My husband and I, both relatively healthy adults in our late 30s who work from home, got our first doses of the Moderna COVID-19 vaccine earlier this month. We never in our wildest dreams imagined being vaccinated so quickly. We just happened to bump into neighbors, who in the most casual way reported that our local Safeway was administering doses that would have to be thrown away if warm bodies didn’t show up before closing time. We later learned this was happening all over Washington, DC and even in other parts of the US.
We didn’t hesitate. It took a herculean effort to produce these precious vaccines, and they’ve been shown to be safe and effective, so there was no question what we should do. We feel very lucky and relieved to have some protection from COVID-19. But even before the needle was in my arm, I had mixed feelings about our luck.
Luck-based inoculations: symptom of a disastrous rollout
My feelings of guilt about getting vaccinated so quickly started as soon as I got in line at the pharmacy. I knew other people are in much greater need of vaccination than us. My mom, my 85-year-old grandmother, my college best friend, a doctor who has intubated dozens if not hundreds of COVID-19 patients; none of them got vaccines before I did. Workers in meat and poultry plants, who are extremely vulnerable to COVID-19 given their working conditions, did not get vaccines before I did. And more broadly, because of longstanding health inequities, communities of color have been hardest hit by the pandemic and consequently should be prioritized for vaccination—but they are not. All of these things were swirling in my head as the needle went into my arm.
But in typical fashion, the White House COVID task force was almost completely incompetent at coordinating a federal plan for vaccine logistics and distribution. A key mistake that they made was abdicating responsibility for federal leadership on vaccine distribution and instead leaving it almost entirely up to state and local officials, even though many said they lacked sufficient resources or capacity to do this. The news has been full of confusing guidance, seniors waiting in hours-long lines, and state planning stymied by a federal vaccine reserve that was—and then wasn’t—coming.
Now the Biden administration must clean up the mess to ensure our population is protected from the virus as quickly as possible. I hope they can, and there are some hopeful signs already: in its first week, the new administration proposed to improve vaccine distribution and logistics and take other helpful steps to slow the continued spread of the virus, including a new mask mandate on federal property.
Here’s how they say they’ll do it—and how the Biden administration should explicitly prioritize some of the most vulnerable.
How the Biden administration aims to speed up vaccination
This recent Wall Street Journal article summarizes the Biden plan. First, the administration will establish community vaccination centers all across the US. It will also reach underserved and rural areas with mobile units and collaboration with primary care doctors. Both the National Guard and the Federal Emergency Management Agency will help support the establishment and operation of these centers and mobile units. National Guard and FEMA will also make the vaccine more widely available for both chain and independent pharmacies, offer the vaccine free of charge to anyone, regardless of immigration status, and will be launching a campaign to encourage people to get vaccinated.
A new CDC director will help, too
The Biden administration selected Dr. Rochelle Walensky, an infectious disease doctor at Massachusetts General Hospital, to lead the Centers for Disease Control and Prevention. She was on the front lines of the COVID-19 pandemic in Boston and saw first-hand how the virus was disproportionately affecting Hispanic communities. She plans to review the current CDC guidance to ensure that the agency stands fully behind what it shares publicly and promises to be more transparent with information about the virus.
The administration also issued a series of executive orders in its opening days that will help coordinate vaccination distribution and logistics. Here is a summary of the orders that will have the biggest effect on vaccine distribution to ensure it reaches those most in need.
1. Establish a Coordinator of the COVID-19 Response that reports directly to the president
On day one, President Biden signed an executive order (EO) establishing a White House position to coordinate the federal response to the COVID-19 pandemic and prepare for future biological and pandemic threats. Jeff Zients, former director of the National Economic Council during the Obama administration has been appointed to the position. Not only does the COVID-19 Response Coordinator advise the president on the federal government’s response to COVID-19, the position will also coordinate efforts across federal agencies.
Most importantly, the coordinator is tasked with reducing racial, ethnic and other disparities in response, care and treatment of COVID-19.
By comparison, former Vice President Mike Pence appointed Deborah Birx to a similar position during his time, but she did not report directly to the president and she did not have a charge with respect to equity. So, this newly elevated position with a new focus on equity will hopefully improve not just vaccine rollout but also our overall response to the pandemic.
2. Center equity in the COVID-19 response and recovery efforts
On day two, the new administration signed an EO directing a government-wide effort to address health equity as it relates to the pandemic, noting that this approach is both a “moral imperative and pragmatic policy”.
This order not only centers equity in the federal government’s response and relief efforts, it establishes a COVID-19 Health Equity Task Force within the Department of Health and Human Services. The task force will convene federal agency heads and nonfederal members with expertise and lived experiences in the disproportionate impact the virus is having on some communities. The group is charged with providing the President with specific recommendations on how to address inequities in the COVID-19 response and relief efforts. It also requires additional data collection in communities of color and other underserved populations.
3. Ensure a sufficient supply chain for response materials for the current and future pandemics
On day 2 the administration also signed an EO to assess inventory of all pandemic-related materials. The order also focuses on ensuring that materials such as tests, personal protective equipment, and vaccines are insufficient supply and works to address price gouging and hoarding.
The order goes on to recommend that a federal strategy be developed to ensure that essential materials to fight future pandemics and biological threats are ready in sufficient quantities.
4. Ensuring that decisions about the response to the pandemic are data-driven
Again, on day 2 the administration issued yet another order to increase COVID-19 data (e.g. tests, illness, deaths, hospitalizations, vaccinations) collection efforts across federal agencies, utilizing existing public health data systems and their connectivity, and advance data collection and analytical capabilities. The goal is to ensure that the federal response and relief efforts to the pandemic are data-driven.
Frontline workers, especially food system workers, must be vaccinated ASAP
One thing is missing from what the Biden administration has proposed so far. They did not explicitly acknowledge that non-healthcare frontline workers, including those in the food system such as farmworkers, meat and poultry plant workers, and grocery store workers should be a priority for vaccination in every state. CDC guidelines indicate that these vulnerable workers should get vaccinated in priority group 1b. Yet states are not following these guidelines consistently, as my colleague Sarah Reinhardt points out in her blog from last week. We need the Biden administration to come out and explicitly say these workers need to be prioritized for vaccination, regardless of what state they work and live in and whether they are US citizens or not. Not only will this protect already vulnerable populations from COVID-19, it will help keep community spread in check across the country.
A good start, but implementation will be key
Objectively, the Biden administration has released an impressive portfolio of proposals and actions to combat the virus and increase the speed and efficiency of the vaccine rollout. And they’ve only been at it a week.
But how such an ambitious and multifaceted plan is implemented remains to be seen. We will keep watch on this administration to hold them accountable for the goals that they have set. In particular, we will also hold them accountable for the strong commitment that they are making to equity in both response and recovery efforts through their words and executive orders. As we have learned over the last four years, both words AND actions matter.
Posted in: Science and Democracy
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