Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics


Healio Interviews

Disclosures: Adalja reports no relevant financial disclosures.
January 20, 2021
4 min read

Q&A: Biden vaccination plan shows ‘willingness to use federal assets’


Healio Interviews

Disclosures: Adalja reports no relevant financial disclosures.
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Days before he was inaugurated, U.S. President Joseph R. Biden Jr. laid out his COVID-19 vaccination plan, which calls for more vaccination centers to be created and federally supported with help from FEMA and the National Guard.

Among other things, the plan also calls for the mobilization of more personnel to administer shots. The plan was released amid widespread criticism that the U.S. vaccine rollout has been slow.

Amesh Adalja quote

Healio spoke with Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, about the plan and what else needs to be done to confront a worsening pandemic.

Q: What are the major differences in the Biden plan as you see them?

A: The major difference is that what we saw in the Trump administration was basically a deferral to the states for that last mile of vaccination to turn a vaccine into a vaccination, where the federal government really wasn't exerting much influence or support, or there was some disconnect between the handoff between the federal government in the state governments as we've seen, kind of the lag in the rollout. What you see in the Biden plan is a willingness to use federal assets, like FEMA and the National Guard, in order to be able to assist states where they are to turn those vaccines into vaccinations, and to have mobile units really getting the federal government involved in what is the actual process of getting people vaccinated, not just delivering vaccine to the state. So, it seems to be a much more active and collaborative role with the states than we saw in the past.

Q: How feasible is it to involve FEMA and the National Guard in vaccine distribution?

A: I don't think we’d traditionally had to do that before, but I think that this is kind of an extraordinary time. We've seen that when states were kind of trying to go with their own plan, it's not really translating into a very fast rate of vaccination. Meanwhile, there are countries like Israel and the United Arab Emirates that have really been able to vaccinate larger proportions of their population. So, I do think that we have to think about this project of vaccinating the country as kind of like a warlike effort, where all hands are on deck. If governments are altering and it's going to be different, it's going to be different in each state where the needs are also different. I do think using assets like FEMA makes sense. The COVID-19 pandemic is a disaster, and that's what FEMA is meant to manage. It was constituted to deal with disasters, and I think that it makes sense. If they can mobilize teams to get vaccine to people and to set up vaccination clinics that are more like vaccination sites vs. what’s happening now in general — where it's very much an appointment-based system — kind of like an assembly line, that’s a good thing.

Q: The Washington Post reported last week that there were no reserve doses available when the administration announced that it would release reserve doses to speed up vaccinations. Are doses being manufactured fast enough?

A: I don't really understand what happened there. This clearly was another example of miscommunication and lack of transparency from the federal government because most people believed that the statement from the secretary was going to translate into more doses going to states. I mean, it was a decision that really was just done on paper and didn't really resolve or translate into more doses being shipped. It's more of like, “Oh, this is going to be our policy going forward,” and it was kind of disingenuous that it wasn't disclosed that there were no more vaccines to be shipped because states started to expand their eligibility, states started to expect that they were going to be more doses coming in, and then there weren't. It was another unfortunate example of how the federal government is really communicating with the public about what the actual status of the vaccines are.

Q: The Wall Street Journal reported that Operation Warp Speed officials waited more than 2 months to approve the rollout plan, leaving states in the lurch. How many of the vaccine rollout issues are issues of planning, and how many are issues related to manufacturing?

A: I think it's almost 100% related to planning. What we know is that many states have doses on hand that they are unable to administer because there wasn't enough planning for how states would be able to do this. We also know that states are underresourced and state health departments are underresourced. They're also doing testing and contact tracing at the same time that they're running a vaccination program, and they're just physically unable to do all of these things at once. Many of us were advocating for planning much, much earlier than that it actually probably started and more funding, and the funding really came through only on Christmas weekend, when the bill was signed, but the vaccination program had already begun by Christmas weekend.

Q: What’s the No. 1 thing that can be done right now to get vaccine doses into more arms?

A: We have to move to mass vaccination, and we have to kind of move away from the bureaucratic process, or the process of you have to have an appointment and then they will check your priority group and all of this type of friction into the system.

We also really just have to think about getting vaccine into people's arms and not allowing all of these other things to become obstacles to that. We just have to kind of change the entire paradigm of how this is done and move to kind of a mass vaccination model to ensure it gets done. That's all dependent upon the supply chain being intact and that we have the doses flowing to be make it happen.