President-elect Joe Biden will move into the White House on Wednesday at a time when the country is battling a global pandemic that has killed 400,000 Americans in less than one year.
“We're inheriting a huge mess here, Jake, but we have a plan to fix it,” Mr Biden’s chief of staff, Ron Klain, told CNN’s Jake Tapper on Sunday.
In response to the “huge mess” Mr Biden was facing, the president-elect unveiled his $1.9trn economic plan, $400bn of which would go directly to Covid-19 relief, that would go into effect at the start of his administration, if it passes through Congress.
This plan, described by Mr Biden as “a whole-of-government Covid-19 response plan that will change the course of the pandemic,” includes $20bn for a national vaccination program and $1,400 stimulus checks to qualifying Americans.
But will Mr Biden’s Covid-19 plan address all areas of need in order for the country to properly respond to the pandemic? The Independent spoke to three of the nation’s leading health experts about what the new administration should do in the first months in office.
Implement a mass vaccination campaign
One of the key priorities in Mr Biden’s coronavirus plan is a mass vaccination campaign that would involve all levels of government working together, from local all the way up to federal. This was in an effort to get 100 million doses of the Covid-19 vaccine into the arms of Americans within 100 days, a lofty goal given how slowly vaccine administration has gone as of late.
The Trump administration created Operation Warp Speed last year to assist with the development, manufacturing and distribution of the vaccines on a large scale.
“Within a year we have two vaccines that are remarkably effective, apparently safe. Who would have predicted that,” Dr Paul Offit, a paediatrician at Children’s Hospital Philadelphia who specialises in infectious diseases, vaccines, immunology and virology, told The Independent.
Dr Offit gave credit to the Trump administration for accomplishing such a scientific achievement. But then the administration left it up to states as to how and where the vaccines were administered to residents, something Dr Offit said should change under the Biden administration.
“It would have been a value to have when [Operation Warp Speed] was mass producing this vaccine, it also was finding a way to mass administer it,” he said.
Dr William Moss, the executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, was in agreement that the country has found itself “flat footed” when it comes to administering the vaccine.
“There was enormous federal investment in the research and development of vaccines, and in [the Trump administration’s] procurement of vaccine doses. That's very, very important,” he told The Independent. “But that's obviously not all of it. There was also, you know, fairly heavy investment and planning in vaccine distribution and getting the vaccines from the sites of manufacturers to the states’ local jurisdictions sites, like healthcare facilities where vaccines would be administered by large pharmacy chains.
“But where we were flat-footed was in the detail planning and the human and financial resources to actually get these vaccine doses into people.”
As of 15 January, the federal government has distributed more than 31.1 million doses to the states. But just over 12.2 million Americans have actually received that first dose, according to the CDC’s Covid vaccine tracker, proving states were having difficulty swiftly administering the vaccine.
Mr Biden’s plan included creating mass vaccination centres in states across the US that would serve as places where thousands could receive the Covid-19 vaccine per day. Additionally, Mr Biden wanted to set up mobile vaccination units in underserved communities.
This underscored what experts have been calling for since the start of the pandemic: federal assistance and funding to states for relief efforts.
“The whole failure of the Trump administration was insisting on putting the states in the lead and the federal government would provide backup support,” Dr Peter Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine in Texas, told The Independent.
“It doesn't work. The states don't have the horsepower either intellectually, in terms of logistics, or financial support to know how to do this. So we're going need the intervention of the federal government,” he added.
Dr Hotez said a goal for the country should be to vaccinate 240 million Americans by August due to the detrimental impact of the novel virus. This would translate to about two million people per day receiving a vaccine.
Based on that goal, he did recommend for the federal government to assist states in opening up vaccination centres to give more people access to the vaccine – a key point in the Biden administration's plan.
“The first component is greatly expanding the number of places where people get vaccinated, especially in low-income neighbourhoods, which are pharmacy deserts more often than not,” Dr Hotez said.
Open up vaccine eligibility
Experts have also called on the Biden administration to open up eligibility requirements to receive a Covid-19 vaccine.
“We're going to have to liberalise the restrictions," Dr Hotez said. “They’re too fussy.”
The CDC recommended for states to first give their vaccine doses to a group defined as “1a”, which included healthcare workers and those living in long term care facilities. This was because of the limited number of vaccine doses available.
But some states had difficulty finding enough people within that group to receive a vaccine, causing doses to expire. The Trump administration later recommended for states to open up the vaccine to those 65 years and older, as well as those living with comorbidities that put them at greater risk if they contract Covid-19.
Dr Hotez warned against vaccine recommendations being geared around “essential workers” or those with “comorbidities” because “it's too hard to operationalise.”
Instead, he wanted the Biden administration to open up eligibility by age or another easy indicator that would make it less confusing for states and the public to understand. “Something simple and straightforward,” Dr Hotez said.
Mr Biden indicated he wanted to simplify the vaccination eligibility process and recommend for states to stop holding onto that second dose of the vaccine. Both the Pfizer and Moderna vaccines – which are thus far the only two companies that have received emergency use authorisation from the Food and Drug Administration (FDA) – require that someone receives the second dose of the vaccine three to four weeks after their first dose.
Initial messaging pushed out from the Biden administration claimed Americans would still receive high efficacy from the first dose of the vaccine, which Dr Offit criticised in a recent interview.
“The messaging problem that the Biden administration had … was that one dose offered a considerable amount of efficacy,” Dr Offit said. “But we only know that works for four weeks, maybe a couple of months. It’s unlikely to induce long-term protection.”
After his public criticism, Dr Offit received a phone call from someone within Mr Biden’s transition team who clarified the administration would focus on a “two-dose strategy”. This point was then reiterated in subsequent interviews by members of Mr Biden’s team when discussing his new plan, all in an effort to avoid future confusion.
Why states would be advised to halt holding onto the second dose was because the incoming administration believed it could ramp up vaccine manufacturing to ensure that second dose would be available to Americans once it was their turn to receive it. Mr Biden planned to utilise the Defence Production Act as one way to increase vaccine manufacturing.
The United States has now averaged more than 4,000 Covid-19 deaths per day, which is far greater than the initial peak of the virus back in April. So Dr Moss said the main goal of any vaccination campaign should be mitigating those numbers. “What I see as our primary goal right now with the vaccines is to reduce hospitalisations and deaths,” he said. “I think that's the metric we need to be following as to whether our efforts at vaccination are having an impact.”
Dr Hotez described the current crisis as a “life or death race” to get control of the pandemic. “Covid-19 is now the single leading cause of death on a daily basis in the United States. We need this high-throughput vaccination system right now,” he said.
Improve nationwide testing and masking
Another area of emphasis within Mr Biden’s Covid plan is to use $50bn to expand testing. This expansion would include purchasing more rapid tests, expanding lab capacity, and improving local jurisdictions in providing access to testing sites.
Dr Hotez said the current system was still “too complicated” to be the most beneficial to Americans.
“We need to be at a point where either there are at-home kits or you can go to any pharmacy and get a quick test,” he said.
Testing has become the nation’s first step towards identifying those who have the virus, tracing it to other population groups, and isolating people so they don’t spread it to others. At-home tests or other options for residents would greatly improve this initiative.
Experts have also indicated they would support a national mask mandate, which would come on the heels of the Trump administration turning the health initiative into a political statement.
“The current administration just denied [the pandemic],” Dr Offit said. “It’s like if we just close our eyes tight enough, this is all going to go away. Donald Trump was actually able to do that, to get people to not mask and not social distance."
Mr Biden said he would employ a national mask mandate that would require the face shield to be worn on federal property, mass transit, and other areas controlled by the federal government. But in some Republican-run states, he would likely struggle to convince governors to require residents to wear masks in other areas of daily life.
Fund Covid genome sequencing
The US has fallen behind other countries on genome sequencing, which identifies new variants of Covid-19 so researchers can better understand the virus and ensure the current vaccine protects against the new variants.
“We should have 10 million virus genomes sequenced by now. We have 50,000,” Dr Hotez said. “We have the highest genome sequencing capacity in the world … and once again we come up small. I don’t know why that happened, but we’re a fraction of where we should be.”
Detecting new variants is an important factor in responding to the novel virus, Dr Hotez said, because it “helps us better understand increase in transmissibility.”
Concern about other Covid-19 variants increased after a new one was detected in the United Kingdom. Vaccine companies said there was no indication yet that the treatments would be less effective against the mutant variant, but researchers said it could be 50 per cent more contagious than the initial variant that originated in Wuhan, China, one year ago.
Another variant has also been detected from South Africa, causing more concern about how the virus is currently mutating.
Dr Moss said new variants have likely popped up in the US, but the country’s lack of genome sequencing meant we’ve just not detected them.
“I would be really surprised if we didn't have more transmissible variants in the United States,” he said. “We've had so much transmission in this country to allow for viral evolution.”
A portion of the funding in Mr Biden’s plan would go towards investing in genomic sequencing so the US could vastly improve its detection of new Covid-19 variants. How much the country would increase its sequencing capabilities was not known, but it was an important step to ensure the vaccine didn’t become ineffective.
“If a variant starts to resist the vaccine, that is a big problem,” Dr Offit said, “and so we need to identify these variants quickly, which means doing a lot of sequencing ... Because imagine trying to make a whole new vaccine again from a virus that now is resistant to the vaccine, right? That's really hard. That would be the worst possible news.”
Fix the CDC’s response
In past public health crises, the CDC has been at the forefront of delivering news and guidance to the American public. But during the Trump administration, the CDC took a backseat in responding to the virus.
This was done, in part, because the Trump administration largely shunned scientists and their grim estimates of how much the novel virus could negatively impact the country. Recommendations that would hinder the economy, such as shutting down businesses, were ignored by the administration for as long as possible – leading to more Covid-19 cases and deaths.
Now health experts are looking for the Biden administration to reestablish the public agency so it can play a key role in responding to the novel virus.
“We should have been hearing from the CDC daily throughout this. They've silenced,” Dr Moss said. “We need the CDC to step up and I think that will happen under the Biden administration.”
Dr Rochelle Walensky, chief of the infectious diseases division at Massachusetts General Hospital and a professor at Harvard, was nominated the president-elect’s pick to take over the position of CDC director from Dr Robert Redfield.
In an opinion piece for The New York Times, Dr Walensky vowed to reestablish public trust in the agency while it works to tackle the pandemic.
“I acknowledge that our team of scientists will have to work very hard to restore public trust in the CDC, at home and abroad, because it has been undermined over the last year. In that time, numerous reports stated that White House officials interfered with official guidance issued by the CDC,” she said, adding that “restoring public trust was crucial."
Under her control, Dr Walensky promised the CDC would provide accurate information to the public, no matter if it’s positive or negative.
“As I start my new duties, I will tell the president, Congress and the public what we know when we know it, and I will do so even when the news is bleak, or when the information may not be what those in the administration want to hear,” she said.
Rejoin the World Health Organisation
The US adopted an “America first” philosophy under Mr Trump, pushing nationalism to the forefront of all policy decisions.
This continued at the start of the pandemic when the World Health Organisation, which focuses on international public health, was criticised by the sitting president for how it addressed China’s involvement in the creation and spread of Covid-19. Mr Trump decided to pull the country from the WHO, a move that was criticised by public health officials because of how imperative the international agency has become in assisting countries during public health emergencies.
Now health officials are looking towards Mr Biden to reestablish the US with the WHO and assist other countries in their response to the novel virus.
“The role of the United States in global public health through support of the World Health Organisation is critical for the US going forward,” Dr Moss said, “and that has all been undermined under the Trump administration.”
Besides joining the WHO again, Dr Moss is looking for the Biden administration to join COVAX, a global initiative created in response to the pandemic to ensure equitable access to the a Covid-19 vaccine for all countries.
“You’re only as strong as the weakest country here,” Dr Offit said, agreeing that the US should strive for equitable distribution of the vaccine on a global scale.
All signs have shown Mr Biden will likely rejoin the WHO within the first weeks of taking office, but he has not officially committed to joining COVAX. Both moves, according to experts, would be important steps in the country’s global response to the virus.
The Biden administration has set the bar high for what they hope to accomplish in the first months in office, but experts are optimistic this could be an imperative turning point for the country in addressing the pandemic– specifically after months of inaction from the Trump administration.
“We've waited a long time to put these things in place,” Dr Hotez said. “I think everyone's just shocked by how poorly it's gone so far. It's more than disappointing, it’s devastating given how dire things are right now.”