How Biden can fix the COVID-19 response while we wait for the vaccine

When the history books are written about this pandemic, this month may serve as the inflection point that started to tilt the COVID-19 crisis toward its end. Pfizer and Moderna’s dual announcements created safe and effective vaccines that withstood advanced clinical trials spurred warranted celebration, but getting everyone in America vaccinated is not like flipping a switch. We are a nation of 330 million, and to ensure widespread distribution, leaders must navigate steep logistical hurdles, strained states and localities, and intense vaccine hesitancy. Scientists are still soberly estimating that we will not fully return to “normal life” until 2022. 

President-elect Biden has promised to control the pandemic his top priority, despite the limited legislative paths presented by a potentially uncooperative Senate. Here are five steps he can take in the first 100 days to turn around the pandemic response and save lives while waiting for the vaccine to be broadly administered. 

l. Rescue the Center for Disease Control and Prevention (CDC)

Biden’s team can bring political acumen, but we need the CDC to supply public health expertise. The agency was once the world’s preeminent public health agency and can be again. It needs ample resources and the independence to deploy them without political fear or favor. 

What to watch for: news conferences where health experts do the talking about where we stand and provide advice about where to go next. 

2. Provide clear, consistent political leadership to states and localities

President-elect Biden needs to find a political path to effective, sustainable, cooperative action across the 50 states. States and even local governments are appropriately making most of the emergency rules, and they will be distributing the vaccine. 

President Biden’s most important legal decisions will make concern when to invoke federal authority and when to leave legal matters to the states. He can start by having the federal government lead by example. Making masks and limited occupancy the rule in federal facilities could help change behavior and save lives. 

What to watch for: President Biden and his team talk to governors and mayors of both parties. Targeted executive orders create federal reforms, and clear messaging and material support guide state action.

3. Expand access to health care 

Health care access is another opportunity for rapid federal legal action. The administration can use its power under the Affordable Care Act (ACA) to make care accessible by easing enrollment in the marketplaces. It can enhance access to Medicaid and provide more support for safety net providers. It can repeal the new public charge rule, which has led many immigrants to fear using public insurance or seeking health care. It can also make sure that vaccines are available to all, regardless of income or immigration status. 

What to watch for: outreach to the 14 states that did not expand Medicaid under the ACA and a new effort to boost enrollment by making insurance marketplaces easier to navigate.

4. Promote equity

The pandemic has exposed and exacerbated a wide range of deep-seated inequities in American society. The administration can work with the CDC, Occupational Safety and Health Administration, and other federal agencies to address disparities like unsafe conditions for low-paid “essential workers” and reduce the stresses – housing, food – that lead people to accept risky working conditions. The Department of Justice and agency civil rights offices can investigate inequitable treatment instances based on disability or other protected status. 

What to watch for: the federal government takes tangible action to collect data on the pandemic’s disproportionate impact on low-income residents and people of color, addresses the factors that enhance vulnerability, and ensures that vaccines and therapeutics are accessible to at-risk populations.

5. Develop and implement a coordinated response

All these steps have to add up to a coordinated response across the federal government and the whole country because legally and practically, neither states nor the federal government can do this on their own. Biden can streamline the disorganized status quo, where governors are left to compete for limited supplies, and individuals and businesses face a crazy quilt of conflicting policies. 

What to watch for: President Biden convenes the nation’s governors and works with them to develop a coordinated 50-state approach to pandemic control that is guided and monitored by CDC, informed by data we all can see, and accountable to a worried public. 

Wendy E. Parmet is the Matthews Distinguished University Professor of Law and Director, Center for Health Policy and Law; Professor of Public Policy and Urban Affairs, Northeastern University School of Public Policy and Urban Affairs. Scott Burris, J.D., is a Professor of Law at Temple Law School, directing the Center for Public Health Law Research. He is also a Professor at Temple’s School of Public Health.