Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath by embracing science, pushing mask-wearing as a patriotic act and leaning on Congress to pass a massive stimulus package.
It’s a strategy that would toss out the Trump administration’s patchwork response that put the burden on states and install a top-down national framework for testing, contact tracing and targeted business closures. Biden’s also promised a national mask mandate, calling it “a patriotic duty.” And public health experts rather than politicians will update the public once Biden is sworn in — meaning sober assessments and realistic timelines will replace Trump’s declarations that the pandemic is all but over and the virus will “disappear” with or without a vaccine.
“You’ll immediately see a change of tone, a change in communication,” said Dr. Ezekiel Emanuel, a health policy and bioethics expert advising Biden. “People can roll their eyes at that, but this is the stuff of real leadership: telling the truth, modeling the right behaviors like wearing a mask, only having small crowds, putting the scientists out there.”
The shift, however, won’t be immediate. A defeated Trump stays in office until Jan. 20, and public health experts expect the coronavirus to keep spreading throughout the country during the transition, adding thousands to a death toll that’s already crossed 230,000. In addition, even the most thoughtful Biden plans won’t be able to wipe out much of the country’s deep cultural divide and skepticism about the virus and antagonism toward the public health steps needed to combat it. Red states and MAGA world will strongly resist Biden’s approach, having embraced Trump’s rosy assessments and his portrayals of masks and business closures as a form of tyranny. New restrictions could also rattle millions of less partisan but crisis-weary Americans who face looming evictions or the expiration of unemployment benefits. For those reasons, the makeup of the next Congress will play a big part determining if Biden can make his plan stick, or whether it will get mired in more rancor.
One of Biden’s first actions, his campaign told POLITICO, would be to press Congress to get a sweeping stimulus bill to his desk by late January that guarantees paid sick leave to all workers, covers the cost of Covid-19 testing and treatment for the uninsured and under-insured and gives states and public health workers the resources they need to slow the spread of the virus and distribute a vaccine if and when one is approved.
“Whatever is being done now, it would be the opposite,” said Chris Jennings, a former White House health policy adviser who served on Biden’s health care unity task force earlier this year. “There will be a much more collaborative relationship with state and local governments. He will empower the agencies, not undermine and discredit them — but he will also hold them accountable for results.”
Biden will inherit stewardship of a country with millions of infected people, millions more who have recovered but are struggling with long-term health problems and crushing medical bills and tens of millions out of work, many of whom are now uninsured. His plan — crafted during the campaign by a core group of scientists, public health experts and former government officials who began meeting in early March — is to quickly stand up a New Deal-style slate of federal policies and programs to combat all these crises at once.
He’s promised to use the Defense Production Act to address ongoing shortages of protective gear for health workers, appoint a supply chain commander to oversee distribution of masks, test kits and vaccines, and create a public health workers corps of 100,000 people to assist overburdened contact tracers. The new administration will lean on holdout governors to implement mask mandates and push Congress to set aside hundreds of billions more to help businesses and schools put measures in place to keep their doors open while curbing infection rates.
Biden will have to do it all while recruiting people to fill out a hollowed out federal workforce that’s been a frequent target of Trump attacks — and restore morale at federal health agencies like the Centers for Disease Control and Prevention where career scientists were repeatedly undercut by the White House.
“I’m not running on a false promise of being able to end this with the flip of switch, but what I can promise is that we will start doing the right things from Day One,” he said in a speech in Delaware in the closing days of the campaign. “We will let science drive our decisions.”
And though Biden raised alarms when he said this summer that he would consider a national shutdown if scientists recommended it, he walked that back in the lead-up to the election, insisting that any restrictions or closures will be temporary and targeted, and the focus will be more on giving schools and businesses the resources they need to reopen safely. It’s an approach that would put the U.S. more in line with countries from Europe to Asia that have brought down infection rates without mass economic devastation.
“I’m going to shut down the virus, not the country,” Biden said in his final debate with Trump. “If you have a reproduction rate in a community that’s above a certain level, everybody says, slow up. More social distancing. Do not open bars and do not open gymnasiums. Do not open until you get this under more control.”
The people fighting the pandemic
To carry out this ambitious agenda, Biden’s transition team is putting together a list of candidates for the Cabinet’s top health jobs, drawing from state health agencies and governorships, academia, think tanks and Obama administration veterans. Many of the contenders for key positions have already been working for months for the campaign or transition, advising Biden on both the policies and staffing needed to tackle the pandemic.
In the mix for secretary of Health and Human Services are former Surgeon General Vivek Murthy, New Mexico Gov. Michelle Lujan Grisham, former Delaware Gov. Jack Markell and North Carolina Health Secretary Mandy Cohen.
Those under consideration for other leading health jobs, advisory roles or potential new roles focusing on racial disparities in health include Emanuel, former Louisiana Health Secretary Rebekah Gee, former Surgeon General Regina Benjamin, former HHS Assistant Secretary for Preparedness and Response Nicole Lurie, Wisconsin Health Secretary Andrea Palm and Neera Tanden, the president of the Center for American Progress and former senior adviser for health reform at HHS.
Other lawmakers and state officials are also under consideration, including Sen. Tammy Duckworth (D-Ill.), recently defeated Rep. Joe Kennedy (D-Mass.), former Gov. Deval Patrick (D-Mass.), and California Attorney General Xavier Becerra, who has led a swath of lawsuits challenging Trump administration health policies.
Test and trace
Biden plans to create a Pandemic Testing Board, modeled on President Franklin Roosevelt’s War Production Board, to ramp up testing amid a fall spike in cases. He has also pledged to double the number of federally run drive-through testing sites and direct more funding to the development of at-home rapid tests.
"Every school, every worker, every American should have easy access to regular, reliable, free testing," he said in a speech in Delaware in the closing days of the campaign. "To achieve this, we need to increase both lab-based diagnostic testing, where the results get back within 24 hours or less, and faster, cheaper screening tests that you can take right at home or in school."
Biden plans to urge all governors to require masks in public for at least three months, and make the case that it’s a “patriotic” act that will significantly help slow the spread of the virus. If governors continue to resist, he’ll lean on mayors and county executives in those states to implement local masking mandates.
In September, he said that if state and local officials refuse, he’ll consider signing an executive order implementing a national mandate, which would likely face legal challenges. Additionally, he plans to issue executive orders requiring masks in all federal buildings and on interstate transportation.
"Our legal team thinks I can do that based upon the degree to which there’s a crisis in those states, and how bad things are for the country, and if we don’t do it, what happens,” he told reporters at a press conference. "The question is whether I have the legal authority as president to sign an executive order. We think we do."
Biden has made it clear that promoting mask usage will be a core piece of his pandemic strategy and a means of avoiding economically painful lockdowns, and has repeatedly referenced CDC Director Robert Redfield’s testimony to Congress that masks are a more reliable virus control strategy than a vaccine — which has yet to be approved, much less distributed.
While Biden’s campaign did not respond to questions about whether he would revive the Trump administration’s abandoned plan to mail masks to every household in the country, Emanuel said it’s “very likely to happen” under a Biden presidency.
Though it’s not yet known if a safe and effective Covid-19 vaccine will be authorized this year, the Biden administration is likely to benefit from the progress made under the Trump administration’s Operation Warp Speed, which has ushered multiple vaccine candidates into Phase III trials in record time.
But even if one or more do emerge, Biden’s team will have to manage the logistical difficulties of distributing the vaccines and planning an outreach campaign to convince a highly skeptical public to take it.
“A vaccine in a syringe is of no use — a vaccine that’s in someone’s shoulder, that’s what we want,” Emanuel said. “So we’re talking about everything from the cold chain, since some vaccines need to be stored at dry ice temperature, to tracking who gets the first dose if a vaccine requires two doses to be administered. That’s not easy.”
Global problems, global solutions
As he battles Covid-19 on the home front, Biden has also pledged to reinvest in international cooperation both to bring the current pandemic to an end and help prevent the next one — and has said he will swiftly move to rejoin the World Health Organization and revive the global health directorate at the National Security Council that the Trump administration disbanded in 2018.
Trump’s retreat from the global area and focus on "America First," Biden has said in speeches and interviews, has eroded U.S. influence and allowed other world powers to fill the leadership vacuum.
Asked in a recent 60 Minutes interview what he sees as the country’s top foreign threat, Biden pointed to the nation’s “lack of standing in the world,” and said reversing that trend is among his top priorities.
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