The president-elect will invest $25 billion to ensure all Americans can get a free vaccine
On Monday morning, president-elect Joe Biden unveiled a plan for ending the Covid-19 pandemic that emphasizes the safe production and equitable distribution of a coronavirus vaccine. The vaccine plan, published on the Biden-Harris transition website “Build Back Better,” builds on promises that Biden campaigned on: His Covid-19 strategy will be directed by science, embrace transparency, and prioritize equality — qualities that have notably been absent from the Trump administration’s Covid-19 strategy.
Donald Trump, who is openly at odds with his coronavirus advisers, remains in office for 71 more days. The number of Covid-19 cases in the United States reached 9.9 million on Monday morning, and the number of deaths passed 237,500. Experts interviewed by the New York Times predict that by the time Biden takes office, there could be as many as 100,000 more deaths.
The current spread of the coronavirus in the United States is deeply concerning, and scientists warn that we are in for a difficult couple of months. Biden’s plan, however, should inspire some confidence — at the very least because of its firm commitment to science.
Science-backed review of vaccine candidates
Most experts predict that a vaccine won’t be widely available until February at the earliest and more likely by July or August. But it’s possible a few vaccine candidates may be ready for regulatory review by the time Biden becomes president in late January. His plan lays out three principles for reviewing candidates: that scientists will make all decisions about safety and efficacy, clinical data for approved vaccines will be made public, and expert criticism would not be censored. These principles address the ongoing concerns that rigorous safety and efficacy testing will be skipped over in favor of expediting a vaccine for political reasons — fears stoked by Trump’s insistence that a vaccine would be available by Election Day.
Though Pfizer, a front-runner in the vaccine race, released data on Monday showing that its candidate vaccine is over 90% effective, Biden urged patience. In a statement, he praised the efforts of Pfizer’s scientists but warned that “it will be many more months before there is widespread vaccination in this country.”
Further underscoring his commitment to science-based policy, Biden named 13 experts to his Covid-19 Advisory Board on Monday, including Rick Bright, MD, a former vaccine expert to the White House who was fired after he filed a whistleblower complaint to Congress about the Trump administration’s failure to heed his advice about acquiring masks and other PPE. In a statement released Monday, he said that this advisory board would “help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.”
By making trust in science a central pillar of his plan, Biden takes an important first step toward rebuilding the deeply eroded public trust in the Centers for Disease Control and the Food and Drug Administration. For widespread vaccination to be possible, it’s crucial that Americans trust these institutions, which will play key roles in manufacturing, testing, and distributing a vaccine.
Equitable distribution of a vaccine
The second key feature of Biden’s vaccine plan is its emphasis on fair and equitable distribution. As he previewed in mid-October, his administration will invest $25 billion in vaccine manufacturing and distribution to “guarantee it gets to every American, cost-free.” Developing vaccines, the plan reads, “isn’t enough if they aren’t effectively distributed.”
One way in which Biden plans to do so is to establish a dedicated Covid-19 Racial and Ethnic Disparities Task Force to address concerns about distribution among minority groups. (This, the plan points out, was initiated by Vice President-elect Kamala Harris.) The coronavirus pandemic has laid bare the disproportionate impact of disease on people of color, especially Black people, due to long-standing systemic racism. This task force will transition to a permanent Infectious Disease Racial Disparities Task Force after the pandemic ends.
In early October, the National Academies of Science, Engineering, and Medicine released guidance similarly stressing the need for an equitable distribution plan that takes into account racism, poverty, and bias in the United States. This guidance was meant to be used by the Centers of Disease Control and Prevention and the National Institutes of Health, which are helping shape the Trump administration’s vaccination strategy. The Trump administration’s current distribution plan, however, does not include details on which groups will be vaccinated first, and prior to the election, it did not release a coronavirus plan for a potential second term.
A few questions remain
The Biden plan also promises that consumers will not be price-gouged as vaccines and treatments come to market. This part of the plan may hinge in part on the future of the Affordable Care Act (ACA), which the Trump administration is trying to overturn and Biden wants to reinvest in. According to fact-checking by CNN, “without the ACA, experts say there is no mechanism for the federal government to guarantee that Covid-19 vaccines will be covered by private insurance plans.” Nevertheless, the Centers for Medicare and Medicaid Services has maintained that it is committed to providing a free vaccine to all. Starting Tuesday, the Supreme Court will hear arguments about the constitutionality of the ACA.
The Trump administration also promised free vaccines for all Americans, investing around $12 billion in vaccine development, according to NPR. However, its negotiation with Congress for a relief bill that would free up money for vaccine distribution has stalled. For his plan to work, Biden will also have to push for this money when he takes office.
Ultimately, it’s up to states to figure out how to distribute a vaccine once it’s approved by the federal government. State governors have struggled to come up with their own distribution plans in the midst of the chaotic election season and changing timelines of the Trump administration, and they will likely look to Biden for help come January. It isn’t clear how the health care giant McKesson Corporation, which has been contracted by the Trump administration to distribute the Covid-19 vaccine, fits into Biden’s plan.
Though many details of Biden’s vaccine plan have yet to be ironed out, some scientists on Twitter were quick to praise it. “Just look at this plan. Pinch me,” wrote Elaine Hernandez, PhD, a medical sociologist and health demographer at the University of Indiana. “It’s literally everything that my colleagues and I would want, including my own top wish list item of a task force specifically addressing racialized and ethnic health inequities,” wrote Uché Blackstock, MD, a popular science communicator and health equity advocate. And for many others, exasperated after months of uncertainty, just having an actual plan was reason enough to celebrate.