A8 EZ RE THE WASHINGTON POST.WEDNESDAY, JANUARY 19 , 2022
fight omicron.
As the White House focused
heavily on vaccinations, some of
its other priorities seemed less
urgent as infections declined
through last spring and early
summer, prompting many in and
out of the administration to
think the pandemic was on its
way out.
One promise was to “effective-
ly distribute tests” so Americans
wouldn ’t need to wait in lines
again to find out whether they
were infected — an unfulfilled
vow for the thousands of Ameri-
cans in long testing queues be-
fore the holidays.
Another promise was to give
Americans clear guidance to
help them decide whether and
when to wear masks, get booster
shots or gather with others. But
health officials struggled to ex-
plain their changing recommen-
dations, leaving many people
confused and frustrated. The
CDC only Friday updated its
long-standing mask guidance,
saying N95 and KN95 masks
offer better protection than cloth
coverings against omicron.
The White House had “no
plan” to explain to Americans
why and when they needed to be
tested for the virus, said Scott
Becker, head of the Association
of Public Health Laboratories,
which helps provide coronavirus
testing. “U.S. leaders didn’t really
educate the consumer who’s nev-
er used these things before. ...
Now, we’re playing catch-up.”
Officials also neglected a core
promise to make “predictable”
test supply purchases, industry
leaders said. Manufacturers who
had shut down plants as demand
for their products dropped pre-
cipitously last spring scrambled
to ramp up this winter. Rather
than prioritize large orders of
tests last year, which could have
equipped the nation to deal with
a new surge, Biden officials fo-
cused on a vaccination campaign
that seemed to be succeeding at
driving down case numbers.
“I think there’s more that can
be done there to ensure predict-
abilit y,” said Scott Whitaker,
head of AdvaMed, an association
that represents manufacturers of
coronavirus tests and other med-
ical devices.
Several industry leaders refer-
enced how Abbott Laboratories,
a maker of coronavirus rapid
tests, last year destroyed testing
components because the market
had dried up as case numbers
fell, as the New York Times first
reported. “That was a hugely
unfortunate situ ation,” Becker
said. Abbott has denied that it
destroyed any finished Binax-
NOW tests or “usable test com-
ponents.”
Recently, as omicron surged,
the Biden administration took
steps to shore up testing capac-
ity, including committing to buy
1 billion additional at-home
te sts, launching a website where
Americans could order them
free, and requiring insurers to
cover the cost of rapid tests
purchased online or in retailvate local “community corps” to
serve as trusted messengers. The
federal government set up doz-
ens of vaccination centers for
Americans to get shots, a m ove
hailed even by some Trump offi-
cials, and enlisted public service
communications experts like the
Ad Council to craft pro-vaccine
messaging campaigns, a step the
Trump administration never
to ok.
White House of ficials and al-
lies say the proof they succeeded
is th at about 250 million Ameri-
cans have received at least one
dose, up from about 15 million
when Biden took office, accord-
ing to The Post’s tracking. Some
of those were skeptics who were
won over by those campaigns.
And yet, despite the presi-
dent’s insistence that the virus’s
recent casualties are the result of
“a pandemic of the unvaccina t-
ed,” some Americans, especially
rural Republicans, remain
strongly resistant. About a q uar-
ter of adults have declined to get
the shots, and many parents
remain uncertain about vacci-
nating their children. Even fully
vaccinated Americans appear to
be tuning out health officials’
exhortations, with 38 percent
heeding calls to get boo ster
shots. Public health agencies also
have struggled to communicate
why so many vaccinated people
have gotten infections, after
Biden officials assured Ameri-
cans last year that vaccinations
would largely prevent them.
Over and over, the administra-
tion’s messaging has been under-
cut by a shapeshifting virus —
with corrosive effects on public
trust. By November, less than
half of Americans said they were
“optimistic” about the state of
coronavirus vaccinations, down
from two-thirds the prior Janu-
ary, the Kaiser Family Founda-
tion found.
The administration has been
less successful fulfilling 33 pledg-
es intended to curb viral spread
by expanding access to tests,
improving data surveillance and
issuing clear messages to the
public, among an array of other
measures.
“It was a lofty goal that, in
retrospect, is not something that
could be achieved by a s ingle
government over a p eriod of one
year,” said Michael Osterholm,
director of the Center for Infec-
tious Disease Research and Pol-
icy at the University of Minne-
sota, and among the former
Biden advisers who urged him in
recent journal articles to reori-
ent his strategies around “living
with the virus.”
Biden pledged to improve
re al-time data analysis, for in-
stance, so policymakers could
make decisions more effectively,
and the public, better under-
stand its risks. But his former
advisers said that U.S. leaders
still rely on data from overseas
when judging vaccines’ durabili-
ty and their effectiveness against
variants, slowing down decisions
like recommending booster
shots and shifting policies toplaybook left by the Obama-
Biden administration and then
failed to develop one of his own
as covid ravage d the country —
an issue Biden and his allies had
hammered throughout the cam-
paign.
“Our national strategy is com-
prehensive. It’s based on science,
not politics. It’s based on truth,
not denial,” Biden said as he
unveiled the plan on Jan. 21,- “It’s complete detail on
what we’re going to do. ... This is
the plan. This is the plan.”
In the weeks to come, more
than a dozen current and former
members of the administration
said th ey looked to Biden’s plan
for their marching orders on how
to fight covid, with senior offi-
cials carrying a copy into meet-
ings and checking collective
progress against its goals.
“It was a c ombination road-
map-marching orders, ‘this is
what we’re going to do,’ ” said
Gayle Smith, who led the State
Department’s covid response last
year. “I think it ma ttered. And I
think it still ma tters.”
The plan also was widely ap-
plauded outside of the adminis-
tration, with public health and
policy experts praising it as clear
and comprehensive — and over-
due, after Trump’s failure to
articulate a strategy.
“I think they earned our trust
with a good pandemic plan,” said
Julia Raifman, an assistant pro-
fessor of health policy at Boston
Universi ty. “And then they did
not follow through on it.”
Experts broadly agree that the
Biden administration achieved
its goal to widely vaccinate
Americans, carrying out more
than 40 promises to get more
shots in people’s arms.
As surgeon general, Vivek H.
Murthy, who helped write the
plan, led an arr ay of efforts to
combat misinformation and acti-
needed to coordinate a world-
wide pandemic response were
restored.
But each of the outside experts
characterized key parts of
Biden ’s plan as unfinished, say-
ing that much work remains to
fulfill the president’s promises to
protect essential workers, curb
the virus’s spread and restore
Americans’ trust in the federal
government, among other goals.
“All of the items here, you
could credibly say, have been
addressed in some way, mo st of
them substantively,” said Krish-
na Udayakumar, director of the
Duke Global Health Innovation
Center, referring to Biden’s glob-
al strategy promises such as
supporting the WHO, joining a
vaccine-sharing alliance and re-
suming global leadership after
the Trump administration re-
treated from those roles. “The
administration can and does
credibly say they are doing more
than almost every other country.
... And it is also true that none of
it is even close to being enough to
end the pandemic.”‘Marching orders’
The “N ational Strategy for the
Covid-19 Response and Pandem-
ic Preparedness,” unveiled by the
president on his first full day in
office, took shape in transition-
team meetings in September- Drawing on contributions
from more than 100 people, the
plan was conceived as a path to
lead the United States out of this
pandemic while preparing for
the next one. Vaccines were a
central plank but far from the
sole priority — in part, because
the shots were still months away
from being authorized by regula-
tors.
The plan was also envisioned
as a rebuttal to former president
Donald Trump. Biden said
Trump had ignored a pandemic
forecasting hub at the Centers
for Disease Control and Preven-
tion.
Officials say they have used
the pandemic plan as their com-
pass and have worked around-
the-clock to implement it.
“The team sort of teases me
that it ’s my security blanket,”
said Jeff Zients, the president’s
coronavirus strategy coordina-
tor, who keeps a blanket in his
office that is emblazoned on one
side with the image of the plan’s
cover. (The other side reads “ex-
ecution, execution, execution,” a
not-so-subtle exhortation to his
staff who sometimes borrow the
blanket when they get cold.)
“If you look across the seven
areas, I think we’ve made a lo t of
progress across all of them,”
Zients added, touting metrics
about expanding access to tests,
reopening schools and immuniz-
ing millions of Americans. “It’s
the execution that’s led to 210
million people now fully vacci-
nated and 80 million boosted,”
he said.
Zients acknowledged one
area, however, in which “we
underestimated in that original
strategy ... the amount of disin-
formation and the fact that peo-
ple wo uld actually stand in the
way of the pandemic response
for political or other motiva-
tions.”
Asked by The Washington Post
to grade Biden’s progress, 17
outside public health experts
credit the administration with
achieving some of its most im-
portant priorities. They note that
about 63 percent of Americans
are now fully vaccinated, helping
to protect them from the worst
consequences of the virus.
Health disparities that Biden
inherited, linked to higher covid
death rates among communities
of colo r, were dr amatically re-
duced. Global health alliancesbiden’s first year
new daily records and more facili-
ties move to ration care. Many
Americans say they’re confused
by government pronouncements
and losing faith in the agencies
handling the response. Essential
workers in packing plants, food
service and emergency response
say they still feel endangered by a
virus that Biden had vowed to
control.
“He promised he would take
care of health workers, but it
doesn ’t feel that wa y,” said Cathy
Kennedy, a neonatal nurse who
helps lead the California Nurses
Association. Kennedy said she
worried that infected colleagues
are being rushed back to work by
short-s taffed hospitals and
blamed the White House fo r
failing to enact permanent work-
place safety standards to protect
them.
As he prepared to take office,
Biden oversaw a 2 00-page pan-
demic plan that promised to
restore trust in the federal gov-
ernment, protect essential work-
ers and slow the coronavirus’s
spread. But, as president, he has
struggled to execute key parts of
it.
Page 59 promised “predictable
and robust” federal purchasing
of coronavirus tests — a pledge
that industry leaders say fell far
short, as Americans continue to
line up to get tested while com-
plaining they can’t find home
test kits.
Page 81 pled ged to “support
schools in implementing COVID-
19 screening testing,” but many
parents, teachers and staff say
that schools have largely been
left to fend for themselves.
And Page 103 vowed “to en-
sure patient safety” in nursing
homes by boosting staffing and
vaccinations, yet worker sho rtag-
es persist and elderly residents
lag behind on getting booster
shots.
Some of Biden’s biggest chal-
lenges on executing that plan
have been beyond his control,
including courts that delayed
and then blocked his vaccina-
tion-or-test mandates; Republi-
cans who fought calls for mask-
ing and promoted vaccine disin-
formation; and, most significant-
ly, an unpredictable virus that
has evolved to evade some pro-
tections conferred by vaccines
even as it became more transmis-
sible.
“This is a g ood plan overcome
by events,” said Andy Slavitt, who
served as a s enior adviser on the
White House covid response last
year. “Everyone had a failure to
anticipate delta and omicron, the
administration included.”
But many say the United
States would have been be tter
prepared to deal with the virus’s
curveballs if the administration
had more quickly delivered on
promises to improve testing and
real-time virus surveillance and
encou rage d masking nation-
wide, rather than focusing so
heavily on vaccines. The nation’s
struggles to ramp up access to
rapid coronavirus tests this win-
ter could have been avoided, for
instance, had the White House
stuck to pledges to boost test
supply last year and explain to
Americans when to use them,
said outside advisers and co-au-
thors of Biden ’s plan.
“We’d be in a better place to
deal with omicron, because we’d
have more tools to fight it,” said a
person who helped craft Biden’s
plan and spoke on the condition
of anonymity to discuss their
work.
About 49 percent of Ameri-
cans said that Biden was doing a
good job handling the covid
outbreak, down from 67 percent
who approved of his response
last March, a period when the
virus was receding, a ccording to
a CBS News/YouGov poll re-
leased this week. Thirty-six per-
cent of Americans said that U.S.
efforts to contain the virus were
currently going well.
Even some of Biden ’s allies are
demanding answers about why
long-standing issues remain un-
resolved.
“I’m frustrated we ’re still be-
hind on issues as impo rtant to
families as testing and support-
ing schools,” said Sen. Patty Mur-
ray (D -Wash.), who grilled Biden
officials at a Sen ate Health, Edu-
cation, Labor and Pensions hear-
ing last week. “That’s not to say
we have not made progress. It’s
just clear we haven’t made
enough.”
White House officials insist
they have carried out virtually all
of the promises in Biden’s plan, a
list of seven broad goals that
contain more than 180 discrete
pledges that include addressing
“disinformation and misinfor-
mation” and vaccinating Ameri-
cans, as well as rejoining the
World Health Organization and
launching a national epidemic
BIDEN FROM A
Some architects of president’s c ovid plan say focus on vaccinations isn’t enough
DEMETRIUS FREEMAN/THE WASHINGTON POST
President Biden attends a pandemic response meeting last week in a White House auditorium. As he prepared to take office, Biden oversaw a 200-page pandemic plan that
promised to restore trust in the federal government, protect essential workers and slow the coronavirus’s spread. But, as president, he has struggled to execute key parts of it.MICHAEL S. WILLIAMSON/THE WASHINGTON POST
Shonda Grappe, left, a pediatric intensive care nurse, delivers supplies to nurse Brittany Rowell in
early August in Little Rock, Ark. More hospitals are moving to ration care amid n ew daily case records.