In Summary:

• As the coronavirus pandemic rages in Michigan and across the nation, new variants of the virus that are more highly transmissible have emerged.
• A change in presidential administrations has also occurred (exactly one year after the U.S. reported its first COVID-19 hospitalization).
• The new presidential administration has signaled major policy changes that will mean a bigger federal role of working actively with states in response to the ongoing pandemic.

On Wednesday, January 20, 2021, Joseph R. Biden, Jr. was inaugurated as the 46^th President of the United States of America.

A change in presidencies often means many things to many different people, but in the context of an ongoing pandemic, it’s worth considering what this change in administration might mean for health policy, both nationally and here in Michigan.

President Biden has already taken quick action through executive orders to address many pressing COVID concerns.

While Michigan and other states had previously been left largely on their own to manage the pandemic, the Biden administration appears to favor a more active federal leadership role, as well as more opportunities for working cooperatively with states.

President Biden’s Coronavirus Pandemic Strategy

The Biden administration’s pandemic response will focus on expansion of public health capacity for testing, contact tracing, and vaccine distribution, and scaled up production of testing and vaccine supplies, as well as personal protective equipment (PPE), and an effort at clearer, more consistent public health guidance and messaging at the federal level.

The administration has also created a new COVID-19 Response Coordinator position within the administration to organize the various aspects of a more aggressive federal response to the ongoing pandemic (that will require action from various agencies and departments across the federal government).

Changes in Federal Guidance and Messaging

President Biden issued mask requirements for federal buildings and lands (ostensibly the only spaces the president has the authority to implement such a rule), and has directed various federal agencies to implement mask mandates for interstate travelers. The president also issued a 100-day mask challenge, asking people to join him in wearing a mask during his first 100 days as president (predicted to be the worst of the pandemic so far). This challenge also calls upon state and local officials to mandate that masks be worn in their respective jurisdictions. This is consistent with public health orders and guidance in place in Michigan.

A top priority for the administration is to bolster the ability of public health departments to test and trace the virus. Increasing both testing sites and laboratory capacity, as well investing in improved testing technology would be pursued to speed up the testing process. A new Pandemic Testing Board will be tasked with facilitating a “surge” in coronavirus testing capacity. Additionally, a U.S. Public Health Jobs Corps would seek to mobilize at least 100,000 new public health workers to perform essential functions (like contact tracing). Michigan turned to volunteers last year due to a stark lack of state and local personnel capacity for performing this important work. 

The Biden administration has also suggested using the Defense Production Act (DPA) to increase the availability of personal protective equipment (PPE). Beyond replenishing stockpiles, the administration intends to prioritize healthcare providers in the hardest hit areas.

Vaccine Rollout

President Biden has set a goal of 100 million vaccine doses administered in the first 100 days of his administration. This represents a 25 percent increase from the current national rate of 800,000 doses administered per day. While 25 percent may not seem like an enormous increase, one might still consider this an ambitious goal. It may also be that the president is attempting to make an achievable promise while hoping to deliver even better results.

Despite various missteps in the ongoing COVID-19 vaccine rollout, the U.S. still leads much of the world in the number of doses administered per capita (currently 5 doses per 100 people), with the exception of some global outliers: Israel, the United Arab Emirates, Bahrain, and the United Kingdom. Having administered 598,127 vaccine doses so far, the rate in Michigan is slightly better at 5.96 doses per 100 people.

The new administration nonetheless plans to collaborate with Michigan and other states to help them pick up the pace.

The Biden administration has signaled an intent to utilize the DPA to increase the supply of glass vials, stoppers, needles, and other supplies to speed up vaccine production and distribution. This would accelerate the pace of doses and supplies moving to states. Additionally, the new administration plans to distribute most vaccine doses to states as they are produced. 

Even if Michigan gains access to more doses and supplies, administering these doses presents other challenges.

So far, states have been left largely on their own to determine policies and distribute the vaccine. In many states, including Michigan, this state authority has been passed down to local and tribal governments, along with hospital systems and other health care providers. The lack of a clear central message and strategy has led to confusion for many citizens and even health professionals. The steps and locations for obtaining the vaccine in Michigan have varied widely from county to county, as have supplies.  

The Biden administration has proposed massive federally managed vaccination clinics, utilizing both the Federal Emergency Management Agency (FEMA) and the National Guard. States would be reimbursed for National Guard deployment, and vaccines would be provided with no out-of-pocket costs to individuals. 

To improve equity in distributing the vaccine, the administration will move to allow federally qualified health centers (FQHCs) to directly access vaccine supply. Currently, FQHCs in Michigan enroll with public health departments as vaccine providers to receive a portion of allotted doses. Supplies vary on a county by county basis, however, making it hard for some community health centers to effectively plan and prioritize vaccine distribution. The administration also plans to launch mobile clinics specifically providing vaccine access to marginalized or otherwise medically-underserved communities.

Scaling up vaccine distribution to such a magnitude also creates workforce demands. The Biden administration has proposed expanding the number of “qualified professionals” to administer the vaccine by including retired physicians or nurses who may no longer possess a current licence. Biden’s Public Health Jobs Program will bolster the workforce needed to manage such efforts, and to reach out and educate communities.

Looking to the Future

President Biden has directed the U.S. to rejoin the World Health Organization in an effort to ensure a coordinated international pandemic strategy. Looking to the future, the administration is also restoring the White House National Security Council Directorate for Global Health Security and Biodefense, relaunching the U.S. Agency for International Development’s pathogen-tracking program, and increasing federal public health capacity (particularly epidemiologists and other analysts tasked with detecting and tracking emerging health threats).

Other executive orders will direct appropriate federal agencies to publish clear and consistent safety guidelines for safely reopening businesses and schools. The administration plans to ask Congress to provide related financial assistance for both businesses and schools to help cover the cost of PPE, as well as other tools and safety adaptations associated with resuming full activity.

While everyone is tired of this pandemic that has truly put Michigan’s public health capacity to the test, the pandemic is far from over. Nonetheless, a stronger federal presence is likely to provide welcome relief in Michigan (and elsewhere) as we strive to achieve a new normal.