with Alexandra Ellerbeck

In its first 18 hours, the Biden administration has promised to alter the course of the coronavirus pandemic with a new national mitigation strategy, a dozen executive orders and new mask mandates.

But when it comes to ramping up immunizations, President Biden is keeping the goal modest.

His aim — 100 million shots administered in the next 100 days — would require a roughly 25 percent ramp-up from the current daily rate, which is hovering around 800,000 shots administered per day. That daily rate, achieved in the final days of the Trump administration, has remained flat over the past few days but is more than double what it was two weeks ago.

Biden seems to be taking an under-promise and over-deliver approach, after his predecessor repeatedly made unrealistic promises about immunizations that didn't transpire.

Yet leaders of Biden’s coronavirus response team insisted the 100 million goal is still “ambitious.”

“It’s a much faster pace than the current pace,” said Jeffrey Zients, White House pandemic response coordinator. He added that it is “just the start.”

So far, at least 14.3 million Americans have received at least one shot of either the Pfizer or Moderna vaccines. More than 2.2 million have been fully vaccinated. Reaching the administration’s goal would mean that somewhere between 50 million and 100 million more people would be either partially or fully vaccinated by the end of April.

“We do believe the comprehensive strategy we’ve outlined will get the job done,” Zients said.

That strategy, which White House Chief of Staff Ron Klain previewed over the weekend, involves a more robust federal response to the pandemic, including drawing on National Guard troops to help get vaccines administered, helping states with funds from the Federal Emergency Management Administration and ultimately providing Americans with more locations they can go to get immunized.

The coronavirus team has now put more flesh onto that framework.

This morning the administration released a 21-page plan it says will transform how the vaccine rollout is going.

Besides calling on Congress to appropriate more money to states, it envisions the creation of mass vaccination sites, including in stadiums, gyms and community centers, along with a program to build the public health workforce to help with testing, contact tracing and vaccination.

“The strategy also incorporates the vaccine plan’s call for greater use of the Defense Production Act, a decades-old law giving the government power to boost manufacturing during wars or other national emergencies,” Amy Goldstein reports. “The idea is to help produce supplies to expedite vaccine production, such as glass vials, stoppers, syringes and packaging. Trump officials insisted they also used the law, and it is not clear exactly how the new administration will change that.”

“The strategy also folds in a decision Biden announced this month to distribute most vaccine doses as they are made, rather than holding back significant reserves for the second doses required for the Pfizer-BioNTech and Moderna vaccines,” she adds.

The Biden administration is also rejecting recent Trump administration changes to how the vaccines are allocated and prioritized.

It is recommending that states make anyone over 65 years eligible to get the vaccine. But it’s not adding to that group those who are younger with a preexisting condition, as the Trump administration recently recommended.

People under age 65 with high-risk medical conditions are indeed more vulnerable to the virus. But they’re also a huge group — about 100 million. The current vaccine supply is far short of what would be needed to vaccinate them, too.

Nor will the new administration start allocating vaccine doses to states based on share of elderly residents vs. the general population. Trump’s health secretary, Alex Azar, announced that shift in allocation strategy earlier this month, along with a new system of rewarding states for quickly administering shots. Biden officials also rejected that approach.

“We are not looking to pit one state against another,” Zients said, when asked by reporters about that approach. “We don’t envision punishing states, but rather we want to focus on equity and efficient processes to get needles into arms.”

Biden is also signing a flood of pandemic-related executive orders.

He signed three of them yesterday. They require the use of masks and social distancing on federal property, direct the U.S. to rejoin the World Health Organization and re-create a White House unit on global health security and biodefense disbanded a few years ago.

Today he'll sign 10 more executive orders and directives aimed at mitigating various pandemic-caused crises. They include:

  • Creating a Pandemic Testing Board that can spur a “surge” in the capacity for coronavirus tests.
  • Fostering research into new treatments for covid-19.
  • Strengthening the collection and analysis of data to shape the government’s response to the crisis.
  • Directing the federal occupational safety agency to release and enforce guidelines to protect workers from getting infected.
  • Directing the Departments of Education and Health and Human Services to provide guidance on safe reopening and operating for schools, child care providers, and institutions of higher education. 
  • Requiring mask-wearing in airports and other modes of public transportation including trains, airplanes, maritime vessels and intercity buses.
Norris Cochran will serve as acting secretary of Health and Human Services.

Cochran, a civil servant, has served as deputy assistant secretary of budget at HHS for nearly a decade. He'll lead the agency while California Attorney General Xavier Becerra awaits Senate confirmation.

The new administration announced dozens of other appointments after the inauguration.

Longtime Becerra aide Sean McCluskie will be the HHS chief of staff. Sarah Despres, director of government relations at Pew Charitable Trusts, will serve as a counselor to the health secretary. Topher Spiro, a prominent health policy expert at the Center for American Progress, will be head of health programs at the Office of Management and Budget.

The Biden administration has also named acting heads of HHS's many branches. They include Janet Woodcock, who will helm the Food and Drug Administration, and Liz Richter, who will lead the Centers for Medicare and Medicaid Services.

Ahh, oof and ouch

AHH: Trump health officials offered some parting thoughts.

Robert Redfield, who served as director of the Centers for Disease Control and Prevention from 2018 until noon yesterday, praised Biden's plan to vaccinate 100 million Americans but took issue with statements from Biden's team criticizing the vaccine rollout.

“I’m not trying to criticize the Biden administration at all. But he’s pledged to do 100 million people in 100 days. We’re on the verge of delivering 1 million a day, and yet I heard his chief of staff on the Sunday talk shows saying that our vaccine program was a disaster and they inherited a mess,” Redfield told the New York Times's Sheila Kaplan. “I’d rather they would be thankful. That’s better dialogue than political hyperbole.”

The former CDC director has faced criticism for early blunders in response to the pandemic, including problems with the initial rollout of coronavirus tests. He also faced attacks from Trump and other political officials when he contradicted the White House's optimistic messaging on the course of the virus. Still, he refused to comment on Trump directly in the New York Times interview, calling himself a “chain-of-command kind of guy.” 

“My greatest disappointment was the lack of consistency of public health messaging and the inconsistency of civic leaders to reinforce the public health message,” Redfield said. “You can read between the lines what that means — ‘civic leaders.’ ”

FDA chief Stephen Hahn was somewhat more forthcoming about his relationship with Trump. In an interview with Politico, Hahn described a “clash of cultures” between the FDA and the White House, which he said constantly pressured the agency to move faster on approving vaccines and therapeutics.

Surgeon General Jerome Adams was also among dozens of other Trump appointees who resigned from HHS on Wednesday. His departure is notable because his role is considered largely nonpartisan, and some surgeon generals have served across multiple administrations, Dan Diamond reports. Adams, an anesthesiologist and former Indiana health commissioner, faced criticism from Democrats for defending Trump’s statements. 

OOF: Temperature problems may have spoiled more than 16,000 vaccine doses in Maine and Michigan.

Maine announced that it may have to throw out 4,400 doses of vaccine after workers found that the electronic temperature monitors on the vaccine shipments indicated that the vials could have spoiled. Authorities in Michigan reported similar issues for a shipment of Moderna vaccine containing nearly 12,000 doses, Andrea Salcedo reports.

“Both cases highlight one of the ongoing logistical problems in distributing coronavirus vaccines, which must be stored between minus-25 degrees Celsius and minus-15 degrees Celsius (minus-13 and 5 degrees Fahrenheit), according to CDC guidance,” Andrea writes.

The discoveries sparked separate investigations by the Centers for Disease Control and Prevention, Moderna and a distributor, McKesson Corp., which shipped doses to Michigan. So far, The Post’s vaccine tracker reports that around 68,914 Maine residents, 5.1 percent of the population, and 420,144 Michigan residents, accounting for 4.2 percent of the population, have received a first dose of the coronavirus vaccine. 

The news of spoiled doses comes as a number of states report that they are struggling with vaccine shortages. New York Mayor Bill de Blasio, for instance, announced that the city had to cancel 23,000 appointments for people awaiting their first dose of the vaccine amid shortages, the Associated Press reports.

OUCH: China is spreading conspiracy theories in an attempt to discredit Western vaccines and deflect blame for the initial coronavirus outbreak.

“Europe and Australia should reject the ‘hasty’ American vaccines linked to elderly deaths, Chinese scientists say. Western media refuses to investigate the dangers of the Pfizer-BioNTech shot, fumed a state television anchor. The coronavirus could be a plot involving former U.S. defense secretary Donald H. Rumsfeld, suggested a state media editor. And the real origin of the virus? Perhaps the U.S. Army's Fort Detrick should be investigated, intoned a Foreign Ministry spokeswoman,” Gerry Shih writes.

“One year after the coronavirus was first widely reported in China, the country’s state media and officials are again pitching a flood of theories about its origins (not China) and which vaccines are safe (not American),” he continues.

Scientists say it is possible, although unlikely, that the virus was carried to China via cold-chain packaging, and most researchers say it’s important to continue studying the side effects of the Moderna and Pfizer vaccines, although clinical trials suggest that severe adverse reactions are exceedingly rare. 

Still, many experts think that the recent barrage of nationalist narratives from Chinese officials, media and researchers may be an effort to deflect attention amid the World Health Organization’s visit to the country to investigate the origins of the virus. It also comes as clinical trials have shown that China’s leading vaccine contenders may lag behind those approved in the United States in terms of efficacy. 

More in coroanvirus

Europe is telling people to ditch the cloth masks and opt for medical-grade protection.

“Faced with new, more contagious, strains of the coronavirus and a winter surge in cases, European nations have begun to tighten mask regulations in the hope that they can slow the spread of the virus,” Loveday Morris and Rick Noack report.

Germany has made it mandatory for people on public transport or in supermarkets to wear either a surgical mask or an N95 mask or the Chinese or European equivalents, KN95 or FFP2s. France’s health advisory council also discouraged cloth or homemade masks, expressing concerns that they might not be sufficient against the new, more contagious strains of the virus. A growing body of evidence suggests that medical-grade masks may offer significantly more protection compared with single-layer cloth masks.

The new recommendations reflect increased supply of medical masks compared to the early days of the pandemic, when many health officials urged the public to forgo medical-grade masks to preserve resources for front-line health-care workers. The World Health Organization still advises restricting medical masks to medical workers, people who have coronavirus symptoms, or others who are at high risk. 

Not all scientists agree on the recommendations. Despite encouraging surgical masks, France’s health authority expressed concern that the higher-grade fitted masks could be worn incorrectly. Other critics have raised concern over the cost or environmental waste.

Emerging coronavirus variants may dodge some of the body’s immune response triggered by vaccines.

So far, vaccines appear to be effective against new variants of the coronavirus vaccine, which have been first identified in Britain, then in South Africa, Brazil and the United States. 

“But two small new studies, posted online Tuesday night, suggest that some variants may pose unexpected challenges to the immune system, even in those who have been vaccinated — a development that most scientists had not anticipated seeing for months, even years,” the New York Times’s Apoorva Mandavilli.

The studies, which have not been peer reviewed and are based on laboratory experiments, found that the variant of the virus first found in South Africa may be less susceptible to the body’s immune response provoked by a previous coronavirus infection or by a vaccine. 

Still, scientists expressed confidence that the existing vaccines would prevent severe illness. The concern raised by researchers who reviewed the new studies is that people who survived mild infections might be susceptible to reinfection from a new variant. They also raised the concern that existing vaccines, while keeping people out of the hospital, might not prevent people from becoming mildly infected and potentially contagious.

The findings raise the possibility that researchers should start preparing in case some variants escape vaccine protection.

“The mRNA technology on which the Pfizer and Moderna vaccines rely can be altered in a matter of weeks, and far more easily than the process used to produce flu vaccines. But it would be wise to prepare for this eventuality now and think through not just the technical aspects of updating the vaccines, but the testing, approval and rollout of those vaccines, experts said,” Apoorva writes.

A nursing home chain that lost thousands to covid-19 gave its outgoing CEO a major bonus.

Genesis HealthCare, one of America’s largest nursing home chains, gave its chief executive George Hager Jr. a $5.2 million retention payment in late October. He ended up retiring early this month, despite the payout, and will have to give some to it back. But the Genesis board still agreed to give him a $650,000 bonus and a $300,000 consulting contract.

“Under Hager’s leadership the more than 300 Genesis nursing homes experienced 14,352 confirmed cases of covid-19 through mid-December, according to reports the company made to Medicare officials. The total number of residents who died of the disease was 2,812, as of Dec. 20. Both figures are higher than in comparable nursing home chains,” Will Englund writes

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