In many ways, Decision 2020 came down to the pandemic. Vice President Biden and Senator Kamala Harris made coronavirus control a central part of their message to voters. “I’m not going to shut down the country. I’m not going to shut down the economy. I’m going to shut down the virus,” Biden’s account tweeted in the final days. Meanwhile, President Trump continued to downplay the risks—even as his campaign rallies spread the virus across the country—and considered firing his top medical and scientific advisers, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the top U.S. expert on the pandemic.
The choice to address the pandemic didn’t have to be political. It was made so by the Trump administration’s decisions to downplay Covid-19 and appropriate safety measures. Now, Biden and his first crop of appointees will have a chance to take a different approach. In his victory address Saturday night, Biden pledged a new coronavirus task force, starting Monday. “Our work begins,” he said, “with getting Covid under control.... I will spare no effort, none, or any commitment to turn around this pandemic.”
Biden has several serious challenges ahead of him to curb the coronavirus’s exponential growth. First, he won’t take office for several months, which means the virus will continue to spread largely unabated if nothing is done. But perhaps most importantly, his administration needs to regain shattered trust in public health officials and agencies. He’s not just starting from scratch in creating a federal response; he’s facing a deficit with nearly a year of disinformation and deep politicization of the virus and its risks.
“The difficult thing for the Biden administration is that they will take office after the worst of SARS-CoV-2 has already torn through our communities,” Dr. Megan Ranney, an associate professor of emergency medicine and public health at Brown University, told me. “The next two months are going to be a defining moment for our country.... His administration will be unable to influence our course until January 20 at the earliest.”
The good news is that Biden already has momentum, with a team of experts poised to put already-developed strategies in place during the transition. Assembling that team was the most important first step, Dr. Georges Benjamin, executive director of the American Public Health Association, told me. “Initially, it’s all about leadership and organization. That’s extremely important here,” he said. “It starts, first of all, with having a coherent, organized incident command structure” that “defines who’s in charge.”
Crucially, that work has to start before Inauguration Day. “An emergency is not the time to begin exchanging business cards,” Benjamin said. “They need to get these people to know one another, understand what they need to do, and get them functioning at least intellectually as a team.”
Biden assembled a strong health advisory panel in late January, back when Trump first began insisting the virus would simply go away. The team will form the basis of the Biden White House coronavirus task force, which is already beginning work and includes seasoned experts from previous administrations like David Kessler, a former U.S. Food and Drug Administration commissioner, and Vivek H. Murthy, the former surgeon general. Ronald Klain, once the vice president’s chief of staff and now a top contender for the position in a Biden administration, was the White House Ebola response coordinator.
“The [team] that the Trump administration has now, obviously it’s dysfunctional, doesn’t work, and to an extent it really doesn’t exist,” Benjamin said. The White House coronavirus task force, led by the frequently absent Vice President Pence, assembled some experts with no clear roles and no defined plan for U.S. agencies like the Centers for Disease Control and Prevention, the FDA, and Health and Human Services. “In many ways, that undermined their whole response,” Benjamin said.
Biden has also pledged to restore support to the World Health Organization. Public health experts who have spoken with Biden’s team believe he may do so on the first day of his presidency. Returning to the organization would signal a greater willingness to address the international issues raised by the virus, in addition to domestic concerns.
One of the top priorities is to establish a federal system for acquiring and distributing supplies. In the absence of national leadership, states, cities, and counties were left to develop their own plans—and, frequently, to compete against each other for resources like tests and protective gear. “That resulted in everybody paying more for materials and products than they needed to, when we could have leveraged the buying power of the national government and the clout of the national government,” Benjamin said. A new administration could negotiate better prices and equitable distribution to the places that need these supplies the most—including places that might not be able to afford these resources on their own. “Then you use the power of government to identify what the choke points are and what the needs are,” he said, which will likely include everything from swabs and reagents for testing to building up a contact-tracing workforce, to distributing ventilators and medications. There are preexisting tools for helping the federal government do that, Ranney pointed out: Fully activating the Defense Production Act would increase domestic production of masks, other personal protective equipment, and testing supplies.
Another priority, Ranney said, should be federal data collection. A robust national database could build from existing work by organizations like GetUsPPE to distribute resources equitably. But better data at the federal level would help in other ways, too. “It’s essential to empower the CDC to collect and share real-time, accurate data on every facet of this pandemic,” Ranney said. “It’s absolutely ridiculous that our best sources of data remain private or academic datasets.” Expanded, accessible data “would inform every part of future responses to both this pandemic and future ones—ranging from decisions about school reopening to decisions about who needs to be prioritized for PPE and testing supplies, to decisions about vaccine distribution.”
Biden’s pandemic plan, which was first released in March, says he would prioritize testing and contact tracing, making drive-through testing sites more common and accessible and investing in at-home and rapid tests. He will also focus on producing enough PPE for those who need it, as well as additional protections for those most vulnerable to the virus—from the elderly to marginalized communities. And finally, it promises that a Biden administration will emphasize evidence-based guidelines that are clear and easy to follow, and would plan for the equitable rollout of potential treatments and vaccines.
What would clear, evidence-based guidelines look like? We probably won’t see a federal mask-wearing mandate, because the legality of such a move is unclear. But Biden would encourage and support local and state mask mandates. And while that might sound vague, it could actually work, said Benjamin. “They can put out the science to the general public, so the general public can see the benefits of mask-wearing. We’ve not had a campaign to convince the American people that mask-wearing is right,” Benjamin said. “The evidence is now very clear that wearing a mask is probably the single most effective thing that you can do until we get a vaccine—of all the layered protections that we have.”
That’s another crucial component in an effective pandemic plan, experts say: It shouldn’t hinge on a vaccine. A vaccine, Benjamin said, “will help us, but it’s not the silver bullet. It is an important tool in our tool kit, and they’re going to have to be careful they don’t oversell it.”
Trump has frequently overpromised the potential of vaccines—from assuring one would be available by Election Day to asserting vaccines will return life to normal. But early vaccines may or may not be highly effective. And even if they are, manufacturing delays mean it could take months or years before they are available to most of the American public. Biden’s plan does contain a provision to help with that: He has pledged to restore U.S. support to the World Health Organization, which would allow the U.S. to join COVAX, the international coronavirus vaccine facility, and address some supply shortages.
Funding is another key part of the pandemic response. A major stimulus bill would support chronically underfunded state, county, and city departments of health, Ranney said. And it would allow small businesses to offer comprehensive paid and sick leave, “thereby allowing people the economic freedom to do the right thing for their community.” But not all communities have been hit equally by the pandemic. “We know that Black, Hispanic, and Native American communities have been disproportionately affected by this virus. It’s on us to make sure that we address this financial and emotional burden,” Ranney said.
And perhaps most importantly, making sure people across the country understand the risks and what to do about them will be key. “The risk communication has been terrible, the coordination has been terrible. The president undermines everything that his experts are saying, and that’s a problem, too, and hopefully we’ll have a president in the White House who will give a consistent message,” Benjamin said. “And the only way to reestablish this trust is to be consistent and focused, and I believe the rest of these folks will come on board.”
None of these efforts, from testing and tracing to focusing on equality and economic recovery, is groundbreaking in the public health world. “This is not rocket science,” Benjamin said. “We know what works and what doesn’t work.” Putting these most basic principles into practice could make an enormous difference.