The Biden Agenda

Biden will arrive in office amid a pandemic. It will be his biggest challenge — but also an opportunity.

Jamie Roderick, 35, a volunteer for MoveOn, helps place 1,000 signs featuring the faces of nurses and other front-line health-care workers, as well as signs calling for more personal protective equipment (PPE), on the lawn in front of the Capitol on April, 17. (Evelyn Hockstein for The Washington Post)

As President-elect Joe Biden and his team devise a governing strategy to defeat the coronavirus pandemic — the incoming administration’s most urgent priority — they have become centrally focused on instilling broad, bipartisan faith in vaccines.

With the first vaccine against the virus, developed by Pfizer and a German biotech firm, now allowed for public use, the president-elect regards it as imperative to “deweaponize” attitudes toward immunization among his political adversaries, as one member of his coronavirus advisory board put it, speaking on the condition of anonymity about internal matters without permission to discuss them openly.

“We can’t have a repeat of masks,” the member said, referring to the intense partisan polarization over wearing face coverings that President Trump fostered and that public health experts bemoan as one reason the United States leads the world in coronavirus cases and deaths.

Biden has not spoken publicly about behind-the-scenes concern that leading Republicans might foment opposition to the shots, which are expected to slow the virus’s spread significantly if enough people receive them.

Yet he has talked with increasing frequency about vaccines’ capacity to tamp down the virus’s transmission only “if they’re injected into an arm of people, especially those most at risk,” as he said last week at an event in his hometown of Wilmington, Del. And the idea of conquering Republicans’ reluctance about vaccination is one way to understand his oft-stated desire to be "a president for all the people.”

Health policy experts say Biden’s capacity to mold bipartisan receptivity to being vaccinated has implications for his broader agenda to expand health coverage and access to affordable care. “If you can’t do this one, you are not going to be able to get buy-in on universal coverage,” said Robert J. Blendon, a professor of health policy and political analysis at Harvard University who studies public opinion about health care.

Blendon said GOP candidates this year and officeholders have not indicated they will take a wholesale stand against coronavirus vaccines — but will emulate Trump in rejecting a strong federal role in setting pandemic policy in favor of state and local decisions. Republicans “are going to fight [the government deciding] who gets the vaccine, who distributes it and if there’s any need for [vaccination] requirements before you can go to work, school, get on a plane,” Blendon said.

The political stakes and the consequences for public health are considerable, said Larry Levitt, executive vice president of the Kaiser Family Foundation, a health policy group.

“The success of Biden’s presidency likely rests in large part on tamping down the pandemic and having a successful vaccine rollout," Levitt said. “The Biden administration is going to need to bring red America and blue America together. If the vaccine is a repeat of masks, our efforts to end the pandemic will be stymied.”

Health-care workers administer coronavirus tests outside a high school in Eau Claire, Wis., on Nov. 21. The testing site handles hundreds of tests per day. (Michael S. Williamson/The Washington Post)

The transition’s unspoken concern about which Americans will be willing to get vaccinated — and the dangerously uneven embrace of masks — runs through the three parts of a plan Biden introduced this month for starting to control the pandemic during his first 100 days in office.

Biden has said that on the day he is sworn in, Jan. 20, he intends to sign an executive order requiring masks to be worn everywhere the federal government has jurisdiction, including on buses and trains that cross state lines. He also has promised to enable “the majority of our schools” to reopen and stay open, and to distribute “at least 100 million covid vaccine shots” during the 100 days.

Already, the president-elect and his top pandemic advisers are showing wariness about the adequacy of distribution procedures. David Kessler, a co-chairman of the advisory board and a former Food and Drug Administration commissioner, said that, based on reviews underway of what the Trump administration has set up, “there are elements of a plan that exist to get it shipped to certain locations."

“But there is a world of difference between a vaccine and a vaccination,” Kessler said in an interview. “Once a vaccine arrives in a state or a city, what happens?”

Biden has indicated that he thinks the government is not fully prepared. He said last week that “without urgent action by this Congress this month to put sufficient resources into vaccine distribution and manufacturing … there’s a real chance that, after an early round of vaccination, the effort will slow and stall.”

His emphasis on bipartisanship and on enhancing equity — he is forming a coronavirus equity task force — is a departure from the Trump administration’s approach to contending with covid-19, the disease caused by the virus that has infected more than 16.5 million people in the United States and killed more than 300,000. It comes on top of his basic view that the federal role should be more assertive. The extent to which these values will infuse his broader health-care agenda remains to be seen, with many policies being discussed within the transition but not yet decided.

Still, much of Biden’s broader goal of expanding health coverage will depend on his ability to persuade congressional Republicans to go along, especially if the Senate remains in GOP control after a pair of runoff elections in Georgia next month.

The pandemic’s primacy among the issues Biden is inheriting was evident in his decision to create the 13-member coronavirus advisory board less than 48 hours after he clinched the election, his first act as president-elect.

According to people familiar with the board’s activities who spoke on the condition of anonymity to describe internal workings, its three co-chairs have informally divided responsibilities, with small working groups under them. Surgeon General-designee Vivek H. Murthy is focusing mainly on improving coronavirus testing and the supplies of personal protective equipment. Marcella Nunez-Smith, named to lead the new equity task force, has been focused on global equity issues. And Kessler, one of the people under consideration to lead the FDA again, is working primarily on vaccines.

In tandem with that board, the transition has a health-care policy team, which has been combing through Biden’s campaign promises on the pandemic and other health-care goals, figuring out how to adapt them into policies for governing — which ones still are pertinent, what the sequence should be and whether ideas should be added.

Paige Thompson, a nurse, checks in on patient Rodney Hopp in the covid-19 ward at Tampa General Hospital in Tampa on Aug. 19. (Michael S. Williamson/The Washington Post)

The coronavirus-fighting ideas being evaluated are drawn largely from plans that Biden began to issue in late winter, not long after the crisis started and five months before he became the Democratic presidential nominee.

A March 12 document listed actions Biden vowed to take “on Day One as president,” if Trump hadn’t done them first. The list included restoring a unit within the White House’s National Security Council for global health security and biodefense, an office that President Barack Obama created and that Trump dismantled two years ago.

On the list, too, is a commitment to “ensure that every person who needs a test can get one” free, including by establishing at least 10 mobile testing sites and drive-through facilities in each state. Biden promised to issue a daily White House report about the number of tests performed and to provide enough protective gear for health-care workers, emergency personnel and others at heightened risk of infection because of their jobs.

And he called for 14 days of paid leave for workers who are sick with the coronavirus or who are caring for ill relatives or other loved ones.

In an update of his plan in late June, Biden said he would form a Pandemic Testing Board, double the number of drive-through testing sites and "increase the numbers until there are no more lines.” He pledged to hire at least 100,000 people nationwide to help build a “contact-tracing workforce.” And he said he would invoke the full powers of the Defense Production Act, a law that gives a president authority to take steps to increase manufacturing for national defense purposes.

According to people inside and outside the incoming administration who are familiar with this process, most of these and other ideas remain works in progress, in part because transition members have gotten a late start in delving into the inner workings of what the Trump administration has and has not accomplished. The president delayed allowing Biden representatives inside federal agencies, as Trump attempts to cling to the presidency for another term despite the election results.

“We need to know more about the Trump plan to get Americans vaccinated,” Kessler said in the interview. “I am in dozens of meetings on vaccine distribution issues” to learn from the current administration exactly what has been set up.

Kessler reflected the concern about whether Republicans will buy into the mass vaccination campaign. “We need everyone across the political spectrum pulling together to get the job done and Americans safely vaccinated,” he said.

Although there is no precise goal for the vaccination effort, Anthony S. Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, whom Biden has appointed his chief medical adviser on the coronavirus, recently estimated that vaccinating 75 percent to 85 percent of the population would “crush” the outbreak by the end of next year. The White House coronavirus task force said recently that 100 million well-targeted vaccinations could slow the virus’s spread by late spring.

Mayo Clinic paramedic Adam Glass, a paramedic with the Mayo Clinic, helps load covid-19 patient Rita Huebner into an ambulance in Eau Claire, Wis., on Nov. 18. (Michael S. Williamson/The Washington Post)

Evidence exists of a partisan divide in attitudes toward getting the Pfizer vaccine or others that could be coming soon, according to public opinion surveys. A Quinnipiac University poll, conducted last week among registered voters just before federal regulators authorized the Pfizer vaccine, found that, overall, about 6 in 10 of those surveyed said they would be willing to receive a coronavirus vaccine if government health officials approved it.

Half of the Republicans surveyed said they would be willing, compared with 8 in 10 Democrats and nearly 6 in 10 independents.

An ABC News/Ipsos poll, conducted after the first coronavirus vaccine was allowed, found a sharper split, with 26 percent of Republicans surveyed saying they will never receive a vaccine, compared with 6 percent of Democrats.

In general, polls in past weeks have shown that Americans’ willingness to receive a coronavirus vaccine has risen since early fall but is lower than it was over the summer. And recent surveys by both the Pew Research Center and the Kaiser Family Foundation have found considerable division on how soon people want to get vaccinated, with more preferring to wait than wanting to receive a shot as soon as possible.

“It is absolutely critical for the transition and the new administration to be reaching out to Republicans on this issue of vaccine,” said Dan Mendelson, a Clinton administration budget official who founded Avalere, a health-care consulting firm.

Attitudes about important public health issues, research has shown, can be influenced by high-profile messengers with credibility among groups that identify with them. For that reason, Mendelson said, “you want prominent Republicans endorsing the vaccine and the president-elect’s plans.”

“The complication is Trump is preventing this by continuing this charade that he is going to overturn the election," Mendelson said. “So you have Republicans from [Senate Majority Leader Mitch] McConnell on down [who] you can’t put on a covid transition assignment, because they haven’t even acknowledged that the new government is forming.”

Kessler said: “We understand there are people who have concerns about the vaccine. We will address those concerns in a scientific, evidence-driven manner.” To start, he said, the public must be allowed to see all the effectiveness and safety data that federal regulators and advisers review for each vaccine candidate they are asked to allow.

The Biden coronavirus advisory board member who spoke on the condition of anonymity said the country lost the battle over wearing masks because Trump and other senior Republicans have displayed skepticism about their value.

If that partisan schism can be closed for the herculean effort of immunizing a nation against a lethal virus, the member said, “everything else is logistics and tactics.”

Nursing staff members at Griffin Hospital in Derby, Conn., stand and clap for Vernon Johnson as he is released after recovering from covid-19. "Here's Comes the Sun" is played on the intercom during each release. (Michael S. Williamson/The Washington Post)

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