“What we’re inheriting is so much worse than we could have imagined,” says Jeff Zients, President Joe Biden’s COVID-19 response coordinator. Basically, some Biden administration officials say, there was no plan. Now there is.
President Biden characterizes his plan as “a full-scale war-time effort.” The 200-page National Strategy for the COVID-19 Response and Pandemic Preparedness outlines seven goals:
Goal 1: Restore trust with the American people.
This goal promises transparency, facts, and science, which sounds like a good prescription to me. As a first step, President Biden signed executive order—Organizing and Mobilizing the U.S. Government to Provide a Unified And Effective Response to Combat COVID-19 and to Provide United States Leadership on Global Health and Security and Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats. These orders establish a White House-led national COVID-19 response structure and re-establish the Obama era White House Directorate on Global Health Security and Biodefense “to monitor and rapidly respond to emerging domestic and global biological threats and pandemics.”
As part of this goal, regular public health briefings began again. Dr. Fauci sounded like someone newly released from chains: “The idea that you can get up here and talk about what you know, what the evidence — what the science is, and know that’s it, let the science speak, it is somewhat of a liberating feeling.”
Goal 2: Mount a safe, effective, comprehensive vaccination program.
Across the country, frustration with vaccination programs is high. South Carolina’s Beaufort Memorial Hospital and Erie County, NY canceled thousands of appointments after vaccine shipments came up short of what had been promised. Minnesota’s vaccination scheduling website and phone number crashed within minutes of opening on Tuesday.
Pfizer-BioNTech and Moderna, the two approved vaccine makers, have committed to delivering 200 million doses by the end of March, and more after that. As they continue to ramp up production, a third vaccine, this one from Johnson & Johnson, is on the horizon.
The Biden plan calls for at least 100 million vaccinations in the first 100 days of his presidency. Vaccinations began December 14, with only 17 million vaccinations in the first 37 days. Back in December, experts said his goal was too optimistic. Now, with vaccinations at around one million per day, it sounds do-able and many think the goal should be even higher.
“This will be a whole-of-society effort that mobilizes every resource available to us,” the plan says. That includes invoking the Defense Production Act to meet supply shortages ranging from PPE and test kits to syringes to administer the vaccine. The plan also promises federal coordination of vaccine delivery, mobilization of public health clinics as vaccination sites, and creation of federal mass vaccination sites, in partnership with states and local communities. Support will come from a variety of federal agencies, beginning with the Federal Emergency Management Agency (FEMA) and the Department of Defense.
The plan insists on prioritizing vulnerable and underserved communities, such as long-term care residents and staff, incarcerated individuals, tribal nations, veterans, and more.
This goal will require Congressional action to provide funding for many of the components.
Goal 3: Mitigate spread through expanding masking, testing, treatment, data, workforce, and clear public health standards.
Executive orders have already implemented some of the actions set out in this goal:
- Protecting the Federal Workforce (including mask-wearing on federal property and in government buildings)
- Promoting COVID-19 Safety in Domestic and International Travel (testing, mask-wearing, quarantine, etc.)
- Improving and Expanding Access to Care and Treatments for COVID-19 (accelerating development of treatment therapies, expanding capacity of health care institutions and access to health care)
A COVID-19 Pandemic Testing Board will coordinate testing with states and localities and the private sector.
This goal calls for creation of a United States Public Health Job Corps of at least 100,000 people, recruited from the communities they serve. They will “conduct culturally-responsive outreach and engagement, testing, contact tracing,” and will receive health care training.
Congress will need to appropriate money to do the job.
Goal 4: Immediately expand emergency relief and exercise the Defense Production Act.
The executive order on Sustainable Public Health Supply Chain authorizes use of the Defense Production Act to meet shortages in the supply chain by “acquiring additional stockpiles, improving distribution systems, building market capacity, or expanding the industrial base.”
The president issued a Memorandum to Extend Federal Support to Governors’ Use of the National Guard to Respond to COVID-19 and to Increase Reimbursement and Other Assistance Provided to States. This means FEMA funds will go to support the fight against COVID, rather than being diverted to build the border wall—but FEMA will still run out of funds.
Congress will need to appropriate money to do the job.
Goal 5: Safely reopen schools, businesses, and travel, while protecting workers.
From child care centers to higher education, safe reopening of schools is a priority, with an emphasis on worker safety. This goal emphasizes supporting a return to safe, in-person learning as quickly as possible, with a goal of reopening a majority of schools within 100 days, with support from FEMA disaster relief and emergency assistance.
Reopening businesses and travel is also identified as a priority. That includes setting safety standards and reducing the costs of pandemic-related supplies.
Paid leave for workers who must go into quarantine or isolation is part of the goal. Congress will need to reimplement and extend the emergency paid leave program.
Relevant executive orders include:
- Supporting the Reopening and Continuing Operation of Schools and Early Childhood Education Providers—This order directs federal agencies to provide evidence-based guidance to states and schools on what safety measures are needed and to assist in “implementing mitigation measures such as cleaning, masking, proper ventilation, and testing.” The order covers much more, including specific consideration of disparate impacts, considering race, ethnicity, disability, English-language-learner status, and income; equitable allocation of testing supplies; “trauma-informed care, behavioral and mental health support, and family support”; direction to the FCC to increase connectivity options for students.
- Protecting Worker Health and Safety—This order includes a mandate to OSHA to issue guidance to employers on workplace safety during the pandemic within two weeks, to issue any necessary standards by March 15, and to enforce those standards. Until now, OSHA has not acted to protect workers from COVID-19. The order also directs cabinet members (Agriculture, Labor, Transportation, Energy, Health and Human Services) to find ways to protect workers not protected by OSHA.
- Promoting COVID-19 Safety in Domestic and International Travel
Goal 6: Protect those most at risk and advance equity, including across racial, ethnic, and rural/urban lines.
COVID-19 has disproportionately affected racial and ethnic groups.
From the goal statement: “The COVID-19 pandemic has exposed and exacerbated severe and pervasive health inequities among communities defined by race, ethnicity, geography, disability, sexual orientation/gender identity and other factors. … The Federal Government will address disparities in rates of infection, illness, and death.”
Ensuring an Equitable Pandemic Response and Recovery—directs data gathering and response, establishes a COVID-19 Health Equity Task Force within HHS, and directs agencies to cooperate.
Goal 7: Restore U.S. leadership globally and build better preparedness for future threats.
Most notably, the United States has reversed the previous administration’s decision to leave the World Health Organization and has joined the COVID-19 Vaccines Global Access (COVAX) Facility. Some 190 other countries participate in COVAX.
Congress will need to approve funding for international assistance and vaccines for the global war on COVID.
This goal looks to the future, naming epidemic and pandemic preparedness, health security, and global health as essential to U.S. foreign policy and national security.
The Biden plan is huge, as it needs to be to meet the huge challenge of the pandemic. Republicans in Congress will criticize and resist. Indeed, they have already begun to do so. Democrats must not give in. We need what we have needed for the past year and have not had: that “full-scale war-time effort” to defeat COVID-19.
President Joe Biden: “And when I say war time, people kind of look at me like ‘war time?’ Well, as I said last night, 400,000 Americans have died. That’s more than have died in all of World War II. 400,000. This is a wartime undertaking.”