit and took notes on the remarks.President Cyril Ramaphosa of South Africa was equally pointed, the person said. Mr. Ramaphosa called the vaccine inequities “unjust and immoral” and reiterated his proposal that developing countries should be able to manufacture their own doses.More than 4.7 million people around the world, and more than 678,000 in the United States, have died of Covid-19 — a “global tragedy,” Mr. Biden said. While three-quarters of Americans have had at least one coronavirus shot, less than 10 percent of the population of poor nations — and less than 4 percent of the African population — has been fully vaccinated.Worldwide, 79 percent of shots that have been administered have been in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Covax, the W.H.O.-backed international vaccine initiative, is behind schedule in delivering shots to low- and middle-income nations that need them the most.The United States has pledged to donate 1.1 billion doses of Covid-19 vaccines to low- and middle-income nations.Daniel Irungu/EPA, via ShutterstockAt a briefing held by Physicians for Human Rights this week, Dr. Soumya Swaminathan, the chief scientist of the W.H.O., issued a plea for nations to work together to distribute vaccines in a coordinated and equitable way. She also urged countries to share their excess supplies.“A country-by-country approach, a nationalistic approach, is not going to get us out of this pandemic,” she said. “And that’s where we are today.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Experts estimate that 11 billion doses are necessary to reach widespread global immunity. Before Wednesday, the United States had promised to donate more than 600 million doses. The additional 500 million that Mr. Biden pledged brings the total U.S. commitment to 1.1 billion doses, more than any other country.“Put another way, for every one shot we’ve administered to pay in America, we have now committed to do three shots to the rest of the world,” Mr. Biden said.But activists, global health experts and world leaders say donated doses will not be enough. They are calling for the Biden administration to do more to scale up global manufacturing of vaccines, particularly in Africa, where the need is greatest.“The Covid-19 pandemic reminds us of the importance of diversification of production centers across the world,” President Joko Widodo of Indonesia, which has suffered one of the biggest surges in cases, said in his General Assembly speech. “We know that no one is safe until everyone is.”The landscape for getting shots into arms has become increasingly challenging since Covax was created in April 2020. Some Asian countries have imposed tariffs and other trade restrictions on Covid-19 vaccines, slowing their delivery. India, home to the world’s largest vaccine maker, has banned coronavirus vaccine exports since April, although officials say they will resume next month.In his opening remarks, Mr. Biden called on other wealthy nations to live up to their donation commitments. He also appeared to take a veiled shot at China, which did not participate in the summit, and has for the most part been selling — rather than donating — its vaccine to other countries.“We should unite around the world on a few principles: that we commit to donating, not selling — donating, not selling — doses to low- and lower-income countries, and that the donations come with no political strings attached,” the president said.He also announced a vaccine partnership with the European Union and said the United States was working to scale up production overseas through a partnership with India, Japan and Australia that was “on track to produce at least 1 billion vaccine doses in India to boost the global supply by the end of 2022.”The doses the Biden administration is donating, however, have been trickling out slowly. So far, 157 million have been shipped overseas. Dr. Peter J. Hotez, an infectious disease expert at Texas Children’s Hospital who helped develop a coronavirus vaccine that is being manufactured in India, said the president should have laid out “a frank articulation of the magnitude” of the shortage.“We don’t need it by 2023,” Dr. Hotez said. “We need it now, over the next six to eight months.”Rick Gladstone