The day President Donald Trump turns the White House over to Joe Biden, COVID-19 will remain just as big a threat to Americans. But the strategy for tackling it will change dramatically.
Public health experts expect a major reset, including a renewed emphasis on science, better communication and efforts to simultaneously boost the economy and public health rather than pitting the two against each other.
The shift is expected to be swift once Biden takes office.
“The public will immediately notice a vast change in science messaging from the White House,” said Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “The Biden administration will both convey pro-science messages and model the best behavior from among all White House and Cabinet staff.”
President-elect Biden has long been wearing face coverings and maintaining distance from others while in public, and he has said he plans to continue that practice.
Dr. Ezekiel Emanuel, chair of the department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine, said he expects to see changes in role modeling, communications, spending, collaboration with industry – and in just about every other way.
“You’re going to see a very different approach here,” said Emanuel, an oncologist and former health policy adviser in the Obama administration.
A Biden administration will be much better at communicating with the public, said Dr. Tom Frieden, who ran the U.S. Centers for Disease Control and Prevention under President Barack Obama.
“Of all the failures – and there are many in this (Trump) administration when it comes to dealing with COVID – the one that I think has been most costly in terms of undermining an effective response is the failure to communicate effectively,” said Frieden, now CEO of Resolve to Save Lives, an initiative to prevent epidemics and cardiovascular disease.
Biden has pledged to put scientists not politicians behind the microphone, make testing widely available and free, expand national surveillance programs, and restore the CDC’s real-time dashboard tracking virus-related hospital admissions.
He also has promised to quickly launch a national plan to distribute personal protective equipment to health care workers and first responders and ask for clear, national guidance from the CDC on containment, school openings, travel and gatherings.
Public health officials, not surprisingly, are far more supportive of Biden’s approach than they have been of Trump’s. Now, several said, there has to be a process of rebuilding the public health system and the public’s faith in it.
“If we now prioritize science and public health the way we should have at the beginning, hopefully we can restore some strength to the system,” said Dr. Howard Koh, a faculty member at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School, and a former assistant secretary for health for the U.S. Department of Health and Human Services.
Too many Americans have died unnecessarily during the pandemic, he and others said.
“When a loved one dies, that’s a tragedy,” Koh said. “When a loved one dies from a death that could have been prevented, that’s a tragedy that haunts you forever.”
As soon as he takes office, Biden has vowed to restore the type of daily, expert-led briefings that were typical for previous epidemics, such as H1N1 and Zika virus.
“One of the first things that will happen will be an unmuzzling of the scientific and technical personnel in the health agencies. We will start seeing the leaders of CDC and FDA being allowed to be on television and to communicate through other means with the public,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security.
When Frieden helped with the government’s Ebola response, he held regular news conferences, which he viewed as two-way communications. The journalists learned from him and he learned from them – about what people were thinking and ways he could communicate better, he said.
“That’s really what has to resume,” he said.
More than just vaccines
Vaccines likely will remain a top priority of the new administration but not the sole priority, as it was under Trump, Emanuel said.
“You have to chew gum and walk at the same time,” he said.
That means other areas such as therapeutics, testing, hospital capacity and personal protective equipment will get more attention, Emanuel said. “Vaccines, it’s central, it’s fundamental, but it’s not the only game in town. Resting everything on one intervention is a mistake.”
Vivian Ho, a health economist at Rice University and Baylor College of Medicine, both in Houston, said she hopes the new administration will put more focus on testing, too. “This is something that has gotten a little bit of traction, but not enough,” she said.
She said it would be less expensive to spend a few billion dollars giving away hundreds of millions of cheap, rapid tests – which people could take at home, work, school, before entering bars or restaurants or getting on a flight – than even more money to support closed businesses.
She agrees that therapies also are crucial. “We actually can keep you from getting hospitalized if you get the virus. That’s a great solution until we can get someone vaccinated,” she said.
Biden has said he would be in favor of requiring every American to wear a mask when in a public place or business.
Some question whether the president would have the authority to do that, given the limitations on federal executive power. But Dr. Michael Ewer, a visiting professor in the Health Law and Policy Institute at the University of Houston Law Center, says Biden does.
“He has the power to say we will have a more uniform approach to public health measures,” Ewer said. There will be people who oppose that, he said, but “do they have a leg to stand on legitimately? The answer is, from a public health standpoint, almost certainly not.”
The Constitution gives the federal government the power to protect the general welfare, Ewer said, and the courts have generally supported restrictions on individual rights to that end. Seatbelt and no-smoking laws are examples.
Biden has said he would rejoin the World Health Organization, which Trump began to withdraw from in July, and reestablish the White House National Security Council Directorate for Global Health Security and Biodefense, which was eliminated by the Trump administration in 2018.
“I think the United States would rejoin WHO on the 21st of January. I think you can put that on your calendar,” Toner said.
He also expects the United States would strengthen its connections with the United Nations and join in the international effort to get COVID-19 vaccine to low- and middle-income countries.
The COVAX initiative is made up of every nation on the globe except the United States, Russia, Belarus, Kazakhstan, Malaysia and five small island countries or micro-states. A pandemic is by definition global, and if it’s not controlled everywhere it will continue to reinfect the United States, Toner said.
“We should do it not only for moral reasons but out of our own enlightened self-interest. We want to control disease outbreaks in all countries, especially those that don’t have the wherewithal to do it on their own,” he said.
He also expects that a Biden administration would seek a rapprochement with China, at least in terms of its health system.
Organization and coordination
Organized, coordinated management of the pandemic also will be a top Biden priority. The new administration consists of “people who know how to mobilize government, people who know how to have government connect to private industry,” Emanuel said.
Emanuel said he expects the Biden approach will be similar to what presidents Franklin Roosevelt or Lyndon Johnson would have done to respond to the biggest health threat in a century.
“They would just create a torrent and whirlwind of task forces: Bring the experts in and let ’em at it,” he said. That wouldn’t be the most efficient approach, “but would it get across the finish line? Absolutely. They knew how to bring together the full force of the federal government, coordinate with private industry where that was possible, take over things where necessary. That’s what you’ve got to do.”
Lori Post, director of the Buehler Center for Health Policy and Economics at the Northwestern University Feinberg School of Medicine, hopes Biden’s actions will resemble Roosevelt’s, who managed to create an office of malaria control even though World War II was raging. Formed in Atlanta, where malaria was then a major problem, the office later became known as the CDC and established the United States as the preeminent source of public health information in the world.
Woodrow Wilson, on the other hand, who was president during the 1918 flu outbreak, ignored his advisers and sent infected American soldiers overseas, allowing the virus to spread worldwide. It killed about 50 million people. He caught the flu himself, though he and his doctors lied about his infection, and he never truly recovered, Post said.
A tricky transition
Although most new administrations avoid directly contradicting their predecessors, Biden already has said he will keep or reinstate Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. Trump recently threatened to fire Fauci, who remains one of the most trusted voices in the country on infectious diseases.
“Normally a president-elect would be pretty circumspect about what he would say that would contradict the sitting president,” Toner said, adding that things might be different this time. “It’s sort of tricky because none of the previous rules of political etiquette seem to apply anymore.”
Although Georgetown’s Gostin said the arrival of a vaccine plus Biden’s more aggressive approach will reduce COVID-19 infections by late next year, Americans shouldn’t expect a rapid turnaround in cases, hospitalizations or deaths.
“Sadly, the virus is already too deeply embedded in communities right across the country,” he said. “And safe behaviors are already too politically divisive to see uniform and consistent changes in personal behavior.”