On the one-year anniversary of the first COVID-19 case detected on U.S. shores, President Joe Biden released a national strategy aimed at curbing the coronavirus pandemic.

“For the past year, we couldn’t rely on the federal government to act with the urgency and focus and coordination we needed,” Biden said in an address Thursday. “We have seen the tragic cost of that failure.”

Biden cautioned that it could take months to contain the virus, but “help is on the way.”

The national plan includes standing up federal vaccination sites and more domestic production of personal protective equipment. That represents a shift from the Trump administration, which tasked states with decisions involving vaccinating, testing, obtaining supplies, reopening schools and businesses and other issues.

That contributed to the United States having one of the highest COVID-19 mortality rates in the world, according to University of South Carolina pandemic historian Nükhet Varlık. 

“They did not pay attention to pandemic preparedness plans,” said Varlık. “The Trump administration was not very keen on scientific expertise and institutional knowledge.”

The plan comes amid a critical point in the pandemic, with vaccinations rolling out at a pace much slower than would be necessary to reach herd immunity this year while a more infectious mutation gains ground. 

A White House COVID-19 Response Office will replace the Trump administration’s Coronavirus Task Force, which met sporadically. The president will also appoint a COVID-19 response liaison for each state, an approach based on the response to Hurricane Sandy in 2012.

The Defense Production Act

Biden signed 10 executive actions addressing COVID-19 on Thursday, a day after taking three other related executive actions.

The first executive order would direct federal agencies like the one overseeing the Strategic National Stockpile to deploy wartime powers if necessary to increase personal protective equipment and other needed supplies. 

While Trump did deploy the Defense Production Act to put the government at the front of the line for the purchase of supplies, the White House was loath to direct companies to boost U.S. manufacturing. Months into the pandemic, Federal Emergency Management Agency documents showed U.S. manufacturing of key supplies had barely increased.  

Personal protective equipment remains in dire short supply,  according to the nonprofit collaborative GetUsPPE, a private initiative to coordinate distribution of PPE.

More recently, supply chain experts have sounded the alarm about supplies necessary for vaccination, which have been used more rapidly than anticipated in part because vials of a vaccine made by Pfizer and BioNTech were found to contain one more dose than expected. 

Another concern is nitrile gloves, which are not included in ancillary supply kits the federal government supplied with vaccines. 

Standing up 100 vaccination sites

In a presidential memo, Biden also directed FEMA to begin constructing at least 100 federal vaccination centers within the next month. FEMA will increase federal reimbursement to 100 percent, up from 75 percent, for the cost of National Guard personnel and emergency supplies.

A big bottleneck has been that very few places, mostly major hospitals, were prepared to receive vaccine supplies, leading to shortages in some areas and wastage in others. 

The Centers for Disease Control and Prevention also plans to launch a federal program to distribute the vaccine to neighborhood pharmacies, a shift away from a fledgling Operation Warp Speed plan to do the same. An Operation Warp Speed partnership with CVS and Walgreens to supply vaccines to nursing homes has not moved as quickly as predicted, while West Virginia, which partnered with independent pharmacies instead, vaccinated its vulnerable population at a speedier pace.

The Trump administration tasked states with building major vaccination sites, such as in stadiums. During the last week of the administration, Health and Human Services Secretary Alex Azar said the federal government would support major state-run vaccination sites, but provided few details. 

While having more vaccination sites is helpful, more consistent vaccine shipments are needed, according to local public health officials. While the Trump administration indicated it would double the national supply last week, the federal reserve was in fact depleted, sending many officials scrambling, according to Adriane Casalotti, a spokesperson for the National Association of County and City Health Officials.

Protections for workers

Another executive order would task the Occupational Safety and Health Administration, or OSHA, with releasing guidance to shield workers from COVID-19.

Under the order, OSHA and the Mine Safety and Health Administration could establish emergency temporary standards requiring businesses to implement infection control measures, which might include ensuring employees are six feet apart and have masks.  

Efforts by unions last year to require an OSHA “emergency temporary standard” in congressional relief packages were opposed by certain business groups, including hospitals.

OSHA also would be directed to target the worst violators. While infections in congregate workplaces like meatpacking plants have driven infections and deaths, OSHA fines have been relatively rare, and usually set back an employer just a few thousand dollars.

“It’s a new day,” said Debbie Berkowitz, a worker safety advocate with the National Employment Law Project. 

Berkowitz, who has lobbied for stronger OSHA protections for workers since last March, said she has “no doubt” OSHA will issue an emergency standard and employers with large outbreaks who violated the law will face a crackdown. 

Safe schools and state efforts

Another executive order would direct the departments of Education and Health and Human Services to issue new guidance on opening schools.

It also directs federal officials to collect data on the socioeconomic impact of state closures, including the impact on low-income families and students with disabilities. It encourages the Federal Communications  Commission to improve internet coverage for students learning remotely.

A separate executive action to increase funding to states for personal protective equipment and other safety supplies through FEMA is also likely to aid educators. In September, in the midst of hurricane season, FEMA reportedly told states it would no longer provide funding for PPE in schools. 

“Finally, we have a president who is committed to doing what educators, parents and students have yearned for since the first weeks of the pandemic—a real national plan to crush COVID that follows the science and secures the resources to make in-school learning safe,” teachers union leader Randi Weingarten, president of the American Federation of Teachers, said in a statement. 

Separately, another executive order would centralize information about different states’ pandemic plans to create more transparency into what approaches are working and what approaches are not in key areas like vaccine distribution. 

The government will create online tools with information about state vaccination levels, testing and hospital admissions. 

Restoring role of the US in global health

Biden signed a presidential directive to restore America’s role in global health. That follows a letter the president sent to the World Health Organization Wednesday reversing Trump’s intention to withdraw from the global organization.

NIH official Anthony Fauci said in remarks to the WHO Thursday morning that the U.S. will participate in COVAX and the ACT Accelerator, two global efforts to increase access to vaccines and therapeutics across the globe. Rich countries have purchased most of the global supply of effective vaccines. 

Advocates for greater global access to the vaccines cheered the executive orders. But the Biden administration is likely to face ongoing pressure to share patented information on the vaccines, which would lower the revenue that vaccine manufacturers would receive but boost manufacturing.

The executive orders are “very positive demonstrations that this government will use its powers to help the country and the world through the COVID-19 pandemic,” said Peter Maybarduk, an expert in global pharmaceutical policy at consumer advocacy group Public Citizen. “Biden should use his power under existing law to accelerate global vaccine manufacturing — including by sharing the vaccine recipe with qualified manufacturers around the world.” 

The U.S. will also seek to strengthen other existing multilateral initiatives, like the Coalition for Epidemic Preparedness Innovations; Gavi, the Vaccine Alliance; and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, according to the national plan. 

Equity issues

Another executive order establishes a COVID-19 Health Equity Task Force with the aim of counteracting the pandemic’s toll on hard-hit low-income families and communities of color. 

The Biden administration states that it intends to “address unmet basic needs” like food, housing, and childcare for families impacted by the pandemic. 

Bioethics experts say the slow vaccine distribution rollout so far threatens to widen racial and economic disparities.

The administration also issued three other orders.

• One will require mask-wearing in airports and on many trains, airplanes, maritime vessels, and intercity buses. International travelers must supply a negative COVID-19 test to fly. The order also signals the Biden administration’s intent to work with foreign governments on regulating travel across land and sea borders.
• Another creates a COVID-19 Pandemic Testing Board designed to federalize diffuse state and private efforts on testing. The order will state the Biden administration’s goal of spurring more domestic manufacturing of tests and expanding the public health workforce.
• An additional order would direct large randomized trials to beef up research into potential COVID-19 treatments and ensure diverse populations are represented in clinical trials.