Opinion | Biden’s Covid-19 Plan Is Maddeningly Obvious

I wish I could tell you that the incoming Biden administration had a genius plan for combating Covid-19, thick with ideas no one else had thought of and strategies no one else had tried. But it doesn’t.

What it does have is the obvious plan for combating Covid-19, full of ideas many others have thought of and strategies it is appalling we haven’t yet tried. That it is possible for Joe Biden and his team to release a plan this straightforward is the most damning indictment of the Trump administration’s coronavirus response imaginable.

The Trump administration seemed to believe a vaccine would solve the coronavirus problem, freeing President Trump and his advisers of the pesky work of governance. But vaccines don’t save people; vaccinations do. And vaccinating more than 300 million people, at breakneck speed, is a challenge that only the federal government has the resources to meet. The Trump administration, in other words, had it backward. The development of the vaccines meant merely that the most logistically daunting phase of the crisis, in terms of the federal government’s role, could finally begin.

In the absence of a coordinated federal campaign, the job has fallen to overstretched, underresourced state and local governments, with predictably wan results. According to data from the Centers for Disease Control and Prevention, of the roughly 31 million doses that have been sent out, about 12 million have been used.

The good news is that the incoming Biden administration sees the situation clearly. “This will be one of the most challenging operational efforts ever undertaken by our country,” Biden said on Friday. “You have my word that we will manage the hell out of this operation.”

The person in charge of managing the hell out of the operation is Jeff Zients, who served as chief performance officer under President Barack Obama and led the rescue of HealthCare.gov. In a Saturday briefing with journalists, Zients broke the plan down into four buckets. Loosen the restrictions on who can get vaccinated (and when). Set up many more sites where vaccinations can take place. Mobilize more medical personnel to deliver the vaccinations. And use the might of the federal government to increase the vaccine supply by manufacturing whatever is needed, whenever it is needed, to accelerate the effort. “We’re going to throw the full resources and weight of the federal government behind this emergency,” Zients promised.

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Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Most elements of the plan are surprising only because they are not already happening. Biden’s team members intend to use the Federal Emergency Management Agency to set up thousands of vaccination sites in gyms, sports stadiums and community centers, and to deploy mobile vaccination options to reach those who can’t travel or who live in remote places. They want to mobilize the National Guard to staff the effort and ensure that strapped states don’t have to bear the cost. They want to expand who can deliver the vaccine and call up retired medical personnel to aid the campaign. They want to launch a massive public education blitz, aimed at communities skeptical of the vaccine. They’re evaluating how to eke out more doses from the existing supply — there is, for instance, a particular vial that will get you six doses out of a given quantity of Pfizer’s vaccine rather than five, and they are looking at whether the Defense Production Act could accelerate production of that particular vial and other, similarly useful goods.

This plan merits, at least for me, a sense of fury: All of this should’ve been done months ago. These are the obvious ideas. We should be considering the hard, but perhaps necessary, decisions that could radically increase supply: using half-doses, for instance, or joining Britain in rapidly approving the Oxford-AstraZeneca vaccine, even though the vaccine’s clinical trial was marred by shaky study design. I’m of the view that the situation is bad enough, and the costs of waiting large enough, that it might be worth moving forward on both counts, even with imperfect information. But those are difficult calls, with real downside risk. That there is so much low-hanging operational fruit for the Biden administration to focus on instead is a tragedy. It means people who could’ve been saved by simple competence and foresight will die instead.

Even now, the Trump administration’s poor planning and inconsistent communication fog the effort. In recent days, there have been reports that states aren’t receiving the vaccine allotments they’ve been promised. Gov. Kate Brown of Oregon tweeted that the leaders of Operation Warp Speed had directly confirmed to her that “states will not be receiving increased shipments of vaccines from the national stockpile next week, because there is no federal reserve of doses.” The mayor of Los Angeles, Eric Garcetti, said, “the national supply simply isn’t coming.” When I asked Zients whether the federal government had less vaccine supply than has been promised, he wasn’t able to give an answer. “We’ll conduct a full evaluation when we’re in our seats on supply, but it’s hard for me to say more than that right now, given the lack of information sharing from the Trump administration.”

The incoming administration is also free from the delusion that the vaccines will solve the coronavirus crisis on their own. Even on the most optimistic timetable, it will take until well into the summer for America to reach herd immunity. In the meantime, new variants of the virus that spread even faster are taking hold. Ron Klain, Biden’s choice for chief of staff, warned that the coronavirus death toll in America will pass 500,000 by the end of February. And it will not end there. That is why if you look at the incoming administration’s coronavirus rescue package, most of the money is dedicated to the policies that will let us survive this next year.

Of this, $20 billion is directed at the vaccination effort. Another $50 billion is dedicated to standing up the national testing infrastructure that we should’ve had long ago, with an emphasis on deploying rapid testing for asymptomatic individuals who work in high-risk settings and setting up genomic surveillance so we can see when and how the virus is mutating. Then there’s $130 billion intended to retrofit schools so they can operate safely, even with the virus in circulation.

A year into this crisis, America still hasn’t built a national contact tracing apparatus to track and suppress outbreaks: Biden’s plan calls for hiring more than 100,000 public health workers for national contact tracing, local vaccine outreach and more. Congregant settings, like nursing homes and prisons, have been the sites of particularly vicious outbreaks, and Biden wants to create specialized forces that can be rapidly deployed to such sites to save lives. The list goes on.

None of this — none of it — is interesting or surprising. It’s obvious, and it should’ve been done long ago. Back in May, I wrote that we were operating, in effect, without a president and without a national plan. It is January, and that remains true. But that will end on the day of Biden’s inauguration. And then the hard work can, finally, begin.

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