Biden is fighting a pandemic that has killed nearly 600,000 Americans and still infects around 60,000 people a day. He is moving ahead with a national strategy on vaccinations, an equity task force to reach vulnerable communities and regular Covid briefings by experts like Anthony Fauci, the government’s top infectious disease doctor. The success of that strategy will determine how quickly American life, and the economy, get back to a semblance of normalcy.
Vaccination remains the centerpiece of the response — and Biden appealed strongly to Americans to get the shots in his speech before Congress on Wednesday night. The shots have helped push deaths down from more than 4,300 a day in January to around 700 now. “It’s the number one message,” Andy Slavitt, a senior adviser to the White House’s Covid response team, told POLITICO.
In the best case scenario, public trust in the shots will keep rising, particularly among the most vulnerable, including minority groups the administration seeks to reach. Federal, state and local public health officials will quickly deploy expanded tools like rapid testing, wastewater surveillance and contact tracing to spot and contain new outbreaks before they spark a wider surge.
New anti-viral medicines, already in the pipeline, could become available in the foreseeable future, so infected people could be treated at home before they get seriously ill.
“I don’t think we’re going to flip a switch and have this disappear,” said Scott Harris, Alabama’s public health officer. His state is still chipping away at high levels of vaccine hesitancy, including among rural Republicans. But he says state epidemiologists know how to identify and respond to disease outbreaks, whether it’s an old foe like the flu or a new danger like Covid.
But while Biden can push vaccination, testing and tracing, he can’t control what happens in other countries or what the constantly evolving virus does. And he can’t control what vaccine-resistant and mask-shunning Americans do. Even if the country gets “closer to normal” by July 4 as Biden envisioned, it could all still go awry by Labor Day or Thanksgiving.
“We’re on this precipice,” said Rachael Banks, director of public health in Oregon, which has seen its daily cases triple over the last month even though nearly a third of the population has been fully vaccinated.
BIden celebrated the progress in his speech, conjuring up images of grandparents hugging their families “instead of pressing their hands against a window to say goodbye.” But he was frank about the lingering threats. “There’s still more work to do to beat this virus,” Biden told the country. “We can’t let our guard down.”
While the Biden administration celebrates administering 220 million shots and making everyone 16 and up eligible for vaccines, immunizations have dropped off over the past three weeks. Some states have such gluts of vaccines that they aren’t ordering new allotments from the federal government.
With vaccination slowing and many people feeling overconfident, Public Health 101 runs the risk of being undermined by Virus Politics 2021.
Biden overestimated his ability to unify the country, to get Americans to patriotically “mask up” for 100 days. Now, governors are reopening their economies, even in states with low vaccination rates and against the advice of the Centers for Disease Control and Prevention. Virus skeptics keep shunning masks and social distancing. Crisis-weary Americans are beginning to travel again.
That’s understandable, because things are getting better — deaths, hospitalizations and cases have all dropped in these first 100 days. Schools are reopening, though not as fast as Biden pledged soon after his election. Everyone wants to move on. But doing so perpetuates risk.
“We’re not out of the woods,” said Julie Morita, executive vice president of the Robert Wood Johnson Foundation and former Chicago health commissioner, who advised Biden on the pandemic during the transition.
Some Republicans, whose ranks largely downplayed the Covid threat, now say the virus is basically vanquished, even though public health experts advise ongoing caution. “The coronavirus is on the run!” Sen. Tim Scott (R-S.C.) said in the GOP response to Biden’s speech, adding that the president had “inherited a tide that had already turned” under former President Donald Trump.
Progress is unlikely to follow a straight line, and new hot spots continue to emerge. All eyes recently were on Michigan’s soaring case load. That’s now improving but the state, with 3 percent of the U.S. population, still accounts for nearly 10 percent of the country’s new cases. Colorado counties with the lowest vaccination rates are seeing spikes in infections. Washington state’s case rate has doubled over the past month.
With its focus on vaccination, the administration recently launched its Covid-19 Community Corps, a volunteer group that draws from many social, religious and business sectors to amplify the messaging around the safety and efficacy of the shots.
The Federal Emergency Management Agency has stood up community vaccination centers and sent mobile vaccine units to vulnerable populations in rural and tribal areas with little medical infrastructure. The immunization drive has encountered multiple snags, including the mess surrounding the manufacturing partner for the Johnson & Johnson vaccine, but it’s still moving ahead.
Some people may still shun shots, Slavitt said, but it’s the government’s job to make sure “everyone has access, that there are no barriers,” no matter what decision they ultimately make. The White House also is working with employers and businesses to reinforce the safety messages and to create incentives, like paid time off to get vaccinated.
Immunization is the best tool, given the breadth of the U.S. pandemic and the resistance in the country to masks or more drastic measures like lockdowns. But shots alone aren’t enough — not in a country where millions of people insist that they won’t get vaccinated and where millions more regularly struggle to access care. Social distancing, masks in many settings, and related measures will still be needed.
“We’re going to be constantly worrying about potential surges in the future at the local level as long as we have large pockets of the population not getting immunized,” said Angela Rasmussen, a virologist affiliated with Georgetown University and the Vaccine and Infectious Disease Organization-International Vaccine Centre, who sees both progress and a need for ongoing public health measures. “I worry about winter, when it gets cooler and people go back inside.”
Biden’s Covid narrative would then be upended, particularly if outbreaks threaten rituals and family time like Thanksgiving and Christmas.
Alabama offers a case study. Vaccination rates are among the lowest in the nation, but Covid-19 is no longer threatening the state’s health care system as it did earlier this year. Yet it persists — about 400 new cases a day — and remains a life-threatening disease.
“We feel like overall we’re plateaued,” said Harris. “We’re not where we’d like to be, but [we’re] miles better than January.”
His view is in line with most state officials and public health experts who generally agree things are looking better.
“I do feel like we finally have the upper hand,” said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “We have two vaccines that are extraordinarily effective. … We’ve gotten off to a better start vaccinating people than I expected.”
In West Virginia, which has done well on vaccination but still hits wells of hesitancy, health commissioner Ayne Amjad has thought about how to communicate with the public, particularly into the next phase of tamping down outbreaks before they ignite surges.
The phrase “contact tracing,” she noted, makes people fear their privacy has been violated. She prefers “Covid support services” or saying, “let me call your family or friends who you’ve been around.” “Warp Speed,” the description for the government’s vaccine accelerator, scared people into thinking the shots were created too fast. Vaccine “deliberation” is better than “hesitancy.”
“Language matters,” she said. “You can’t convince someone by arguing with them or telling them they are stupid.”
Beyond that, some experts worry that the CDC guidance to states around reopening schools and businesses isn’t specific enough.
“We’re going to face big tests when we try further steps toward reopening — big events, back to school,” said Mark McClellan of Duke University, a former FDA commissioner under President George W. Bush. “We need to be vigilant.”
Nor has the outreach to minorities achieved its goals. They are still being vaccinated at a disproportionately low rate. And they tend to live in densely populated areas where the virus can spread fast.
“You’re fighting against centuries of systemic barriers, and to assume we would close the gap immediately would be naive,” said Shereef Elnahal, CEO of University Hospital in Newark, N.J., and a former state health commissioner. “That said, in terms of access, we’re not there yet for communities of color.”
Banks, Oregon’s public health director, also believes access remains more of a problem than demand in communities of color. If that’s not addressed, a slow-burning Covid epidemic in these communities, long underserved by the health system, could add yet another layer of persistent inequity in health care.
“It’s heartbreaking to watch these inequities unfold in front of our eyes,” she said.
And even if the Biden administration, working with state and local officials, manage to overcome all these domestic challenges, uncontrolled outbreaks in Brazil, India and parts of Europe threaten prospects in the U.S.
“There is this medium-term uncertainty whether there will be a variant that exists now or is coming that really does escape vaccines,” said Marc Lipsitch, a Harvard University epidemiologist.
However, hard it is to live with uncertainty, it’s better than the chaos and crisis of a few months ago, experts say. Amjad knows things can still go badly wrong, but she still sees the progress. “A year ago,” she said, “we were begging for swabs.”