What is H.R. 2118?
(Updated March 11, 2022)
This bill, known as the Securing America From Epidemics (SAFE) Act, would authorize the U.S. to participate in the Coalition for Epidemic Preparedness Initiatives (CEPI), which is an alliance of countries and private partners whose mission is to finance and coordinate the development of vaccines for high-priority, epidemic-level threats.
Additionally, this bill would direct the president to submit a report outlining the following no more than 180 days after this bill’s passage:
Planned U.S. contributions to, and participation in, CEPI;
The manner and extent to which the U.S. would participate in CEPI’s governance; and
- How participation in CEPI would support U.S. government strategies and programs in health security and biodefense.
Finally, this bill would characterize CEPI as a public international organization.
Argument in favor
The Coalition for Epidemic Preparedness Initiatives (CEPI) and its partners, the World Health Organization (WHO) and Gavi, are leading the international effort on COVID-19 vaccine development. As a global superpower, the U.S. should rightfully be a member of the coalition. Joining CEPI would benefit the U.S. by serving as a hedge on development of vaccines for COVID-19 and other future epidemic threats, and benefit the global community insofar as the U.S. could provide much-needed financial and political support for CEPI’s work.
The fact that all current FDA-approved vaccines were developed by the private sector, rather than CEPI, proves that this organization is unnecessary. Alternatively, the U.S. Agency for International Development (USAID) announced $20 million in financial support for CEPI in mid-October 2020, so there’s no need for further Congressional action on this issue. Finally, it’s possible that the World Health Organization (WHO), with its extensive technical expertise and network of academics and experts, would be better-suited than CEPI to ensure global public health and epidemic preparedness.
U.S. COVID-19 vaccine development policy; U.S. membership in the Coalition for Epidemic Preparedness Initiatives (CEPI); and Coalition for Epidemic Preparedness Initiatives (CEPI).
Cost of H.R. 2118
The Congressional Budget Office (CBO) estimates that this bill would require additional appropriations of $4 million a year over the 2023-2024 period to fulfill the $20 million commitment that the U.S. Agency for International Development (USAID) made to CEPI over the five-year period from 2020-2025. Therefore, this bill would cost $8 million to implement.
In-Depth: Sponsoring Rep. Ami Bera (D-CA), who is Chairman of the House Foreign Affairs Subcommittee on Asia, the Pacific, Central Asia, and Nonproliferation, reintroduced this bill from the 116th Congress to authorize U.S. participation in the Coalition for Epidemic Preparedness Innovations (CEPI), a public-private partnership developing vaccines for coronavirus and other highly infectious pathogens:
“The COVID-19 pandemic has shown just how interconnected the global community is. In just months, the COVID-19 virus spread across the world, causing widespread human suffering while crippling the global economy. It is a national security and public health imperative that the United States lead on global health security to both defeat this pandemic, and to prepare for future deadly diseases. A critical institution that is helping lead the international fight against the COVID-19 pandemic is CEPI, which provided early funding for the successful Moderna vaccine, and also co-leads COVAX, the global effort to manufacture and equitably distribute a COVID-19 vaccine to communities across the world. The SAFE Act will allow the U.S. to be a full and active participant in CEPI. By working through organizations like CEPI to develop new vaccine technologies, we will help ensure the world is far more prepared for the next pandemic.”
After this bill’s passage by the House Foreign Affairs Committee on July 29, 2020, Rep. Bera said:
“I’m honored that the House Foreign Affairs Committee passed the SAFE Act. It is critically important that we join international efforts to defeat COVID-19. The Coalition for Epidemic Preparedness Innovations is helping to lead those efforts by funding several vaccine candidates. I believe in American ingenuity but we need to take a portfolio approach to vaccine development. There’s no guarantee that a U.S. backed vaccine will be developed first and or be effective for all Americans. By joining CEPI, we will help ensure that we have access to vaccines the international community is developing. We also know that until this virus is defeated around the world, we will not be safe here at home. Our world and our economies are simply too interconnected.”
Lead Republican cosponsor Rep. Brian Fitzpatrick (R-PA) adds:
“We have seen firsthand the widespread devastating effects of a global pandemic on our health, economy, and national security this past year. Unfortunately, this will not be the last contagious and deadly virus our world will battle and confront, which is why it is of the utmost importance our country continues to be a leader in global health. The Coalition for Epidemic Preparedness Innovations (CEPI) has been integral in our global fight to defeat COVID, providing funding for the Moderna vaccine and ensuring the manufacturing and equitable distribution of the vaccine across the world. Our bipartisan SAFE Act will enable us to continue as a participant in the CEPI and make certain our country and world are prepared for the next pandemic.”
In early September 2020, the U.S. declined to join CEPI’s Covid-19 Vaccines Global Access Facility (COVAX) effort. Instead, the U.S. developed its own domestic effort, Operation Warp Speed. At the time, the Trump administration cited its desire not to work with the World Health Organization (WHO) in its refusal to join COVAX. Explaining the Trump administration’s position, White House spokesman Judd Deere said:
“The United States will continue to engage our international partners to ensure we defeat this virus, but we will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China.”
Despite the Trump administration’s position, the U.S. Agency for International Development (USAID) announced $20 million in financial support for CEPI in mid-October 2020. The funding, which the agency will provide over a five-year period from 2020 to 2025 subject to annual Congressional approval, will support CEPI’s vaccine development programs against its current priority diseases (Lassa fever, Middle Eastern Respiratory Syndrome (MERS), Nipah, Chikungunya, Rift Valley Fever, and Ebola), rapid vaccine development against unknown pathogens, and innovative vaccine platform technologies.
The Biden administration announced its intention to join COVAX on January 21, 2021 — one day after President Joe Biden took office. However, the Biden administration did not increase funding beyond $4 billion that had already been approved for Gavi in December 2020.
Kendall Hoyt, an assistant professor at Dartmouth’s Geisel School of Medicine who has consulted for CEPI, says that trying to “go it alone” on vaccine development hurts all parties. Hoyt explains:
“Here’s the case where what’s efficient and in our best interest is also fair. An opportunity for collaboration and diplomacy and wielding soft power—it’s got everything any enlightened leader would want.”
Some experts would prefer to see the World Health Organization (WHO) serve as the coordinating forum for COVID-19 vaccine development and delivery. Margaret Gadabu, head of chancery at the Malawi Embassy in Washington, is among these people. She says:
“The World Health Organization is the best starting point for coming up with recommendations. It has the technical expertise or linkages with academia and think-tanks to develop the recommendations based on science and data.”
This legislation passed the House Foreign Affairs Committee by voice vote with the support of 25 bipartisan House cosponsors, including 22 Democrats and three Republicans. It was also included in the more than $3 trillion Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which passed the House on a party-line vote in May 2020 before stalling in the Senate.
Of Note: The Coalition for Epidemic Preparedness Innovations (CEPI) was founded by the Bill & Melinda Gates Foundation, Wellcome Trust, World Economic Forum, and the governments of India and Norway in 2017. It works to advance vaccination development, fund technologies to speed up the development and production of vaccines against unknown illnesses, and support global pandemic response capacity.
CEPI, Gavi and the World Health Organization (WHO) launched the Covid-19 Vaccines Global Access Facility (COVAX) to ensure equitable access to COVID-19 vaccines and end the acute phase of the COVID-19 pandemic by the end of 2021. The coalition aims to deliver two billion doses of COVID-19 vaccines by the end of 2021 and facilitate globally fair distribution of vaccines as soon as they are available. As of September 2020, 172 countries were involved in the COVAX effort.
Sponsoring Rep. Ami Bera (D-CA) Press Release (117th Congress)
Sponsoring Rep. Ami Bera (D-CA) Press Release (116th Congress)
CBO Cost Estimate
Causes - HEROS Act
CEPI - COVAX
Kaiser Family Foundation (KFF)
Causes (Previous Version, 116th Congress)
Summary by Lorelei Yang(Photo Credit: SDI Productions)
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