Letter to Congressional Appropriators from Civil Society: Provide Urgent COVID-19 and MPXV Funding

letter to Congress supporting $26.9 billion COVID-19 and MPXV funding request

In a letter sent to lead appropriators on September 27, 2022, Public Citizen, Oxfam America, and 50+ civil society groups called on Congress to at a minimum provide $26.9 billion in urgently needed funds to support the public health response to the COVID-19 pandemic and Monkeypox virus (MPXV) outbreak.

The Honorable Patrick Leahy, Chair, Senate Committee on Appropriations

The Honorable Richard Shelby, Vice Chair, Senate Committee on Appropriations

The Honorable Rosa DeLauro, Chair, House Committee on Appropriations

The Honorable Kay Granger, Ranking Member, House Committee on Appropriations

Please deliver urgently needed funding for COVID-19 and Monkeypox Virus

 September 27, 2022

Dear Chair Leahy, Vice Chair Shelby, Chair DeLauro, and Ranking Member Granger,

As U.S.-based groups concerned with public health at home and abroad, we write to ask you to deliver urgently needed health funding for COVID-19 and the Monkeypox Virus (MPXV) response to protect domestic and global health. Without additional funding, vaccination, treatment and testing programs will falter, as will American research and development efforts crucial to identifying tools to mitigate the effects of current and future pandemics. The outcomes are predictable and dangerous: unacceptably high, long-term health and economic costs of COVID and MPXV for all people, in the United States and everywhere. Congress should authorize at a minimum the $26.9 billion in the White House’s latest funding request, including $4.6 billion for the U.S. global response and $9.5 billion for research and development of lifesaving medical tools to treat and prevent these diseases.[1] We urge you not to leave Americans and people all over the world vulnerable to continued risks of more death, disease and economic disruption from these public health emergencies.

Continued Challenges of COVID-19 and MPXV

As people in America and globally continue to suffer thousands of often preventable daily deaths and long-term health consequences from hundreds of thousands of new daily COVID-19 cases due to the ongoing pandemic, we are also grappling with another public health emergency: MPXV. More than 20,000 cases of MPXV in the United States and 60,000 cases globally have been reported this year.[2],[3]

While the pandemic persists, so do the inequities that continue to undermine domestic and global COVID-19 responses. In America, people with lower incomes are more likely to be unvaccinated and less likely to have access to lifesaving at-home treatments,[4],[5] while people in poorer counties died at nearly double the rate of people in wealthier counties.[6] Although the gap may be narrowing, “people of color are disproportionately impacted by surges caused by new variants, with disparities widening during these periods” and continue to die at higher rates than white Americans.[7]

Globally, people in lower-income countries are 1.3 times more likely to die as a result of the pandemic than people in wealthy countries.[8] Of the 2.5 billion people who still have not received any COVID-19 vaccines globally, a disproportionate number live in lower-income countries.[9] This pattern of inequity has repeated with treatment access as the overwhelming majority of new antivirals purchases go to high-income countries,[10] despite estimated needs for millions of treatment courses in low- and middle-income countries in 2022 alone.[11]

The consequences do not stop at illness and lives lost. Pandemics impact livelihoods too. Disruptions to economic activity and global supply chains impact all people regardless of their health status. The IMF estimated the pandemic will cost the global economy $12.5 trillion through 2024 and pointed to inequities in COVID access in their analysis earlier this year.[12] In America alone, the pandemic is estimated to cost $16 trillion in economic and health damage through 2029.[13] With the perpetual threat of new, deadlier or more disruptive variants as cases continue to proliferate at rates estimated to be 3 to 31 times higher than reported,[14] we cannot afford to ignore COVID-19.

The same trajectory of unequal access is underway for the MPXV outbreak. MPXV, a vaccine-preventable disease, is endemic to West and Central Africa, where vaccine and treatment access is negligible. The current outbreak in the United States and globally is concentrated among gay, bisexual, and other men who have sex with men.[15] In the United States, Black and Latino men are being disproportionately impacted, representing more than two-thirds of US MPXV cases,[16] but less than one-third of first Jynneos vaccine doses administered.[17] Many in other countries have received even fewer doses or none at all. Brazil, which has had close to 10% of global MPX cases, has not received any vaccines or treatments for the disease.[18]

Urgent Need for Additional Funding

Without additional funding, inequities in access to COVID-19 tools and care are expected to worsen.[19] The lack of supplemental funding has already resulted in the end of free COVID-19 tests as well as an end to reimbursement to providers for COVID-19 care including vaccine administration for uninsured Americans,[20] who are disproportionately people of color.[21] Additional funding can help ensure everyone in America is able to access the medical tools they need today and can help deliver the improved medical tools we need to better address COVID-19 in the future, ultimately saving health resources and lives. Fulfilling the MPXV funding request will help ensure there is adequate supply of Jynneos and support Administration efforts to promote vaccine equity and conduct the research needed to understand vaccine effectiveness, optimal use of treatments and more. But an ongoing funding drought will stall research and force tradeoffs between responding to urgent health needs and ensuring we are taking the steps needed now to better prepare for future pandemic threats.

As a champion for global health, America has made many important contributions, including more than $120 billion in global health spending in the past decade.[22] The disruptions to global health and the global economy caused by an insufficient, inequitable COVID-19 response threaten to undermine America’s global health leadership and opportunities to build on these important investments. Given USAID’s initial estimated need for $19 billion for global COVID-19 response,[23] the current White House request for a dramatically scaled back $4 billion, and warnings that the US is running out of money to support lagging vaccination efforts, it is deeply concerning that Congress has failed to approve any additional funding for the U.S.’s global response to COVID-19 in the past six months. The global MPXV response has similarly not been resourced at the levels needed to quickly curb this outbreak.

Urgent approval of the $26.9 billion funding request for COVID-19 and MPXV can help start to fill the gaps of a currently inadequate response and protect America’s public health investments at home and abroad from the continuing damage wrought by COVID-19 and MPXV.


Oxfam America

Public Citizen

Accelerate Global, LLC

ADRA International

American Federation of Teachers

American Friends Service Committee

American Jewish World Service

American Muslim Health Professionals

Appleseed Foundation

Be A Hero

Coalition of Labor Union Women

Congregation of Our Lady of Charity of the Good Shepherd, U.S. Provinces

Doctors for America

Empowering Pacific Islander Communities

Evangelical Lutheran Church in America

Families USA

Friends Committee on National Legislation

Health Care Voices

Health GAP (Global Access Project)

HelpAge USA

HIV Medicine Association

Ibn Sina Academy of Medieval Medicine and Sciences


Infectious Diseases Society of America

Justice is Global

Maryknoll Office for Global Concerns


National Advocacy Center of the Sisters of the Good Shepherd

National Education Association

National Employment Law Project

Network Lobby for Catholic Social Justice

Partners In Health

People’s CDC

PFLAG National

Physicians for Human Rights

Planned Parenthood Federation of America


Presbyterian Church (USA)

Public Advocacy for Kids (PAK)

R2H Action [Right to Health]


Rethink Trade



Tennessee Health Care Campaign, Inc

The Borgen Project

The Episcopal Church

The Leadership Conference on Civil and Human Rights

The Zero Hour with RJ Eskow

TouroCOM – Harlem SNAHP

Treatment Action Group

Union for Reform Judaism

United Church of Christ Justice and Local Church Ministries



[2] https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html

[3] https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html

[4] According to the most recent Census household pulse survey (July 27-Aug 8), people with household incomes below $35,000 are more than twice as likely to be unvaccinated as people with household incomes over $75,000. Census poll disclaimer: “Note: These data are experimental. Users should take caution using estimates based on subpopulations of the data – sample sizes may be small and the standard errors may be large.”


[6] https://www.reuters.com/world/us/us-poor-died-much-higher-rate-covid-than-rich-report-2022-04-04/



[9] https://ourworldindata.org/covid-vaccinations

[10] https://launchandscalefaster.org/covid-19/therapeutics

[11] https://covid19gap.org/assets/publications/COVID-GAP-Oral-Therapeutics.pdf


[13] https://progress.institute/weighing-the-cost-of-the-pandemic/

[14] https://www.bloomberg.com/news/newsletters/2022-06-04/coronavirus-daily-just-how-wildly-are-covid-cases-undercounted

[15] https://www.cdc.gov/poxvirus/monkeypox/cases-data/technical-report/report-2.html#dynamics

[16] https://www.cdc.gov/poxvirus/monkeypox/response/2022/demographics.html

[17] https://www.cdc.gov/poxvirus/monkeypox/response/2022/vaccines_data.html

[18] https://www.nytimes.com/2022/09/12/health/monkeypox-vaccines-treatments-equity.html

[19] https://www.nytimes.com/2022/08/28/health/covid-vaccines-money.html

[20] https://www.hrsa.gov/provider-relief/about/covid-uninsured-claim


[22] https://www.kff.org/interactive/u-s-global-health-budget-tracker/

[23] https://www.politico.com/news/2022/02/18/biden-administration-asks-congress-for-5-billion-to-fight-covid-overseas-00010264