Good morning! And welcome to our first Health 202 collab with our good pal Yasmeen Abutaleb, who wrote today's top with us. 
🚨Today: The House is planning to pass Biden's social spending bill after a record-breaking speech from House Minority Leader Kevin McCarthy: 8 hours and 32 minutes. This comes after the Congressional Budget Office delivered much-anticipated projections for how much the bill will cost and a key estimate on how much Democrats' drug pricing deal will save. But first:

Francis Collins wants online misinformation spreaders “brought to justice”

NIH Director Francis Collins spoke forcefully against the spread of misinformation. (Alex Wong/Getty Images)
NIH Director Francis Collins has a stern message for the American public: The country has, what he called, an epidemic of misinformation and disinformation. And it’s fueling a dangerous distrust in science. 
Conspiracies are winning here. Truth is losing. That’s a really serious indictment of the way in which our society seems to be traveling,” said Collins, who will soon step down as the National Institutes of Health director after serving in both Republican and Democratic administrations. 
Collins made his most forceful comments yet against the pervasive spread of falsehoods online to our colleague Yasmeen Abutaleb. He was defending his own colleague, Anthony Fauci, Biden’s chief medical adviser, against the biggest onslaught of angry messages and threats he's received throughout the entire pandemic.
Those attacks stemmed in part from a viral and false claim that Fauci, who leads the National Institute of Allergy and Infectious Diseases, had funded a medical experiment that involved trapping beagles' heads in mesh cages filled with diseased sand flies. Fauci received so many messages — 3,600 phone calls in 36 hours — that his assistant quit answering the phone, Yasmeen and Beth Reinhard report in a story out this morning.
  • The claim was amplified by a little-known animal rights group called the White Coat Waste Project, which leveraged existing hostility among conservatives toward Fauci to further its cause, The Post’s investigation found. The outrage was supercharged by a bipartisan letter signed by 24 members of Congress that questioned the agency’s funding of medical research on dogs.
  • The claim originated with an error by scientists. NIAID was initially listed as a funder on the study in a paper in a scientific journal in late July. Even after the researchers and the medical journal corrected the error, White Coat Waste continued to promote and fundraise off the false claim. The group said it does not believe NIAID's denial or the corrections.
  • White Coat Waste's message was amplified by a right-wing echo chamber eager to thrash Fauci over everything from vaccine directives to NIH funding of coronavirus research at the Wuhan Institute of Virology and created the biggest firestorm yet for Fauci.
The episode serves as a prime example of how fast a false claim can spread online — and how it can stymie the highest levels of government. The surge of threats and harassment in recent weeks has forced Fauci's staff to spend significant time debunking misinformation and grappling with security concerns.
Fauci testifies before the Senate Health, Education, Labor, and Pensions Committee in July. J. Scott Applewhite/Pool via REUTERS/File Photo (Pool/Reuters)
Here are excerpts from Yasmeen’s interview with Collins:
Cracking down
The rapid-fire spread of misinformation has altered public opinion of the pandemic and coronavirus vaccines. Some 6 in 10 Americans say they either believe the government is exaggerating the number of deaths from the virus or aren’t sure. Nearly 1 in 4 Americans believe covid-19 shots contain microchips or don’t know if the claim is true, according to a recent Kaiser Family Foundation survey.
  • “Truth is supposed to be truth,” Collins said, “and the fact that your truth would be so heavily modified by your social circle or where you get your news tells you we’re in real trouble.”
  • He said he worries about a society where “somebody’s Facebook post carries as much weight as a statement from the director of the CDC about what is the truth of a public health crisis.”
He sees two ways of attempting to curb the spread of misinformation, though admits he’s unsure how successful either has been. 
  • The first: Identify those who are purposefully spreading false information online and bring them to justice.
  • The second: Find a better way to counter false claims with real information. He didn’t specify what exactly either one would entail.
Standing firm
Fauci has been a controversial figure throughout the pandemic, as he openly clashed with President Donald Trump over masks and unproven covid cures, Yasmeen and Beth note. The sparring and public criticism over the last two years has led some “very credible people” to ask Collins if it’s time for Fauci to resign.
  • “I was like, are you kidding me?,” Collins recalled. “Do you then want to hand a victory on a platter to the people who have made up stories and incessantly thrown around information that is absolutely untrue to try to take him down? You want to say okay, they win? Is that your proposal?”
Collins himself has been the target of attacks. Whenever he pushes back on conspiracies, he says he knows he’s going to get “some of the most vile email responses that you can imagine.”

On the Hill

House passage of Biden's economic package appears imminent

Democrats are poised to pass their economic package, which would be a victory for House Speaker Nancy Pelosi. (Jabin Botsford/The Washington Post)
Onward: House Democrats are slated to overcome months of infighting to pass Biden’s sprawling economic package today. The legislation will then head to the Senate, where the two parties will spar over what policies can be included under the budget maneuver Democrats are using to pass the package without any GOP votes. 
  • How we got here: Democrats were ready to pass the bill yesterday, and it seems they have the votes.
  • “But their timetable hit an unexpected snag after House Minority Leader Kevin McCarthy (R-Calif.) took to the chamber floor beginning in the evening. He soon embarked on a form of filibuster, using the unlimited time available to House leaders ahead of votes to rail on the roughly $2 trillion bill,” our colleagues Tony Romm, Paul Kane and Marianna Sotomayor report.
Yesterday, the Congressional Budget Office released a much-anticipated analysis of the package. Aides and advocates were watching closely for estimates of an 11th-hour drug pricing compromise, a key policy for helping pay for the bill. Let’s break down how much the policy saves, which is significantly less than a more sweeping measure the House passed in 2019.
  • Allowing Medicare to directly negotiate the price of prescription drugs: $79 billion.
  • Penalizing drugmakers for hiking prices faster than inflation: $49 billion.
  • Capping out-of-pocket costs for seniors: $1.6 billion.
  • Repealing a Trump-era rebate rule (which was included in the legislation before the compromise): $143 billion. 
  • The total: $297 billion. 
  • Notably, scorekeepers estimated the number of fewer drugs introduced to the market would be roughly one drug over 10 years, and four over the subsequent decade. Drug companies say the drug pricing provisions will thwart innovation.
Par for the course: It’s typical for lawmakers to allege congressional scorekeepers got it wrong. Take House Ways and Means Chairman Richard Neal (D-Mass.), who told The Health 202, he believes the drug pricing provisions will save more than projected.


The Food and Drug Administration is expected to clear booster shots for Moderna and Pfizer today

The FDA had planned to approve Pfizer-BioNTech's request for all adults this week ahead of the Thanksgiving holiday. When Moderna submitted a similar request just days ago, federal regulators began debating if they could approve both applications at once, Politico's Adam Cancryn reports.
Both shots are expected to be cleared by the FDA ahead of a meeting of the CDC's vaccine advisory group this afternoon.
Here's what else you need to know:
  • The location of early coronavirus infections in late 2019 in Wuhan, China, suggests the virus most likely spread to humans from a market where wild and domestically farmed animals were sold and butchered, according to a peer-reviewed article published Thursday in the journal Science, The Post's Joel Achenbach reports. It's the latest salvo in the debate over the origins of the virus. Amid murky data and a lack of transparency from China, it's unlikely to quell theories that the virus may have originated in a lab.
  • The American Medical Association and more than 60 other health-care associations called on employers to voluntarily adopt Biden’s vaccine or testing mandate, The Post's Dan Diamond reports.
  • A House panel probing the government’s coronavirus response issued a subpoena to White House trade adviser Peter Navarro, saying the close ally of Trump has rebuffed the panel’s requests for over two months, Dan writes.

Quote of the week

Agency alert

First in The Health 202: Surprise billing wars continue: The bipartisan leaders of the House Education and Labor Committee are expressing support for the Biden administration’s divisive rule detailing how to protect patients from surprise medical bills.
  • In a letter to three cabinet secretaries, Chairman Bobby Scott (D-Va.) and ranking member Virginia Foxx (R-N.C.) say the regulation aligns with how Congress intended mediators to determine payments during a billing dispute.
  • But other lawmakers have pushed back. Over 150 members wrote to the Biden administration blasting the aspect of the rule Scott and Foxx endorsed.
In other health news:
  • The Biden administration sent a letter to Puerto Rico’s top Medicaid official yesterday explaining its rationale for rejecting a government watchdog’s findings that it erred in calculating increased payments for the island’s safety net program.
  • HHS reversed Trump-era waivers allowing child welfare agencies to bypass federal nondiscrimination requirements if they claimed the requirements conflicted with their religious beliefs. Critics argued that the waivers allowed taxpayer-funded foster care agencies in some states to discriminate against LGBTQ parents.
  • HHS is expected to release a report today that finds educators for the youngest children have high uninsurance rates. Some 15.7 percent of workers in early child education centers were uninsured in 2019 and 9 percent of preschool and kindergarten teachers are uninsured. In comparison, only 2.4 percent of high school teachers lack health insurance.

Sugar rush

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