Inauguration Day marks a serious milestone in the coronavirus pandemic and a new chapter in the United States' response to it.
On January 19, the United States exceeded 400,000 coronavirus deaths. A day later, newly elected President Joe Biden was ready to launch an ambitious plan to tackle the public health crisis, including the distribution of 100 million vaccines in its first 100 days, issuing a "100 Days Masking Challenge" to encourage the public to wear masks and demand that people stay physically away and wear masks in federal buildings and on federal land.
The president also intends to ask Congress to spend $ 400 billion to start its national COVID-19 response. The plan includes:
$ 20 billion for a national vaccine program that would partner with states, localities and tribal nations to accelerate the launch of vaccines. The plan requires more vaccination sites, including mobile centers, and expanding efforts to reach unattended communities. The National Guard will also be available for states to assist in the effort; $ 50 billion to expand testing, including strengthening laboratory support and acquiring rapid antigen testing; local health departments; Extending paid leave programs to allow more workers to stay home if they are sick.
Exactly the money earmarked for these and other efforts depends in part on Congress, and details are likely to change in the coming weeks. Science News spoke with Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis and advisor to the Biden transition team’s COVID-19 advisory board, about the new administration’s plans to treat the pandemic. This interview was edited for brevity and clarity.
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SN: How would you describe the general state of the pandemic and the response to the pandemic that the Biden administration is now facing?
Osterholm: There are two components. The first is the general lack of a national plan [of the previous administration] and the lack of coordination regarding the delivery of vaccines. There has not been enough investment in state and local delivery systems, not enough attention has been paid to vaccine hesitation. Expectations were mismanaged. They are inheriting an incredible challenge from the vaccine, and it will take some time to steer that boat.
The additional challenge, which in a way is my worst nightmare, is strain B.1.1.7 which is impacting both right now in the UK and Ireland. It could take the pandemic to a whole new level. It is possible that in mid-late February we may see a period in which what is happening now does not seem so bad. And all of this is falling right into the lap of the Biden administration.
SN: How can the Biden administration improve the launch of vaccines in the United States?
Osterholm: First of all it's just transparency. The administration just has to be honest with the American people about how realistic in terms of production and when certain people can get vaccinated. The previous administration sometimes exceeded in excess how many vaccines will be available when. When you create that kind of short-term excitement over the availability of the vaccine when it’s just not there, it creates confusion, anger, and long-term lack of confidence. [The Biden administration] is going to have to deal with [those feelings].
The next big thing is to provide support to local and state health departments that are really the air traffic controllers in our communities for vaccination. All public health is local and varies dramatically across the country. To deliver a vaccine in a certain local area, you need to know the area and how to get the best vaccine there. Local public health departments know how to do it. They know what volunteer organizations they can call, what community centers they can use, if they can get help from emergency response bodies at universities or medical schools.
There has never been much support from the federal government. Local health departments are extended to breakpoints. The [Biden’s] plan recognizes the key role that health departments play and provides support in terms of funding as well as people.
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SN: How can the Biden team make sure people actually get the vaccines?
Osterholm: The first is to understand why people hesitate and there is no answer. It is different for different groups. Healthcare workers may hesitate for different reasons than essential workers; it may be different for younger blacks versus older whites. Some people may be concerned about safety, others may have heard misinformation about DNA-altering mRNA vaccines.
You need to check the different concerns of the different groups, then you can figure out how to provide this kind of information to that group, find out who the colleagues you can bring together to build trust. For example, top professional sports heroes could publicly promote the vaccine. This kind of trust building is really important.
SN: What other major pandemic challenges does the Biden team face and what can it do to improve them?
Osterholm: Managing the potential impact of variant B.1.1.7. It will call for many additional measures to reduce transmission in a country that has gone far beyond pandemic fatigue and is almost at a stage of pandemic anger. How do you respond to that?
It has health workers begging people not to put themselves at risk because of what they are living in hospitals, working 16 to 18 hours just trying to keep people alive. At the same time, you have people saying, "My small business has closed, I've lost my livelihood, I'm done. And I'm angry." And that anger and frustration usually gets in the way of government and I’m sure it will be thrown at the Biden administration.
This administration sees it and is ready to do it. [Biden] acknowledges that this is difficult.
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