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With Katherine Ellen Foley, Carmen Paun and Megan R. Wilson

ALREADY AMONG US? While pandemic preparedness has been largely focused on the emergence of new diseases, one of the biggest names in global health raises another concern: Existing diseases could grow into global threats because of climate change.

Peter Sands, head of the Global Fund, one of the world’s largest funders of HIV, tuberculosis and malaria programs, told POLITICO’s Ashleigh Furlong that the next pandemic-causing disease could already be here.

“Are we in a little bit of a danger of kind of fighting the last war, assuming the next threat is going to be like the one we’ve just experienced, when the next health crisis could actually be the impact of climate change fueling existing diseases, as opposed to some new disease X?” asked Sands, who has been executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2017.

It’s already happening, Sands said.

In Pakistan, flooding that research indicates was likely made worse by climate change killed more than 1,700 people in 2022. But, in the aftermath, malaria cases surged and the number of deaths from the disease far exceeded direct deaths from flooding.

The concerns come as global health leaders are alarmed by governments having too many pressing crises demanding cash and attention. Ambitious pandemic prevention ideas from recent years are increasingly facing a different reality.

“Unfortunately, we tend to treat a pandemic as things that threaten those of us who are lucky enough to live in rich countries,” said Sands. But with 2021 seeing 247 million cases of malaria in 84 countries where malaria is endemic, “it feels a bit like a pandemic,” he added.

WELCOME TO THURSDAY PULSE. Have you heard about a recent or growing disease outbreak? What about new international plans to address pandemic preparedness?

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TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Megan R. Wilson, who explains the bills the Senate HELP Committee will consider next week, which aim to enhance access to generic drugs and medications for rare diseases. The package also includes a 91-page bill targeting pharmacy benefit managers and their business practices — likely to bring ire from the industry.

CMS ON TRANSPARENCY — The House Energy and Commerce Health Subcommittee held a sweeping hearing Wednesday about competition and transparency in the health care system, Megan reports.

CMS Administrator Chiquita Brooks-LaSure answered questions about CMS’ approach to a number of policies, including its Alzheimer’s drug coverage — as Katherine reported Wednesday — and price-transparency legislation.

At the hearing, Brooks-LaSure said the agency would strengthen its enforcement of hospital price-transparency rules — including moving bad-faith actors straight to a corrective action plan. CMS later released additional details.

“This additional clarity will help hospitals continue to comply with the rule — which CMS found a majority of already are,” Ariel Levin, the American Hospitals Association’s director of coverage policy, told POLITICO in an email.

Brooks-LaSure told E&C Chair Cathy McMorris Rodgers (R-Wash.) that CMS could use additional authority from Congress to go even further on price transparency.

McMorris Rodgers, though, pressed her on being more aggressive where CMS already has authority — including a paused part of the transparency rules, which require insurers to disclose historical data about the net prices of covered drugs.

Brooks-LaSure said the agency is committed to working on the measures: “It just takes time.”

Later, the health panel heard from advocates — including groups representing hospitals, pharmacy benefit managers, patients and employers — about several proposals it’s considering. Policymakers are looking at measures that take aim at high health costs and increasing consolidation among hospitals and doctor groups and insurers with PBMs.

AND ON ALZHEIMER’S DRUG COVERAGE — Nearly a third of the House E&C Health Subcommittee spoke in support of broadening access to the new Alzheimer’s drug Leqembi, Katherine reports. The drug, one of two granted accelerated approval to treat Alzheimer’s disease in nearly two decades, is covered only for Medicare beneficiaries enrolled in a randomized clinical trial. However, there are no trials enrolling for Leqembi or Aduhelm, the first drug in this class to receive accelerated approval.

Lawmakers argued that the restrictive coverage is detrimental to patients and at odds with the FDA’s authority. “When did CMS decide or get authority to operate like a scientific regulatory body when that’s the FDAs job?” asked Rep. Morgan Griffith (R-Va.).

“Has the FDA told you that accelerated approval is not full approval and should be treated differently?” asked Rep. Larry Bucshon (R-Ind.), vice chair of the subcommittee.

“We consider accelerated approval in a different category,” said Brooks-LaSure.

“You do, but the FDA does not,” Bucshon replied.

ACCESS AT THE CDC — Randi Weingarten, the president of the American Federation of Teachers, defended her labor group’s actions during the Covid-19 crisis before House Republicans on Wednesday, while GOP lawmakers sought to blame pandemic school shutdowns on the teachers union and its firebrand leader, POLITICO’s Juan Perez Jr. reports.

At the core of the convening was the union’s influence over the CDC’s school-reopening guidance from the Biden administration, issued in February 2021 during a fierce nationwide debate over reopening schools.

Weingarten’s prepared testimony and a letter to the subcommittee from her defense attorney said the union was given a copy of the CDC’s draft guidance so it could offer comments. She said the labor group didn’t draft or substantially revise the document and carried no control over whether the CDC would accept AFT’s recommendations.

But some Republicans questioned why the union “was offering scientific advice to the CDC in the first place.”

RISANT RISES — Kaiser Permanente is acquiring Geisinger Health to create Risant Health, a new nonprofit created by Kaiser Foundation Hospitals to expand its value-based care business, POLITICO’s Dan Goldberg reports.

Kaiser Permanente, the California-based health group that serves 12.6 million people across eight states and the District of Columbia, and Geisinger Health, which includes 10 hospital campuses and a health plan with more than 500,000 members, announced the deal Wednesday.

Kaiser Permanente is committing up to $5 billion over five years to launch Risant Health, according to Steve Shivinsky, Kaiser’s director of national media relations.

It’s the latest example of dominant regional players consolidating across the country in an effort to improve their bottom lines through scale. Value-based care programs, which have been gaining momentum for over a decade, work best in integrated models with many patients who spread out the risk of health care costs.

One key detail: The deal requires state and federal regulatory review.

DEALING WITH DRUG MONEY — Experts on drug trafficking and money laundering called on the U.S. government to provide more resources to fight Chinese organizations that help Mexican drug cartels launder money from the trafficking of fentanyl and other deadly synthetic opioid drugs, Carmen reports.

U.S. agencies like the Drug Enforcement Administration need more translators and data analysts that can put together data from the financial system and law enforcement to track the flow of drug money to Chinese organizations, said Christopher Urben, a former DEA assistant special agent in charge of the Special Operations Division, speaking at a hearing Wednesday in the House Committee on Oversight and Accountability Health Care and Financial Services Subcommittee.

Chinese money-laundering organizations have in recent years made it easier, faster and cheaper for Mexican drug cartels to launder their profits from fentanyl in the U.S., effectively fueling fentanyl trafficking in the U.S., Urben said.

BIDEN’S MENTAL HEALTH PITCH — On Wednesday, first lady Jill Biden touted her husband’s goals for students, including a significant focus on mental health care as a national priority, POLITICO’s Mackenzie Wilkes reports.

The first lady spoke at the International Summit on the Teaching Profession, co-hosted by the Education Department, in Washington, where she was joined by Education Secretary Miguel Cardona, who said addressing a shortage of teachers would be key to ensuring students’ wellness.

Their comments could signal which policies will be a focus of the president’s 2024 campaign.

“Today, so much has changed and gotten better, but recovery isn’t always the same as healing,” the first lady said. “Throughout the world, young people are wrestling with their mental health, and it’s up to us to give everyone the understanding and the support that they need. Here in the United States, that’s one of our top priorities.”

Jake Brennan is now associate director of congressional affairs at the American Osteopathic Association. He previously was a senior associate at Avalere Health.

STAT reports on a growing climate movement taking shape in medical education.

The Wall Street Journal reports that veterans have filed half a million claims for toxic exposure from burn pits after coverage was expanded.

USA Today reports on a group of young women seeing staggering rates of uterine cancer.