National strategy addresses vaccine supply, racial disparities, and more

The Biden Administration revealed a 198-page Covid-19 pandemic response plan designed to bolster vaccine supplies, reduce viral spread, protect the U.S. workforce, and address issues of racial equity in healthcare.

The “National Strategy for the Covid-19 Response and Pandemic Preparedness” kicked off Thursday, Jan. 21 — President Biden’s advisers released an executive summary outlining the plan on Jan. 20, and the full strategy is available on WhiteHouse.gov. This plan was crafted in response to the Covid-19 pandemic response enacted by the outgoing Trump administration — a response that was severely lacking and left Biden’s team stunned, according to The New York Times.

“What we’re inheriting is so much worse than we could have imagined,” Jeff Zients, the new White House Covid-19 response coordinator, told the Times. “The cooperation or lack of cooperation from the Trump administration has been an impediment. We don’t have the visibility that we would hope to have into supply and allocations.”

The Biden administration previously revealed plans for a $1.9 trillion Covid-19 relief proposal, the “American Rescue Plan,” which the President hopes to pass to assist Americans and businesses who are struggling during the pandemic. In a White House Press briefing on Jan. 21, White House press secretary Jen Psaki, along with NIAID director Anthony Fauci, MD, reasserted President Biden’s push for bipartisan support for the bill, saying “This crisis is dire, and it requires immediate action, and we hope and expect members of both parties to work together to do that.”

Asked what aspects of the bill are intended to be bipartisan, Psaki pointed out that relief funds would be going to widely supported initiatives such as unemployment insurance and increased vaccine distribution. “So, part of the discussion we’ll be having with [Republican] members is, what do you want to cut?” she said.

The Biden administration’s National Strategy is organized around seven central goals:

  1. “Restore trust with the American people.
  2. “Mount a safe, effective, and comprehensive vaccination campaign.
  3. “Mitigate spread through expanding masking, testing, data, treatments, health care workforce, and clear public health standards.
  4. “Immediately expand emergency relief and exercise the Defense Production Act.
  5. “Safely reopen schools, businesses, and travel while protecting workers.
  6. “Protect those most at risk and advance equity, including across racial, ethnic, and rural/urban lines.
  7. “Restore U.S. leadership globally and build better preparedness for future threats.

Restoring Trust

As part of its plan to restore trust in the federal government’s response to the Covid-19 pandemic, the administration promised transparency and open communication with the public. This goal prompted President Biden to issue two Executive Orders: Organizing and Mobilizing the U.S. Government to provide a Unified And Effective Response to Combat Covid-19 and to provide United States Leadership on Global Health and Security, which will establish “a White House Covid-19 national response structure to coordinate across the U.S. Government and [restore] the White House Directorate on Global Health Security and Biodefense established by the Obama Biden Administration; and Ensuring a Data-Driven Response to Covid-19 and Future High Consequence Public Health Threats, which will direct steps to enhance federal agencies’ collection, production sharing, and analysis of data to support an equitable Covid-19 response.

This goal also includes conducting regular expert-led, science-based public briefings on the state of the pandemic and prioritizing outreach to state and local governments, the public and private sectors, vulnerable communities, students, workers, and community leaders to enact the Covid-19 response and guide policy and implementation.

Addressing Vaccines

In order to achieve its goal of mounting a safe, effective, and comprehensive national vaccination strategy, the Biden administration intends to expand Covid-19 vaccine manufacturing and purchasing by employing the Defense Production Act, deploying onsite support to monitor contract manufacturing operations, and purchasing additional FDA-authorized vaccines. “The effort includes prioritizing supplies that could cause bottlenecks, including glass vials, stoppers, syringes, needles, and the ’fill and finish’ capacity to package vaccine into vials,” the administration explained.

The Executive Summary also went over plans to increase vaccination rates by releasing the national Covid-19 vaccine reserve and urging states to vaccinate priority groups at a faster rate, as well as create additional vaccination facilities, improve vaccine access in hard-to-reach and high-risk populations, and educate citizens on vaccines in an attempt to reduce vaccine hesitance. The administration also expressed a desire to allow more healthcare professionals to administer vaccines in order to facilitate this plan.

Stopping the Spread

The administration noted that ramping up vaccine production will not be enough to control Covid-19 unless there are also plans in place to mitigate the spread of the virus. To help accomplish this, the Biden administration issued four Executive Orders: Protecting the Federal Workforce and Requiring Mask-Wearing, which requires masking and physical distancing in federal buildings, on federal land, and by federal employees and contractors; Promoting Covid-19 Safety in Domestic and International Travel, which will direct agencies to require masks on airplanes, trains, and other forms of public transportation; Establishing the National Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for Covid-19 and Other Biological Threats, which establishes the Covid-19 Pandemic Testing Board “to oversee implementation of a clear, unified approach to testing” and direct agencies to facilitate free testing for the uninsured, as well as testing asymptomatic individuals in congregate settings and schools; and Improving and Expanding Access to Care and Treatment for Covid-19, which “outlines steps to bolster clinical care capacity, provide assistance to long-term care facilities and intermediate care facilities for people with disabilities, increase health care workforce capacity, expand access to programs designed to meet long-term health needs of patients recovering from Covid-19, and support access to safe and effective Covid-19 therapies for those without coverage.

Expanding Pandemic Relief

The Biden administration outlined plans to increase emergency funding to states and improve the Federal Emergency Management Agency (FEMA) response. The President also intends to issue an Executive Order, A Sustainable Public Health Supply Chain, which will direct agencies to “fill supply shortfalls using all available legal authorities, including the [Defense Production Act] DPA,” as well as to increase domestic manufacturing of antigen and molecular-based tests, PPE, vaccines, and therapeutic drugs.

Reopening Safely

The National Strategy includes plans to safely reopen schools, businesses, and travel while ensuring workers are protected during the pandemic. To achieve this, the President announced an Executive Order Supporting the Reopening and Continuing Operation of Schools and Early childhood Education Providers, which will require the Departments of Education and HHS to provide guidance on the safe reopening of schools. The administration will also use FEMA funds to help support schools opening, and the President has called on Congress to provide “at least $130 billion in dedicated funding to schools, $350 billion in flexible state and local relief funds… and additional resources so that schools can safely reopen, including funds to implement screening testing.” The President has also asked Congress to provide $25 billion to support child care centers, as well as $15 billion to assist families struggling to pay for child care. He also announced Executive Order Protecting Worker Health and Safety, which directs the Occupational Safety and Health Administration (OSHA) to issue updated guidance on worker protection.

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Protecting At-Risk, Marginalized Populations

The Biden Administration announced an Executive Order called Ensuring an Equitable Pandemic Response and Recovery, which forms a task force aimed at addressing Covid-19-related health and social inequities and coordinating an equitable pandemic response. The President also announced Executive Order Ensuring a Data-Driven Response to Covid-19 and Future High-Consequence Public Health Threats, which directs federal agencies to expand data infrastructure and improve the collection and reporting of health data for high risk populations.

The National Strategy also includes plans for ensuring equitable access to supplies such as PPE, tests, drugs, and vaccines that are critical to slowing the spread of Covid-19, as well as improving social service safety nets to assist families who are struggling to meet basic needs, including food, housing, and transportation.

Rehabing U.S. Role in International Health

In an attempt to “restore U.S. leadership” and better prepare the nation for future public health threats, the Biden administration announced plans to rebuild the nation’s relationship with the World Health Organization (WHO), ceasing the process of withdrawal from the organization that was launched by the Trump administration and participating in the WHO Executive Board meeting this month.

Fauci announced the administration’s decision in a video conference with WHO’s executive board, adding that the U.S. will resume full funding and staffing support for WHO.

“This is a good day for WHO and a good day for global health,” Tedros Adhanom Ghebreyesus, director-general of WHO, said in a statement regarding the decision. “The role of the United States, its… global role is very, very crucial.”

The administration also announced plans to strengthen U.S. biopreparedness; President Biden announced the restoration of the White House National Security Council Directorate for Global Health Security and Biodefense, which was originally created during the Obama administration. The National Strategy also outlined plans to establish a National Center for Epidemic Forecasting and Outbreak Analytics “to modernize global early warning and trigger systems to prevent, detect, and respond to biological threats.”

“To execute on the National Strategy, the White House will establish a Covid-19 Response Office responsible for coordinating the pandemic response across all federal departments and agencies,” the administration noted in the Executive Summary. “Through implementation of the National Strategy, the United States will make immediate progress on the seven goals. To monitor outcomes, the National Strategy includes the creation of publicly accessible performance dashboards, establishing a data-driven, evidence-based approach to evaluating America’s progress in the fight against Covid-19.”

Fauci Talks New Strains, Herd Immunity, and Freedom from Trump

Speaking at the White House press briefing, Fauci expressed relief at working with the Biden administration following a strained relationship with the outgoing Trump Administration that started in the early days of the Covid-19 pandemic.

“You said I was joking,” Fauci said in response to a question about earlier comments on his relationship with Trump. “I was very serious, I wasn’t joking.” He added that working with the previous administration was sometimes “uncomfortable,” particularly when the pandemic response wasn’t driven by science, as he noted with the case with the Trump administration’s push to use hydroxychloroquine to prevent Covid-19 severity despite evidence that the treatment was ineffective and possibly harmful to patients.

“Let the science speak,” Fauci noted. “It is somewhat of a liberating feeling.”

Fauci also confirmed reports regarding the proliferation of new, mutated strains of Covid-19, noting that the U.K. strain, B.1.1.7 — which the CDC recently projected will be the predominant viral strain by March of this year — appears to be twice as transmissible as the original SARS-CoV-2 virus. And, while increased transmissibility does not necessarily equal a more deadly virus, Fauci pointed out that more cases will lead to more hospitalizations, and the resulting strain on health care resources could potentially increase the number of deaths. A greater concern, he added, stems from reports that another Covid-19 strain discovered in South Africa, 501Y.V2, may render the currently approved Covid-19 vaccines less effective.

Asked how quickly U.S. residents could expect to be vaccinated, Fauci noted that it was difficult to predict. “if we get 75 to 80% of the country vaccinated, say by the end of the summer… I believe, by the time we get to the fall, we will be approaching a degree of normality… The concern I have, and something we are working on, is getting [to the] people who have vaccine hesitancy who don’t want to get vaccinated.”

John McKenna, Associate Editor, BreakingMED™

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