Every pandemic starts as a squall—a localized disturbance in a single city or town, causing all manner of problems there, but sparing the larger world outside. Squalls become storms, however, and storms become tempests and before long the entire world is being lashed by winds of disease and death that no one saw coming just a few months before. As President Joe Biden takes office, he is facing nothing short of a pathogenic typhoon, with COVID-19 raging around the world, nowhere more so than in the U.S., with some 24 million cases and 400,000 deaths—more than 20% of the global toll.
If the pandemic unfolded in stages so too must it be contained that way. During the campaign, Biden promised swift action on such steps as testing, vaccine manufacture and distribution, and preventive measures like mask mandates. That, he’s said, will be followed by other steps like improving surveillance of emerging variants of SARS-CoV-2, extending unemployment benefits to people whose jobs were lost as a result of quarantining and lockdowns, extending the moratorium on evictions, and ensuring that people who contract COVID-19 and survive don’t face discrimination in insurance benefits. It would, the candidate promised, be nothing short of a stepwise, war-like mobilization.
Less than a week before his inauguration, Biden unveiled a massive $1.9 trillion plan, proposing short-term, medium-term and long-term fixes intended to bring the current rate of infection and death under control and set the U.S. up for a sustainable recovery from both COVID-19 and the economic devastation it has wrought, in the coming year and beyond.
The proposed bill is a shaggy thing—equal part hit list and wish list, containing long-hoped-for Democratic goals like increasing child tax credits and boosting support for pre-K childcare and public transportation, most of which are likely to face GOP pushback in a closely divided House and a 50-50 Senate. But much of the rest is precisely targeted to meet the current crisis and then build on that hoped-for success. That kind of focus can’t come too soon.
“We are inheriting a situation that could politely be said to have been neglected,” says an incoming Biden official working on COVID-19 response. “There’s been no plan in place for the country even for 2020, never mind 2021 or 2022.” Here is what the Day One priorities for the new Administration look like and some of the steps that will follow them.
Starting on day one
The president’s most conspicuous and sound-bite-friendly pledge is to launch his recovery program by vaccinating 100 million Americans within the first 100 days of his Administration. It’s achievable, but only if the right pieces fall into place. The first, of course, is getting the vaccines manufactured, which may call for invoking the Defense Production Act (DPA)—a step the president can take by executive order before the sun even sets on inauguration day—requiring industry to accept and prioritize government contracts to ramp up production fast.
The Administration also plans to lean on states both to expand and make uniform the categories of people who are eligible to receive the shots, including all people 65 and older—who currently are eligible in some states but not others—and front-line workers who are not necessarily medical workers, like transit, pharmacy and grocery employees. That could not come with a first-day order, but Biden can impose first-day pressure. Even if he doesn’t enjoy much of a new-president honeymoon, it could be hard for governors to make the case that their seniors and front-line workers don’t deserve extra protection. Implemented well, both the production and eligibility steps could help the U.S. not only meet the president’s target, but actually exceed it, especially if, as expected, the Johnson & Johnson and AstraZeneca vaccines are soon approved, joining the Moderna and Pfizer-BioNTech shots in the vaccine arsenal.
“Getting the vaccine rollout to at least one million a day is what the president promised,” says Dr. Leana Wen, an emergency physician and public health professor at George Washington University, and previously Baltimore’s Health Commissioner. Even then, of course, it would take 328 days to vaccinate 328 million Americans—and that is just the first shot. “Working up to at least three million a day is going to be critical,” says Wen. As yet, the Biden Administration has not laid out a clear plan for how to triple the already ambitious 100-day target.
Still, a steady and predictable flow of vaccines could help address a vexing problem that’s occurring now, with hospitals and clinics holding back shots, keeping them in stock for fear that if they administer all of their initial supply at once, they’ll have nothing left when people return for their second dose three or four weeks later. “We should have people putting those vaccines in arms the moment they can,” says Dr. Howard Forman, professor of public health and management at Yale University and a practicing physician. “I should have confidence in my supply chain like I do in FedEx. And I don’t mean FedEx ground; I mean 99.99% certainty that I’m getting it tomorrow.”
Of course, just having vaccines on hand is not enough if there aren’t the necessary resources to administer them. Within one month of taking office, Biden thus envisions establishing a network of federally funded vaccination centers across the country in places that are both easily accessible and able to accommodate large numbers of people, like stadiums, school gymnasiums and community centers. That would be another Day One move: “On my first day in office, I will instruct the Federal Emergency Management Agency, FEMA, to begin setting up the first of these centers,” Biden said in a Jan. 15 address to the nation unveiling his $1.9 trillion plan.
Mobile vaccination clinics, which can also come via Day One order, would help bring the vaccines to people, rather than requiring people—some of whom are sick or elderly or otherwise less able to travel—to come to the vaccines. A standing army of up to 100,000 health workers will be recruited to help with such work as vaccine outreach and contact tracing.
“So much of that infrastructure should have been in place months ago, but it is not,” Wen says.
Then too, there is the immediate business of prevention, testing, and health care worker protection. On his first day in office, Biden can sign an executive order he has announced that will require masking by federal employees on federal property, as well by all people on busses, trains and planes traveling across state lines. He has also pledged to double the number of drive-through testing sites across the country and to use the DPA to increase the availability of personal protective equipment in hospitals and other health care settings. Finally within the first 100 days, Biden promises to reopen schools nationwide, providing federal funding to help improve sanitation and make social distancing possible—with barriers between desks say, or tenting for outdoor learning.
None of this is cheap and Biden doesn’t pretend it is. Reopening schools will cost up to $170 billion; testing and vaccine rollout will be another $160 billion; manufacturing necessary PPE will cost another $30 billion—all of which was spelled out in a document the transition team released along with the announcement of the overall plan.
“In this moment of crisis, with interest rates at historic lows, we cannot afford inaction,” Biden said in a Jan. 14 address to the nation. “I know what I just described will not come cheaply, but failure to do so will cost us dearly.”
Other steps will not be nearly as hard on the federal purse. Biden plans to sign another executive order, in his first few days in office, committing the U.S. to rejoining the World Health Organization and plans to relaunch the United States Agency for International Development’s (USAID) pathogen-tracking program to help detect emerging viruses and strains. Both steps will help restore the U.S.’s place as a global health leader.
Plans for the mid-term
Cash is at the center of another tranche of Biden plans—targeted at the economy, which has contracted its own pandemic-related illness. Making good on a campaign pledge, the president is calling for an additional payment of $1,400 to individuals earning up to $75,000 per year or couples earning $150,000, which will add to what Biden calls the $600 “downpayment” on stimulus money taxpayers received in the relief package passed in the final weeks of the Trump administration. He also hopes to extend unemployment benefits through the end of 2021, add an additional $400 per week in unemployment supplement payments and extend emergency paid sick leave through Sept. 30. The existing moratorium on evictions would be extended to the same date and Biden seeks $25 billion in rental assistance to keep people in their homes after the protections lapse, plus $5 billion to provide housing for people already rendered homeless by the pandemic. This, the Biden team argues, is both a public and moral imperative.
“I don’t think that there’s an argument that a public health crisis doesn’t require a good safety net,” says the Administration official. “If you’re going to ask for sacrifices of your citizenry like the ones we’ve seen in the last year, you’re going to have to let them know that there’s a country looking out for them.”
Messaging—which costs little or nothing at all—will be important too. Biden has promised transparency in communicating about the virus and the outlook for national recovery and has regularly offered hard facts to a public already suffering from pandemic fatigue.
“Truthfully, we remain in a very dark winter,” he said in his Jan. 15 address. “The honest truth is, things will get worse before they get better.”
A release from the Biden transition team explicitly promised “a federally led, locally focused public education campaign that will build public trust through increased transparency, communication around progress and setbacks, and a public education campaign that addresses vaccine hesitancy and is tailored to meet the needs of local communities.”
That’s important as far as it goes, but the plan is vague on who will do the messaging—and it can’t all come from Biden alone. Forman sees a place for all manner of public figures to help sell the safety and efficacy of vaccines and explain the challenges the nation still faces. “The messaging piece may have to include more celebrity endorsements of vaccines,” he says. “It may have to include more community connections with religious leaders, ministers and so on.”
Wen sees a similar role for expected sources like the Centers for Disease Control and Prevention—whose credibility was tarnished during the Trump years due to excessive politicization on topics like climate change and, later, the efficacy of mask wearing—as well as for less expected sources like corporate figures. “Business leaders and CEOs will be critical because of the unfortunate narrative that somehow the choice is between public health and the economy,” she says. “They will be key messengers.”
What Biden should do down the line
If the Biden plan has a weakness, it’s in the challenges some of its longer-term provisions are likely to face on Capitol Hill. Many of those proposals involve the progressive goodies that are likely to run into Republican resistance—$20 billion in aid for public transit, $13 billion in federal nutrition assistance programs; aid to states in funding Supplemental Nutrition Assistance Program (SNAP) benefits; increasing the child tax credit to $3,000 per child. While the plans may have tangible benefits in a time of economic suffering, they are less directly linked to the pandemic than the rest of the proposal is.
More important downstream effects will come from long-term implementation of programs to track mutations of the COVID-19 virus and to conduct surveillance of the next virus to jump species from animal to human as SARS-CoV-2 did. That, says the Administration source, is why re-engaging with the WHO and relaunching the USAID’s pathogen-tracking program is so important.
“I think rejoining the world is a critical first step,” he says. “Being at the table and having an ability to share knowledge, whether it’s a new strain, a new virus, is important. This is not a uniquely American problem.”
An additional long-term issue the Biden team plans to address is eliminating health inequities in both treating and preventing COVID-19. Black, Latino and Indigenous American communities are being infected at roughly four times the rate of whites and dying at three times the rate, as Biden pointed out in his Jan. 15 address.
“We have seen health disparities unveiled and unmasked,” Wen says. “We have seen that, once again, it’s those who are most disadvantaged and the most vulnerable who suffer the most.” Vice President Kamala Harris has proposed a COVID-19 Racial and Ethnic Disparities Task Force to ensure health equity in dealing with the crisis, and further proposes converting the body to a permanent Infectious Disease Racial Disparities Task Force after the pandemic is over. The proposal—which was featured conspicuously during the campaign—does not, however, appear as part of the $1.9 trillion plan, though the plan does mention health disparities repeatedly and they are framed as central to the president’s thinking.
If there’s a certainty in exactly how the Biden plan will unfold over the next 24 or 12 or even three months, it’s that there’s no certainty at all. Viruses are at once both mindless and clever—infecting and eluding, spreading and shape-shifting. It takes a set of policies that are equally adaptable, equally nimble to defeat them. The new president’s plan is an ambitious first step. A lot of sure-footed steps remain before the pandemic is defeated.
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Contributor: Jeffrey Kluger