In 2020, Joe Biden campaigned as the antidote to COVID-19. “As president, the first step I will take will be to get control of the virus that has ruined so many lives,” Biden declared in his speech to the Democratic National Convention. “The tragedy of where we are today is it didn’t have to be this bad. Just look around. It’s not this bad in Canada or Europe or Japan or almost anywhere else in the world.”
But as the first year of his presidency draws to a close, Biden has yet to execute that first step, and Americans are still perishing from COVID at higher rates than the citizens of other wealthy nations. Meanwhile, the most contagious coronavirus strain yet, Omicron, has just attained dominance within the U.S., and is about to collide with a hospital system that is already understaffed and overwhelmed.
All this amounts to an epidemiological emergency for the United States, and a political crisis for the White House.
Yet the demands of public health and those of politics aren’t perfectly aligned. A majority of U.S. voters are fully vaccinated, and thus unlikely to suffer life-threatening illness from contracting COVID. Much of the unvaccinated minority, meanwhile, is ideologically opposed to public health mandates of any kind. The bloc of voters that is both at great personal risk from the virus and supportive of coercive containment policies is therefore small. In this context, minimizing deaths from Omicron – and maximizing Biden’s approval rating – are distinct objectives. Discouraging Americans from holding large Christmas gatherings may slow the virus’s spread, but it would also exacerbate the public’s sense that the president has failed to restore normalcy, as he promised. Politically, safeguarding the public’s sense that life is more normal today than it was a year ago may be more important than safeguarding the American hospital system.
Or at least, the president’s address on Omicron Tuesday evinced concern for that possibility. In his remarks, Biden announced a series of escalations in his administration’s COVID-19 Action Plan. Among them: FEMA will establish pop-up vaccination clinics in areas where booster shots are hard to find; 1,000 military medical professionals will soon deploy to overburdened hospitals; and the government will buy 500 million at-home rapid tests, which it will send to Americans upon request, free of charge.
If these measures conveyed a sense of emergency, much of the president’s rhetoric sought to counter that impression. Biden began his remarks by assuring the fully vaccinated that they have “a high degree of protection against severe illness,” and that they “should feel comfortable celebrating Christmas and the holidays as you planned it.” He insisted that Omicron would not send the U.S. “back to March 2020” and that K-through-12 schools would remain open.
With COVID now (apparently) destined for endemicity, a policy regime that balances minimizing infection against other competing goods is plainly warranted. And even if this weren’t the case, the White House is manifestly incapable of dictating the American public’s level of concern for public health. This said, the administration’s preoccupation with promoting a sense of normalcy — and/or, its own willful faith in the pandemic’s steady retreat — seems to have left it underprepared for the present wave.
The emergence of a variant as transmissible as Omicron could hardly have been assumed. But the prospect that this holiday season would spark a surge of COVID infections — given America’s lackluster vaccination rate — should have been anticipated. Yet this winter’s surge caught the White House flat-footed. The administration failed to accelerate the provision of booster shots to nursing home residents in the autumn. And it did little to rectify the nation’s substandard health data collection practices, which have left the CDC incapable of precisely tracking hospitalizations and deaths by vaccination status or timing, age, comorbidities, or other relevant variables. This has undermined the government’s ability to ascertain the precise stakes and proper timing of booster shots, as well as the clinical severity of new variants. It allowed America to enter the winter with shortfalls of testing capacity and vaccination sites.
Even after Omicron’s emergence, the administration did not mobilize all resources at its disposal to deter its spread. Earlier this month, Biden unveiled a less ambitious COVID-19 Action Plan at the National Institutes of Health, one that promised to make COVID tests reimbursable for those with private health insurance (and a penchant for keeping receipts and submitting claims). At a White House press briefing around the same time, NPR’s Mara Liasson asked why the U.S. wasn’t simply sending COVID test kids to all households, as many foreign nations had been doing. White House Press Secretary Jen Psaki infamously replied, incredulously, “Should we just send one to every American?”
It apparently took an avalanche of Twitter “dunks” to persuade the administration that this question was not rhetorical.
To be sure, responsibility for the COVID pandemic’s unexpected resilience — and exceptional lethality within the U.S. — can’t be pinned on Biden alone. The American right in general, and conservative media in particular, have fomented an anti-vaccine movement far larger and more militant than that of the median OECD country. In late summer, Biden wanted to start encouraging all Americans to get booster shots eight months after their second dose, but had his hand stayed by the CDC and FDA. Both of these developments have played a significant role in producing America’s lackluster vaccination rates. At present, only about 60 percent of Americans have had at least two COVID shots (or a single-dose Johnson & Johnson vaccine) while only 55 percent of our seniors have received a booster shot; in many other nations, those figures are closer to 80 and 90 percent, respectively. Meanwhile, many Republican-led states have restricted the authority of municipalities to enact mask mandates, while fighting to block the president’s vaccine mandates in court. So, the U.S. was always going to be an unusually favorable breeding ground for viruses in 2021.
Nevertheless, there is more that the Biden administration could still be doing to contain Omicron, including measures that would not run afoul of its political imperatives. As Eric Topol of the Scripps Research Institute notes, the administration could recommend booster shots four months after one’s second dose — instead of six months after, as current federal guidance holds — since evidence now suggests that antibody levels meaningfully wane long before the six-month mark. Producing 500 million free at-home rapid tests is good; but producing a couple billion would be better. Meanwhile, Uncle Sam could bulk buy KN95 masks for virtually nothing, and disseminate them to all U.S. households. More critically, it could direct federal resources into rapidly scaling up production of Paxlovid, an antiviral that has proven effective at drastically reducing viral loads in those infected with earlier COVID strains, and is expected to hold up well against Omicron. As Topol notes, having this treatment available to healthcare workers could be indispensable in averting catastrophic staffing shortages at the nation’s hospitals.
The Biden administration could also do more to promote vaccination abroad. The U.S., like every other wealthy nation, has skimped on the global vaccination drive to a degree that is both morally odious and mindlessly self-defeating. It has also done relatively little to empower low and middle-income countries to build up their own vaccine manufacturing capacity.
None of these measures would impinge on the median voter’s personal liberty or sense of normalcy. They pose no tradeoff between the White House’s political and public health imperatives.
Other arguably worthwhile measures would. The administration could redefine “fully vaccinated” to mean boosted. The case for such an action is simple: Having two shots doesn’t mean what it used to. Every day, Americans who swiftly secured vaccinations in the spring, but have yet to get boosted, grow less resistant to infection. The policy does seem liable to inspire some near-term political blowback, at least if the three-shot standard were applied to vaccine mandates and passport policies. This said, anything that expedites the stabilization of American hospitals is liable to have some long-run political benefit.
A vaccine mandate for airline passengers would similarly help contain viral spread by nudging up vaccination rates, while likely sparking some political discontent. Given that most Americans fly rarely if at all, however, the tradeoff here might be favorable.
We are not going back to March 2020. But we’re not returning to February of that year either. The era of endemic COVID is one that demands the government’s unyielding vigilance. To make life in America feel normal, the White House must operate on the presumption that it is anything but.
More on omicron
- Is Omicron a New Wave or a Parallel Pandemic?
- What We Do and Don’t Know About the Omicron Variant
- Where to Get Home COVID Tests and Why They’re So Hard to Find