Facing a renewed surge of COVID-19 cases from the highly transmissible omicron variant, President Biden announced a new battle plan, including buying 500 million rapid tests and mobilizing 1,000 military medical personnel to support hospitals.
But Biden is facing pressure from health experts and some Democratic lawmakers to go farther, amid concerns that he is acting too slowly. And the president himself has acknowledged missteps, particularly on the shortage of testing.
“Nothing’s been good enough,” Biden told ABC News when asked about testing shortfalls, while noting that the country is in a much better place than last year, with 200 million people now vaccinated.
Here are five areas where Biden is under pressure to do more.
Testing
No area has been a more visible sign of shortfalls recently than testing, with pharmacies sold out of rapid tests and long lines at testing sites.
Experts did say Biden’s announcement of 500 million free rapid tests is a step in the right direction. But they said far more are needed if people are going to use them regularly, given there are 330 million Americans in the country. And they said the announcement should have come months ago.
“It’s too little, too late,” said Leana Wen, a public health expert at George Washington University.
Biden acknowledged to ABC that “I wish I had thought about ordering half a billion [tests] two months ago.”
The White House has noted it took action to boost rapid testing earlier, including a $3 billion investment. White House press secretary Jen Psaki said actions on testing have been a “building process” over time.
Supplies of Pfizer’s pill
The Food and Drug Administration’s authorization of Pfizer’s pill to treat COVID-19 was a major advance in the run-up to Christmas.
The pill, known as Paxlovid, can help defang the virus, as it has shown to reduce the risk of hospitalization or death by 89 percent in high-risk patients.
The problem, at least in the short term, is there are not enough pills to go around.
The White House said 265,000 courses of treatment will be available in January. Meanwhile, there are over 100,000 new COVID-19 cases every day in the United States.
“Testing and that medication have become the two most important things where there’s a bottleneck on resources,” said Bob Wachter, chair of the department of medicine at the University of California-San Francisco.
“It would have been nice to hear something on what the federal strategy is to make it available faster,” he said of the Pfizer pill.
Some experts have noted other companies could conceivably help make the drug, the way Merck is helping to make the Johnson & Johnson vaccine.
Asked about steps to increase production of the treatment, White House COVID-19 response coordinator Jeff Zients said the pill is complex to make and takes six to eight months to produce.
Still, he said that “now that the pill is authorized,” the administration “will have discussions to explore how we can help them improve their manufacturing capacity even further by providing any resources that they need.”
Booster shots and the definition of “fully vaccinated”
While it has messaged consistently about the importance of booster shots in recent weeks, the official definition of “fully vaccinated” is still two shots for Pfizer and Moderna.
Given the implications for vaccine requirements across the country, some experts are calling for the definition to change.
Wachter said Biden’s speech “would have been a nice opportunity” to announce a changing of the definition.
“You should use the term the way that it means,” he said, noting: “Fully vaccinated at this point is three mRNA shots…that is what you need to have.”
Eric Topol, professor of molecular medicine at Scripps Research, also made the case that the definition should change given waning immunity over time from two shots. He pointed to research that effectiveness against omicron infection fell to about 35 percent after two shots, but rose back to about 75 percent after a third shot.
Asked about changing the definition, Centers for Disease Control and Prevention Director Rochelle Walensky said: “That evaluation is currently underway and, you know, more soon. But to be very clear: Our recommendations are to get boosted.”
Vaccinating the world to prevent new variants
Biden has faced calls for months to do more to vaccinate the world, with some experts calling for the administration to compel vaccine makers to share their know-how with lower-income countries.
The Biden administration notes that it has committed to donate 1.2 billion vaccine doses abroad, of which 350 million doses have been sent so far, more than any other country has donated.
The White House also announced a plan in November to ramp up vaccine manufacturing to one billion doses per year.
A group of Democratic lawmakers is pushing for greater action, though.
“The pace and scale of these efforts remain out of sync with the magnitude of the threat that an unvaccinated world poses to American lives, the American economy, and America’s global leadership,” more than 80 Democratic lawmakers wrote in a letter in mid-December.
The letter was signed by lawmakers including Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.), as well as Reps. Pramila Jayapal (D-Wash.) and Tom Malinowski (D-N.J.).
It called for $17 billion in a coming government funding bill to help vaccinate the world, including for delivery efforts to get shots into arms, as well as for other areas like testing and treatment.
Requiring vaccines for domestic air travel
The Biden administration has embraced vaccine mandates in many forms, including for large employers and for health care workers. But one area where they have so far not taken action is on requiring vaccination for domestic air travel.
Some Democratic lawmakers and experts want to change that.
“As domestic travel increases this holiday season, we urge you to implement new requirements for airline passengers to provide proof of COVID-19 vaccination or a negative COVID-19 test result to board a domestic flight,” Sen. Dianne Feinstein (D-Calif.) and Reps. Don Beyer (D-Va.), Ritchie Torres (D-N.Y.) and Eric Swalwell (D-Calif.) wrote to the administration on Dec. 20. “Ensuring the health and safety of air travelers and their destination communities is critical to mitigating the ongoing COVID-19 surge, especially as the virus continues to evolve.”
Asked about the idea on MSNBC, Psaki said “we know that masking is very effective on airplanes,” and that adding a vaccination requirement “might delay flights.”
She said the administration’s health experts had not called for the step at this point.
“We would do it, though, if the health impact was overwhelming,” she added.