Biden COVID-19 team will ‘follow the science’ to improve vaccine efforts, advisor says
Ahead of an address in which President-elect Joseph R. Biden Jr. called for $400 billion to beef up the country’s response to COVID-19, an adviser vowed that the administration’s efforts will be guided by science.
“The Biden brand is to follow the science,” Celine Gounder, MD, ScM, FIDSA, clinical assistant professor of medicine at the NYU Grossman School of Medicine and a Biden-Harris COVID-19 advisory board member, said Thursday during a webcast hosted by the Johns Hopkins School of Public Health. “From vaccines to therapeutics and diagnostics … everything will be informed by the science.”
As part of the “American Rescue Plan,” Biden will seek $20 billion for a national vaccination program that would include the launch of community vaccination centers and deployment of mobile vaccination units in hard-to-reach areas, and $50 billion for what the plan called “a massive expansion of testing.”
The incoming administration also announced that Biden has chosen former FDA Commissioner David A. Kessler, MD, to be chief science officer for Operation Warp Speed, the federal COVID-19 vaccine effort.
‘Dismal’ vaccine rollout
According to tracking by Johns Hopkins, more than 23 million cases of COVID-19 have been reported in the United States and more than 386,000 Americans have died from the disease.
Biden has vowed to get 100 million people vaccinated during his first 100 days in office. According to the CDC, as of Thursday morning, more than 30.6 million vaccine doses had been distributed but only 11.1 million people had been vaccinated.
“The vaccines offer so much hope, and we’re grateful to the scientists and researchers and everyone who participated in the clinical trials … but vaccine rollout in the United States has been a dismal failure thus far,” Biden said in his address.
Gounder said the incoming administration “is very dedicated to ramping up vaccination because if we do not, if we allow the death to continue at this rate, our overall death toll will more than double.”
“I think right now we understand the gravity of the situation. We are dealing with 4,000 Americans dying of coronavirus every day and it is unacceptable for Americans to be dying at that rate,” Gounder said.
Gounder said the country saw a preview of Biden’s vaccine plan last week when the president-elect said he would release nearly all available doses of COVID-19 vaccine to speed up the rollout.
The Trump administration already announced a similar plan this week, saying it would release all doses of vaccine that were being held in reserve to ensure that everyone who already received a first dose of vaccine could also receive a second dose. It also urged states to open up vaccination to people who were not in the initial groups for prioritization, which could necessitate the availability of tens of millions more doses of vaccine.
Gounder said the transition team realizes that some of the new guidance, “while very well-intentioned,” is hard to operationalize on the ground, and other experts agree.
Andrew T. Pavia, MD, FIDSA, chief of the division of pediatric infectious diseases for University of Utah Health, said the initial rollout has not gone smoothly due in part to a lack of planning and resources.
“The first step of this process — that is, developing highly effective vaccines — has gone really well. That's an important milestone in combatting this pandemic,” Pavia said Thursday during a press briefing hosted by the Infectious Diseases Society of America. “But this phase we've entered now may be even more difficult than developing the vaccines was. We have to get some 600 million doses into the arms of Americans to control this pandemic, and we've known for many months this is going to be an enormous undertaking.”
Julie Vaishampayan, MD, MPH, FIDSA, chair of IDSA’s public health committee and a public health officer with Stanislaus County, California, said sufficient space that meets vaccine storage requirements and convincing at-risk individuals to come to vaccine clinics are all necessary to the rollout, and that expanding vaccine distribution to other groups may be challenging.
“Most of our work and planning is the messaging and outreach to reach that priority population — those most at-risk and those [who] need to get the vaccine first,” Vaishampayan said. “It's easier with health care workers but gets harder as we expand out into groups and requires a lot of planning. One of our concerns is that switching with very little notice [to other groups] doesn't allow that planning process to take place.”
The Trump administration’s revised guidance suggests that states open vaccination to all of their most vulnerable people, including anyone aged 65 years or older and anyone aged younger than 65 years with documentation of a comorbidity. People aged 75 years or older were already in a prioritized group.
Vaishampayan said a barrier to vaccination for older patients is a lack of access to online portals and systems necessary to sign up for vaccination. She also said there is a lack of time and resources to properly address this issue, and that a “significant portion” of eligible individuals are being missed because of it.
According to Gounder, smoothing out the supply chain and simplifying who is eligible for vaccination will be key to moving forward.
“We are concerned about the mismatch between the number of people who are being told they are eligible, and the amount of vaccine that's being distributed and the resources to get that vaccine into people,” Pavia said. “In order to really get vaccination done what we need is an efficient, well-planned system. We need coordination, and we can't have that unless there is absolute transparency.”
In addition to its focus on improving vaccination rates and resources, the new administration also plans to keep an eye on several other factors related to the pandemic.
“We are also very much focused on how we rebuild the public health infrastructure, just recognizing how taxed our clinics and communities really have been because of COVID-19,” said Loyce Pace, MPH, president and executive director of the Global Health Council and a Biden-Harris COVID-19 advisory board member. “We are also very keenly focused on the supply chain and access to and uptake of important innovations like vaccines … and supplies like personal protective equipment and diagnostics, tests and treatment and how they’re distributed equitably around the country communities.”
Another issue important to the incoming administration “is how we reopen and reopen safely, and ensure that the American economy, schools and businesses can get up and running again without putting anyone at increased risk for COVID-19,” Pace said during the Johns Hopkins webcast.
Gounder and Pace noted, however, that things may be subject to change as more science becomes available. “Certain recommendations may change over time,” Gounder said. One such example would be the use of face masks. As of now, the administration is encouraging continued use of face masks following vaccination.
“Right now, we don’t know if the COVID-19 vaccine prevents transmission,” Gounder said. “Again, this kind of guidance will be dictated by the science.”
Additionally, the Biden administration intends to improve surveillance and containment ⎼⎼ especially surrounding the newly emerging variants of SARS-CoV-2 that have been reported in several countries, including the U.S.
“We recognize that the U.S. is not doing enough to track these variants,” Pace said. “The good news is that as far as we know, the vaccine can be defensive against these variants.”
More good news, Pace said, is that “the public health principles we know and love still work and still matter.”
“We still want people masking up; we still want people to limit congregating with those outside of their household; we still want people washing hands,” she said.
Pavia said he was concerned about a lack of COVID-19 precautions among the general public during the vaccine rollout, despite a large surge in cases.
“We know the measures that work: masks, maintaining social distances, avoiding large gatherings and hand hygiene. But we're not using them,” he said. “It's like learning that really good shark repellants will be available in the summer, so people jump into the ocean covered in blood while the great whites are swimming around.”
(Editor’s note: This story was updated after Biden’s address to include his comments and details of the new plan.)
Johns Hopkins. Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html. Accessed on Jan. 14, 2020.