WASHINGTON — The White House could run out of Covid-19 vaccines if it moves forward with plans to encourage all adults to get a second Covid-19 vaccine booster dose by roughly Sept. 1, according to a tranche of budget documents sent to Congress that have not previously been made public.

Although Food and Drug Administration officials have hinted that all American adults may be encouraged to get second boosters this fall, right now, second booster doses are only available to people over the age of 50. The budget documents make it clear that if the administration does want to push second boosters, it will need more money to make it happen: it needs at least 87 million more vaccines for adult boosters, and another 5 million more for first boosters for kids.

The plan is part of a collection of nearly 400 pages of Covid-19 budget documents obtained by STAT, most of which were also included in a binder brandished by press secretary Jen Psaki earlier this spring to showcase the White House’s transparency on how it had spent Covid-related appropriations. The White House offered to make copies for reporters in early April, but then refused to copy the documents or allow them to be photographed when STAT followed up.

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The documents, which STAT is making public in full for the first time, offer a window into the Biden administration’s planning for the next phase of the Covid-19 response, including contingency planning for the purchase of vaccines and therapeutics. It also reflects how the Omicron surge ravaged the Covid-19 response budget.

The insights into the current state of Covid-19 funding come as the White House’s ongoing efforts to get more money are stalling. A bipartisan deal to give the administration $10 billion for the Covid-19 response has been held up over disputes about public health policy related to migrants on the southern border, and it’s unclear if the funding has a path forward.

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Below, STAT highlights a few of the most interesting revelations from the documents.

Vaccine purchasing plans

Although the White House estimates it will need at least 87 million more doses of the Pfizer vaccine to roll out second boosters for all by around Sept. 1, uptake of first booster doses has been relatively low. Only 101 million, or about half of fully vaccinated people eligible for a booster dose, have actually gotten them, according to the Centers for Disease Control and Prevention.

As of March 18, the White House expects that it will have roughly 105 million doses available to support second booster shots for adults in September, even if Congress doesn’t allocate more money to the effort.

The documents also hint that the White House may not order more doses from Moderna. The projections say that the administration could order between zero and 147 million doses from the company. It lists no new orders from Novavax or Johnson & Johnson.

Moderna CEO Stéphane Bancel on Wednesday prepared shareholders for the possibility that Moderna won’t be doing business with the federal government anymore, and will be switching instead to selling its vaccines on the commercial market, which could be more lucrative for the company.

“We’re also working toward assuming that there’s no government order — or American order for vaccines,” Bancel told investors.

Demand can be hard to predict depending on future variants that could emerge, said Claire Hannan, executive director of the Association for Immunization Managers. If there’s another spike in cases, she said, uptake could increase significantly as well.

“It’s critical that Congress provide that funding. We’ve got to stay ahead of the game. We’ve got to be prepared,” Hannon said. “Everybody who wants to get protected should have the opportunity to get the vaccine.”

Supply for boosters for children, which have not yet been authorized, could also be short.

The White House estimated that first booster doses for children would likely be authorized between April 1 and Aug. 1. For children ages 5 through 11, the Biden administration’s projections had a wide discrepancy in how many doses might be available: between zero and 36 million. The White House estimated it would need at least 5 million additional doses for that effort.

The administration expects children could get second boosters too, as soon as Jan. 2023 for children between the ages of 5 through 11, and as early as April 2023 for children under age 5. The administration expects to have no supply on hand in that case, and that it would need to buy at least 67 million doses for that eventual effort.

In its latest pitch to Congress, the White House requested $4 billion to buy around 130 million vaccines. The White House did not provide additional comment on these projections.

Where money to pay for therapeutics will come from

The Biden administration has, for four months, faced a budget shortfall that led officials to hold off on actually paying Pfizer for an additional 10 million doses of its oral antiviral drug, Paxlovid. The administration still owes Pfizer around $5 billion for the doses it has committed to buy.

Responses to questions from lawmakers indicate that the administration is intending to use money Congress set aside for use related to the Defense Production Act instead, as funding intended to buy vaccines and therapeutics has run dry.

“HHS anticipates using a portion of the DPA funding to meet immediate needs for the Operation for development and procurement, in which case these funds would therefore no longer be available for the activities originally planned under those resources,” the Biden administration told Burr in a letter on March 18.

According to most recent budget tables provided to Congress, the administration has $5.6 billion left in the DPA fund from the $10 billion lawmakers allocated last year to bolster medical supplies. The money had been planned for vaccine development, vaccine production capacity, personal protective equipment, and bolstering pharmaceutical supply chains.

The spending on Paxlovid clearly aligns with the fairly vague language in the law about how the money could be spent. However, that means the money won’t be spent on manufacturing capacity that could speed a transition to variant-specific vaccines, if that phase comes.

“It says something about the state of our Covid response when the Biden administration has to dig for change in between sofa cushions, basically, at this stage of the pandemic,” said Zain Rizvi, a research director at Public Citizen.

Vaccine, testing, and therapeutics purchases

The document trove also includes comprehensive summaries of companies that have contracted with the government to provide vaccines, therapeutics, and tests. Much of the information has been publicly disclosed piecemeal, but not in a condensed format.

The documents show the federal government, across the Trump and Biden administrations, has spent $30.4 billion on vaccine purchases, and $21.8 billion on therapeutics including monoclonal antibody treatments and oral antivirals. The therapeutics total does not include the roughly $5 billion that the administration owed Pfizer for antivirals.

The government spent $6.4 billion on a program to send over-the-counter Covid-19 tests to the American public, as of Feb. 8.

The Biden administration has not disclosed the per-unit prices paid for many of the contracts, citing the Trade Secrets Act.

Omicron drained several Covid-19 response accounts

The Biden administration was in a stable financial position for the Covid-19 response as recently as last fall, but the Omicron surge decimated the government’s remaining resources, the documents show.

A month-by-month accounting of a program that paid health clinics, hospitals, and test manufacturers for services provided to uninsured patients shows the costs of both testing and vaccine administration skyrocketed.

Testing claims jumped from 7 million in October to 11 million in November, and vaccine administration claims increased from 3.6 million claims in October to 7.5 million in November.

While the Biden administration still had billions banked for buying testing, vaccines, therapeutics, and medical supplies in October, the totals dramatically decreased by January, according to budget tables provided to committees that control the budget in Congress.

Available funds dropped from $8.5 billion to none for vaccines and therapeutics, $13.4 billion to none for testing, and from $2.2 billion to $854 million for medical supplies.

The full 388-page document is available below.

White House documents detail a looming squeeze on Covid-19 boosters