with Alexandra Ellerbeck

President Biden is promising smoother, more efficient pipelines of coronavirus vaccines.

But that will require fixing communication snafus that are gumming up the whole process of getting Americans immunized quickly.

“We need a general, we need a plan, and then we can all work together to follow the plan,” said Amy Compton-Phillips, chief clinical officer for Providence St. Joseph Health, a West Coast-based chain of hospitals. “We need to know who is getting the vaccine, how much we will get and when we will get it.”

Health providers say they need accurate and timely information about dose shipments.

Providence officials said they’re not receiving information soon enough about how many doses they’ll receive from week to week. That makes it hard to schedule appointments for patients.

“If we don’t know on Monday how much vaccine we will get, it’s impossible to set up appointments for Wednesday,” Compton-Phillips told me.

The federal government is allocating vaccines to states based on the size of their adult populations. But some states say they're running short, while others aren't even ordering all they've been allotted, Isaac Stanley-Becker and Lena Sun report. 

“The result is widespread confusion about how much vaccine is available from one week to the next, and how much supply states actually need to inoculate residents in priority groups,” they write. “Both areas of confusion are barriers to the national immunization campaign that President Biden pledged to mount in his first days in office.”

A 198-page federal coronavirus plan the Biden administration released yesterday references this problem, although it promises to improve communications between the federal government and states and localities — not necessarily health providers themselves. 

“Moving forward, the federal government will provide regular projections of the allocations states and localities will receive,” the document says.

In an earlier section, the plan also promises to “build clear channels of communication with state and local leaders” to execute a “unified federal covid-19 response.”

The plan, posted to the White House website, is the most detail Biden has released on his pandemic response to date.

It lays out seven key goals regarding getting vaccines distributed, expanding testing, reopening the economy and restoring trust in public health guidance. Biden also signed 10 additional pandemic-related executive orders and presidential memorandums dealing with different aspects of the public health crisis.

But the president also offered a sober assessment of where the United States is at in its battle with the coronavirus.

 “The death toll will probably top 500,000 next month,” he said. “Things are going to continue to get worse before they get better.” 

While Biden officials insist they’re starting from square one, that’s not quite true.

Operation Warp Speed, under the Trump administration, contracted with six vaccine developers for enough vaccines to immunize the whole country, and 38 million doses have been distributed so far. The vaccines were developed at a far faster clip than anyone was predicting one year ago.

Yet Biden’s plan does envision a much more robust federal role in getting vaccines administered (we detailed some of that in yesterday’s Health 202). And it offers more reassurance to states that the federal government will put more effort into communicating the plans and try to provide them with more financial resources.

“The 198-page plan released Thursday is far from a federal takeover of the nation’s efforts to cope with the worst health calamity in a century,” our colleagues write. “Yet it represents a pronounced shift away from the Trump administration’s deference to each state to design its own plan for coronavirus testing and carry out other elements of its response.”

Besides shipment confusion, providers also have uncertainty about who is eligible.

This is a particular issue for large hospital chains with dozens of sites, like Providence, which are dealing with dozens of slightly different county and state guidelines for who is eligible to get the vaccine. 

An advisory committee to the Centers for Disease Control and Prevention has recommended three different “tiers” of priority for the first wave of distribution. Tier 1A is health-care workers and long-term care facility residents. Tier 1B is people 75 and older and front-line essential workers, such as first responders or food workers. Tier 1C is people between ages 65 and 75, younger adults with high-risk medical conditions, and any essential workers not included in the first two tiers.

But those are broad categories, open to interpretation. In many cases, states have left it up to health providers or counties to spell out exactly who qualifies for what tier. Recommendations also vary — sometimes on a county-by-county basis — for when health providers should progress down to the next tier.

This confusion is the “number one concern” for county officials, said Blaire Bryant, associate legislative director for health for the National Association of Counties.

“There were a lot of crossed wires on who should be in a priority group,” Bryant told me earlier this week.

Biden’s plan says states should expand eligibility.

This follows upon a similar Trump administration recommendation last week. The plan says states should open up eligibility to front-line essential workers and anyone who is 65 and older, but doesn’t include a recommendation for vaccinating younger people with high-risk medical conditions, a group included in Tier 1C.

“We cannot leave supply unused, or let it expire,” the plan says. 

But all of this depends on Pfizer and Moderna’s manufacturing ramping up. Together, the companies have agreed to sell 200 million doses to the United States by the end of March.

Ahh, oof and ouch

AHH: Fauci returned to the White House for his first news conference under Biden.

Anthony Fauci, the nation’s top infectious-disease expert, told reporters that he feels more liberated to speak freely about the science around the coronavirus under the Biden presidency. Fauci said that he often felt as if there were repercussions for speaking honestly about the coronavirus pandemic under the Trump administration, noting that officials sometimes promoted public health messages that were misleading or not factual.

“The idea that you can get up and talk about what you know, what the evidence is, what the science is,” Fauci continued, “it is somewhat of a liberating feeling.”

On Jan. 20, Anthony S. Fauci, the nation's top infectious disease expert, reflected on his time under former president Donald Trump. (The Washington Post)

Fauci said that there were some signs that the surge of coronavirus cases might be plateauing but that the country could still see increasing hospitalizations and deaths of people infected in recent weeks. He also warned that new, more transmissible variants of the coronavirus could fuel further spread of the virus, although he said that masks and vaccines would still be effective against these strains. 

Fauci serves as the director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president. Earlier in the day, he spoke to the World Health Organization and promised that the United States would resume funding for the international agency.

OOF: A doctor who promoted false claims about hydroxychloroquine was arrested for participating in the mob that stormed the U.S. Capitol.

Simone Gold, the head of America’s Frontline Doctors, a fringe medical group that has pushed unsubstantiated claims about hydroxychloroquine as a treatment for covid-19, was arrested over the weekend for her involvement in the riot at the U.S. Capitol, according to charging documents from the Justice Department.

Gold repeatedly touted the antimalarial drug hydroxychloroquine as a treatment for covid-19, echoing claims made by then-President Trump. Health officials and researchers, however, say that the drug is unlikely to be effective against covid-19 and is accompanied by potential risks. Gold is also an outspoken critic of the coronavirus vaccines.

Simone Gold, a hydroxychloroquine advocate and outspoken critic of the coronavirus vaccine, was among those who entered the Capitol building on Jan. 6. (CSPAN)

Gold confirmed to The Post last week that she was present at the Capitol but denied witnessing any violence. 

The affidavit in support of Gold’s arrest, however, identifies her in a video in which a police officer is pulled to the ground by someone in the crowd. Gold was charged with federal counts of trespassing in a restricted building and engaging in disorderly conduct and violent entry. 

Gold told The Post that she worked as an emergency room physician until this summer, when she was fired after protesting pandemic shutdowns at a right-wing event in front of the Supreme Court.

OUCH: Overweight D.C. residents will get priority for the coronavirus vaccine.

The District is planning to give priority coronavirus vaccines to the broadest possible swath of people with conditions that could put them at higher risk for severe outcomes from covid-19. This includes not only those conditions that the CDC lists as proved to exacerbate complications from the coronavirus — such as cancer, sickle cell disease, smoking and obesity — but also conditions that the CDC says might increase risk. That latter group includes asthma, high blood pressure and being overweight, with a BMI over 25, Julie Zauzmer reports.

“For people who have some of the chronic health conditions, we don’t know that they have higher risk yet from a science perspective,” D.C. Health Director LaQuandra Nesbitt told members of the D.C. Council last week. “We don’t want to make an erroneous decision to exclude them.”

“A promise of vaccines for people classified as overweight or obese could help get vaccines to poorer, majority-Black wards in the city, where vaccination rates have lagged, because a greater proportion of poorer residents are considered obese,” Julie writes. “But offering vaccines to so many adults will be a logistical challenge for the city, which has struggled to keep its website and phone line for vaccine registrations running smoothly for the senior citizens and health-care workers who are currently eligible.”

The health department reports that more than half of the adults in the District — and 72 percent of those living east of the Anacostia River — have a BMI over 25. Some scientists have argued that the District should distinguish between chronic conditions and prioritize those who are likely to be most at risk.

“At some point or another, it’s not much of a discriminator anymore if you define a co-morbidity as something that almost everybody has,” David Kass, a Johns Hopkins cardiology professor researching obesity, told The Post.

Still, vaccinations for people with chronic conditions will only take place after the city vaccinates people over 65, law enforcement personnel, teachers, grocery store workers and some other essential employees. 

More government moves

Biden is expected to rescind the Mexico City Policy in the coming days.

“The so-called Mexico City policy, first established by former President Reagan in 1984 and named for the city he announced it in, requires that foreign groups receiving family planning aid from the U.S. government agree not to provide or promote abortions — even with funding from other sources,” the Hill’s Jessie Hellmann reports.

“Described as a ‘global gag rule’ by reproductive health advocates, the policy has been rescinded by Democratic presidents and reinstated by Republicans since Reagan, and has been in effect for 19 of the past 34 years,” Jessie continues.

Biden is expected to rescind the policy on Jan. 28. That same day he is also expected to order a review of the Trump administration’s changes to the Title X family planning program and disavow the “Geneva Consensus” — an international declaration signed by the United States, Brazil, Egypt, Hungary, Indonesia and Uganda that asserts there is no “international human right to abortion.” 

Federal regulators approved the first long-acting HIV drug combo.

The Food and Drug Administration approved a two-shot combo called Cabenuva, which will allow people with HIV to take monthly shots in lieu of daily pills. 

The new treatment “is expected to make it easier for people to stay on track with their HIV medicines and to do so with more privacy,” the Associated Press’s Marilynn Marchione reports. “It’s a huge change from not long ago, when patients had to take multiple pills several times a day, carefully timed around meals.”

The new treatment may help health-care workers reach groups that might have more difficulty sticking with regular treatments, including people with mental illness or substance abuse problems. 

Sugar rush