Biden Pledges Federal Vaccine Campaign to Beat a Surging Coronavirus

WASHINGTON — President-elect Joseph R. Biden Jr., racing against a surge in coronavirus cases and the emergence of a new variant that could worsen the crisis, is planning a vaccination offensive that calls for greatly expanding access to the vaccine while using a wartime law to increase production.

In a speech on Friday in Wilmington, Del., Mr. Biden told Americans that “we remain in a very dark winter,” allowing, “the honest truth is this: Things will get worse before they get better.”

“I told you,” he said, “I’ll always level with you.” But he also tried to offer hope for an end to a pandemic that has taken nearly 390,000 American lives and frayed the country’s economic and social fabric.

“Our plan is as clear as it is bold: get more people vaccinated for free, create more places for them to get vaccinated, mobilize more medical teams to get the shots in people’s arms, increase supply and get it out the door as soon as possible,” he said, calling it “one of the most challenging operation efforts ever undertaken by our country.”

He pledged to ramp up vaccination availability in pharmacies, build mobile clinics to get vaccines to underserved rural and urban communities and encourage states to expand vaccine eligibility to people 65 and older. Mr. Biden also vowed to make racial equity a priority in fighting a virus that has disproportionately infected and killed people of color.

“You have my word,” he declared, “we will manage the hell out of this operation.”

But the president-elect’s expansive vision is colliding with a sobering reality: With only two federally authorized vaccines, supplies will be scarce for the next several months, frustrating some state and local health officials who had hoped that the release of a federal stockpile of vaccine doses announced this week could alleviate that shortage.

Mr. Biden is clearly prepared to assert a role for the federal government that President Trump refused to embrace, using the crisis to rebuild the nation’s public health services and Washington’s money to hire a new health work force and deploy the National Guard. But many of his bold promises will be difficult to realize.

Even if Mr. Biden invokes the Korean War-era Defense Production Act, it may take some time to alleviate vaccine shortages. The law has been invoked already, to important but limited effect. His promises to build federally supported mass vaccination sites and develop new programs to serve high-risk people, including the developmentally disabled and those in jail, will work only if there are vaccines to administer.

“It won’t mean that everyone in this group will get vaccinated immediately, as the supply is not where it needs to be,” Mr. Biden conceded. But as new doses become available, he promised, “we’ll reach more people who need them.”

The vaccine distribution plan comes one day after Mr. Biden proposed a $1.9 trillion rescue package to combat the economic downturn and the Covid-19 crisis, including a $20 billion “national vaccine program.” The president-elect has said repeatedly that he intends to get “100 million Covid vaccine shots into the arms of the American people” by his 100th day in office.

Time is of the essence. With the number of deaths now up to nearly 4,000 a day, the Centers for Disease Control and Prevention sounded the alarm on Friday about a fast-spreading, far more contagious variant of the coronavirus that is projected to become the dominant source of infection in the United States by March, potentially fueling another wrenching surge of cases and deaths.

“I think we are going to see, in six to eight weeks, major transmission in this country like we’re seeing in England,” Dr. Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Mr. Biden’s coronavirus advisory board. “If we can set up vaccine clinics faster and more efficiently, how many lives do we save?”

In some respects, Mr. Biden’s plan echoes the one outlined this week by Mr. Trump’s health secretary, Alex M. Azar II, who encouraged states to vaccinate those 65 and older. The Trump administration has also pledged to employ pharmacies to administer shots and to invoke the Defense Production Act when necessary.

When Mr. Azar announced Tuesday that the federal government was releasing a stockpile of vaccine doses, some state health officials expected to get more in their weekly shipments to help address soaring demand as the pandemic rages out of control.

But now, the states face a stark reality. That stockpile consisted only of vaccines earmarked for booster shots for people who had already received a first dose. That means the release of this pool will not expand inoculations to a new group of people. Federal officials have said second doses will be prioritized in the weekly shipments to ensure everyone can get a booster shot.

Gov. Kate Brown of Oregon, a Democrat, posted on Twitter that she had received “disturbing news” on Thursday evening: “States will not be receiving increased shipments of vaccines from the national stockpile next week, because there is no federal reserve of doses.” She added, “I am shocked and appalled that they have set an expectation on which they could not deliver, with such grave consequences.”

A senior administration official said on Friday that the government expected the two companies producing vaccines, Moderna and Pfizer, to supply eight million to 12 million vaccine doses a week to the public over the next several weeks — shipments that will then be divided among those getting their first and second shots. The two companies have deals with the federal government to supply a total of 200 million doses to the United States — or enough to fully vaccinate 100 million people — by the end of March.

The European Union is also struggling with shortages, amid news that Pfizer plans to halt production of its vaccine for weeks as it upgrades its manufacturing plant in Puurs, Belgium, to reach its goal of producing two billion doses this year — up from its earlier goal of 1.3 billion. The move will reduce deliveries to European Union member states as well as other countries.

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Answers to Your Vaccine Questions

Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area

You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.

That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.

The plan that Mr. Biden rolled out on Friday is part of a broader effort to use the current crisis to rebuild the nation’s crumbling public health infrastructure — long a goal of Democrats on Capitol Hill. As part of his stimulus package, he has also proposed increasing federal funding for community health centers and has called for a new “public health jobs program” that would fund 100,000 public health workers to engage in vaccine outreach and contact tracing.

“The details still have to be worked out, but this is really a critical recognition that state and local health agencies need to be shored up in a way that they haven’t been in decades,” Dr. Osterholm said.

But Dr. Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials, expressed caution about the idea, and urged Mr. Biden to consult with members of his group before creating a new corps of public health workers.

“We really would like to see him bring a few more people with some on-the-ground experience onto his team,” Dr. Plescia said. “One of the things about a federal jobs corps is, how do those people interface with the state public health departments? You need to really think through that.”

Mr. Biden’s bid to improve public health infrastructure recalls the approach that he and President Barack Obama took with the recession-ravaged economy they inherited in 2009, when Mr. Biden was the newly inaugurated vice president. Rahm Emanuel, Mr. Obama’s chief of staff at the time, said then that a serious crisis should never “go to waste” because it might provide “an opportunity to do things that you think you could not do before.”

In an interview on Friday, Mr. Emanuel, who went on to serve two terms as the mayor of Chicago, praised Mr. Biden for his plan to invest in such clinics — also known as federally qualified health centers, or F.Q.H.C.s.

“The F.Q.H.C. is singularly the best preventive health care for hard to reach communities,” Mr. Emanuel said, adding, that “what’s great about this investment that the president-elect is making is it is laying down a foundation” for a strong public health response to future crises.

Mr. Biden has long pledged to wage a far more aggressive federal response than Mr. Trump’s leave-it-to-the-states approach.

Also on Friday, Mr. Biden’s team announced that it intended to phase out Operation Warp Speed, the Trump administration’s fast-track vaccine initiative. Dr. David A. Kessler, a former head of the Food and Drug Administration who has been advising Mr. Biden on the pandemic, will lead the new administration’s effort to accelerate the development and manufacture of Covid-19 vaccines.

“OWS is the Trump team’s name for their program,” Jennifer Psaki, Mr. Biden’s spokeswoman, wrote on Twitter, using the program’s initials. “We are phasing in a new structure, which will have a different name than OWS.”

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