Where We Stand with the Vaccinations

The vaccine is out there. It’s not being administered fast enough. But now there’s a plan. From The New York Times [with commentary included]:

President Biden’s promise to administer 100 million vaccines by his 100th day in office is no longer a lofty goal; it is attainable at the current pace at which shots are going into arms. In fact, some experts have suggested that the president’s ambition is far too modest. [His ambition is to get the whole country vaccinated; his promise was to do 100 million by late April.]

Federal data shows that the United States is already administering about one million doses a day, and even doubling that rate would not cause the country to fall short of distribution capacity or supply. . . . 

Mr. Biden made the 100-day pledge in early December, before any vaccine had been authorized for use in the United States. At the time, experts called the goal “optimistic” given their concerns about manufacturing and distribution capacity.

Since then, two vaccines have been approved and the United States has secured contracts for deliveries of doses through July. And while some jurisdictions have said that they are running out of doses, states and U.S. territories are using only about half of the shots that the federal government has shipped to them, on average. . . .

Pfizer and Moderna have pledged to deliver a combined 200 million doses by the end of March, with an additional 200 million doses to be delivered by the end of July.

Under those circumstances, it is feasible that up to two million doses could be given per day, and Mr. Biden’s goal of 100 million shots could be reached by early March.

But ramping up vaccinations will not be easy. And national supply and distribution figures do not reflect the often complicated local realities.

“The complexity of administering vaccines may grow over the coming weeks as we open up a lot of new provider sites,” said Dr. Julie Swann, an industrial and systems engineering professor at North Carolina State University who was an adviser to the C.D.C. during the 2009 H1N1 pandemic.

Getting shots in arms has already been hard, Dr. Swann noted. Providers get little notice of how much vaccine they will receive, making it difficult to plan and set up appointments. Estimating demand can be tricky too, which means that vaccines may be used more quickly in some locations than others, leading to wasted doses.

“The administration needs to be both fighting immediate fires and putting in the infrastructure to make this work better, too,” Dr. Swann said [which is what the president and his staff are doing, three days after the inauguration].

Unquote.

The new administration has issued a “National Strategy for the COVID-19 Response and Pandemic Preparedness”. This is the summary of the plan to “mount a safe, effective, comprehensive vaccination campaign”:

The United States will spare no effort to ensure Americans can get vaccinated quickly, effectively, and equitably. The federal government will execute an aggressive vaccination strategy, focusing on the immediate actions necessary to convert vaccines into vaccinations, including improving allocation, distribution, administration, and tracking. Central to this effort will be additional support and funding for state, local, Tribal, and territorial governments — and improved line of sight into supply — to ensure that they are best prepared to mount local vaccination programs. At the same time, the federal government will mount an unprecedented public campaign that builds trust around vaccination and communicates the importance of maintaining public health measures such as masking, physical distancing, testing, and contact tracing even as people receive safe and effective vaccinations. To mount a safe, effective, comprehensive vaccination campaign, the United States will:

  1. Ensure the availability of safe, effective vaccines for the American public.
  2. Accelerate getting shots into arms and get vaccines to the communities that need them most.
  3. Create as many venues as needed for people to be vaccinated.
  4. Focus on hard-to-reach and high-risk populations.
  5. Fairly compensate providers, and states and local governments for the cost of administering vaccinations.
  6. Drive equity throughout the vaccination campaign and broader pandemic response. Launch a national vaccinations public education campaign.
  7. Bolster data systems and transparency for vaccinations.
  8. Monitor vaccine safety and efficacy. Surge the health care workforce to support the vaccination effort.

The plan is only 200 pages long.

Yeah, we’re finally getting an administration that’s competent and wants the government to work. Patience is a virtue.

The Arrival of the Good News Stories

They’re already showing up. For example:

“President-elect Biden to end Keystone XL pipeline in fight on climate change” (Washington Post)

“Attorney Roberta Kaplan is about to make Txxxx’s life extremely difficult” (Washington Post) [she represents E. Jean Carroll, who’s suing him for defamation, and Mary Trump, who’s suing him for stealing her inheritance]

“Biden taps Warren ally Chopra to lead Consumer Bureau” (Politico)

“Txxxx’s Census Director To Quit After Trying To Rush Out ‘Indefensible’ Report” (NPR)

“Biden to sign executive orders rejoining Paris climate accord and rescinding travel ban on first day” (CNN)

“Biden’s ambitious 100-day plan to erase Txxxx’s legacy” (CNN)

Of course, these stories will remind us of what went before:

I wish I could tell you that the incoming Biden administration had a genius plan for combating Covid-19, thick with ideas no one else had thought of and strategies no one else had tried. But it doesn’t.

What it does have is the obvious plan for combating Covid-19, full of ideas many others have thought of and strategies it is appalling we haven’t yet tried. That it is possible for Joe Biden and his team to release a plan this straightforward is the most damning indictment of the Txxxx administration’s coronavirus response imaginable.

The Txxxx administration seemed to believe a vaccine would solve the coronavirus problem, freeing President Txxxx and his advisers of the pesky work of governance. But vaccines don’t save people; vaccinations do. And vaccinating more than 300 million people, at breakneck speed, is a challenge that only the federal government has the resources to meet. The Txxxx administration, in other words, had it backward. The development of the vaccines meant merely that the most logistically daunting phase of the crisis, in terms of the federal government’s role, could finally begin.

In the absence of a coordinated federal campaign, the job has fallen to overstretched, under-resourced state and local governments, with predictably wan results. According to data from the Centers for Disease Control and Prevention, of the roughly 31 million doses that have been sent out, about 12 million have been used.

The good news is that the incoming Biden administration sees the situation clearly. “This will be one of the most challenging operational efforts ever undertaken by our country,” Biden said on Friday. “You have my word that we will manage the hell out of this operation.”
The person in charge of managing the hell out of the operation is Jeff Zients . . . In a Saturday briefing with journalists, Zients broke the plan down into four buckets. Loosen the restrictions on who can get vaccinated (and when). Set up many more sites where vaccinations can take place. Mobilize more medical personnel to deliver the vaccinations. And use the might of the federal government to increase the vaccine supply by manufacturing whatever is needed, whenever it is needed, to accelerate the effort. “We’re going to throw the full resources and weight of the federal government behind this emergency,” Zients promised.

Most elements of the plan are surprising only because they are not already happening. Biden’s team members intend to use the Federal Emergency Management Agency to set up thousands of vaccination sites in gyms, sports stadiums and community centers, and to deploy mobile vaccination options to reach those who can’t travel or who live in remote places. They want to mobilize the National Guard to staff the effort and ensure that strapped states don’t have to bear the cost. They want to expand who can deliver the vaccine and call up retired medical personnel to aid the campaign. They want to launch a massive public education blitz, aimed at communities skeptical of the vaccine. They’re evaluating how to eke out more doses from the existing supply — there is, for instance, a particular vial that will get you six doses out of a given quantity of Pfizer’s vaccine rather than five, and they are looking at whether the Defense Production Act could accelerate production of that particular vial and other, similarly useful goods.

The Start of a New Deal for America

Nicholas Kristof of The New York Times favorably compares Biden’s “American Rescue Plan” to the first days of Franklin Roosevelt’s New Deal. One reason is that it would seriously reduce child poverty:

Coverage of Biden’s $1.9 trillion plan has understandably focused on the $1,400 payments to individuals, the increased unemployment benefits, the assistance to local governments, the support for accelerated vaccine rollout and the investments to get children back in schools. But there is so much more: food assistance, policies to keep families from becoming homeless, child care support, a $15 federal minimum wage and an expansion of the earned-income tax credit to fight poverty.

To me, the single most exciting element of the Biden proposal is one that has garnered little attention: a pathbreaking plan that would drastically cut child poverty.

It is a moral stain on America that almost one-third of people living in poverty are children, a higher share in poverty than any other age group.

So it’s exhilarating that Biden included in his plan a temporary expansion (I hope it will be made permanent) of the child tax credit in a way that would do more than any other single policy to reduce child poverty and make America more truly a land of opportunity. In effect, Biden is turning the child credit into something like the child allowances that are used around the world, from Canada to Australia, to reduce child poverty.

The Biden child poverty plan was previously offered as legislation backed by Senators Michael Bennet of Colorado and Sherrod Brown of Ohio, and a Columbia University analysis found that it would reduce child poverty in the United States by 45 percent. For Black children, it would reduce poverty by 52 percent, and for Native American children, 62 percent.

This is the boldest vision laid out by an American president for fighting poverty, and child poverty in particular, in at least half a century,” said Luke Shaefer, a poverty expert at the University of Michigan.

Americans too often accept poverty or race gaps as hopeless and inevitable. In fact, the evidence suggests they are neither. As Britain’s prime minister, Tony Blair cut child poverty by half with a strategy that included Biden-style child allowances.

[Another] example is the New Deal . . . . Results of Roosevelt’s boldness included Social Security, rural electrification, jobs programs, networks of hiking trails, the G.I. Bill of Rights and a 35-year burst of inclusive growth that arguably made the United States the richest country in the history of the world.

Yet for the last half-century, we mostly retreated. We overinvested in prisons and tax breaks for billionaires while underinvesting in education, public health and those left behind.

So we think of the United States as No. 1, but America ranks No. 28 worldwide in well-being of citizens, according to the Social Progress Index. And the United States is one of only three countries to have gone backward since the index began in 2011.

Americans are less likely to graduate from high school, more likely to die young, less safe from violence and less able to drink clean water than citizens in many other advanced countries. And then along came Covid-19 and magnified the disparities.

As Biden noted in his speech Thursday night, one in seven households in America now report that they don’t have enough food. Some 12 million children live in households that lack enough food. . . . 

Yes, Biden’s proposal would be costly, but a major study from the National Academies of Sciences, Engineering and Medicine found that child poverty is even more expensive, costing America at least $800 billion a year in diminished productivity, higher crime and elevated medical costs.

Helping people is often harder than it looks. But it is difficult to overstate how much difference Biden’s child poverty plan would make for Americans, for economic growth, for the country’s international competitiveness — and, let’s acknowledge it, for the moral framework of the United States. In the long run, this would do more to advance American equality, opportunity and decency than almost anything else.

Unquote.

There will be Republican opposition to Biden’s plan, of course, which will almost certainly mean that it’s effectiveness is reduced. But it’s encouraging that the U.S. Chamber of Commerce, not exactly a hotbed of socialism, has endorsed it (to some extent):

The U.S. Chamber of Commerce welcomes the introduction of President-elect Biden’s American Rescue Plan. Specifically, we applaud the President-elect’s focus on vaccinations and on economic sectors and families that continue to suffer as the pandemic rages on. We must defeat COVID before we can restore our economy and that requires turbocharging our vaccination efforts.  We look forward to working with the new administration and Congress on the details and in ensuring that any additional economic assistance is timely, targeted, and temporary.

It Has To Be Different This Time

Joe Biden’s proposed Covid-19 relief plan is a big deal. From Vox:

The proposal, called the American Rescue Plan, is divvied up into three buckets:

$400 billion for dealing with the coronavirus, including vaccines and testing;

$1 trillion in direct relief to families; and

$400 billion in aid to communities and businesses.

It includes money for testing, vaccines, and public health workers; $400 a week in extended federal unemployment insurance through September; rental assistance; emergency paid leave; and funding for reopening schools, among other items. And, as Democrats promised when campaigning in Georgia, Biden’s plan would send out another $1,400 in stimulus checks, bringing the total this year to $2,000.

Greg Sargent of The Washington Post discusses the relatively encouraging politics of the matter:

The sheer scale of the economic rescue package that Joe Biden has unveiled has surprised a lot of observers who were expecting the president-elect to offer something more in line with his centrist, incrementalist past.

In unveiling the new [roughly] $1.9 trillion package, Biden declared that rather than worry about “our debt situation,” it’s time to spend big “with interest rates at historic lows.” As Slate’s Jordan Weissmann put it: “I would not have anticipated that Joe Biden would become a clear and forceful advocate of deficit spending.”

What accounts for this ambition? Most obviously, this crisis is truly extraordinary. The new leadership must execute a massive vaccine-distribution operation amid a broader effort to tame a raging pandemic, while securing assistance to struggling Americans plus a big burst of stimulus spending to address a deepening economic crisis.

Another obvious answer is that the politics have shifted. The Democratic Party has moved left on fundamental economic questions, due in large part to advocacy from Sen. Bernie Sanders (I-Vt.), Sen. Elizabeth Warren (D-Mass.) and others.

But still another reason, one that has been less remarked-upon, is that many Democrats have lived through what happened when former president Barack Obama inherited another major economic crisis from another Republican president.

As has been endlessly hashed out, Obama opted for a stimulus that fell short of what was needed. Putting aside why that happened, what everyone now knows is that it was a serious mistake. Democrats lost the House in 2010 and spent the remainder of Obama’s presidency locked in brutal fiscal trench warfare with a GOP determined to starve the recovery with austerity to cripple his presidency under the guise of fake concerns about spending and deficits.

Many Democrats who lived through that, a lot of whom are still in Congress and some of whom are advising Biden — who himself lived through it as vice president — must be wary of a repeat.

Making them even more wary, one hopes, is the fact that Republican deficit concerns evaporated once a Republican became president. Indeed, the economy was good (at least until the coronavirus shattered it) precisely because it was fueled by stimulus.

As Neil Irwin reports, the Trump years have caused a change among economists, who are now more receptive to a hotter economy — with higher deficits and lower unemployment — and less wary of inflation than they traditionally have been. That has fueled a political shift toward tolerance of deficits, making Democrats less wary of bad-faith criticism for overspending.

But on top of that sea change, Democrats have to be feeling extra-burned by the fact that the GOP pivoted so abruptly from voicing phony deficit concerns under a Democratic president to not caring about them anymore under a Republican.

The lesson of those years is that Txxxx the political beneficiary of that chicanery. He consistently had high approval ratings on the economy, and he might have won reelection on the strength of that if the coronavirus hadn’t intervened.

Democrats appear to be learning from that lesson right now.

On still another front, the makeup of the Senate Democratic caucus is different. During the Obama years you had centrist old-liners chairing key committees . . . Expected to chair those respective committees in the new Senate now are Ron Wyden of Oregon, Sanders, and Sherrod Brown of Ohio. All are far more progressive than those previous Democratic chairs. . . .

Wyden, for his part, believes this combination of things — an awareness of getting played by phony GOP deficit concerns and more progressive Senate committee chairs — will make this time very different from 2009 and 2010.

“The key lessons we learned were the importance of not assuming there will be multiple bites at the apple and not taking your foot off the gas in the middle of economic recovery,” Wyden told me in a statement. “We cannot let a popular recovery agenda get derailed by fiscal fearmongering that we know is unjustified and phony.”

“Committee chairs are going to be aggressive, and want to get things done,” Wyden added. “Overall, I think the dynamics have changed a lot since 2009.”

To be sure, it still remains to be seen how big a package Biden will actually wrest from Congress. He has already announced he hopes to pursue bipartisan support in the Senate rather than try to get the legislation passed with a simple majority via the “reconciliation” process.

So it’s still possible that Biden could end up on a futile hunt for Republican support or end up compromising his stimulus package downward. But there is at least some reason for optimism that Democrats have learned from what happened last time. . . .

This Is Almost Unbelievable

From The Washington Post (MY EMPHASIS ADDED):

When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing coronavirus vaccine doses held in reserve for second shots, NO SUCH RESERVE EXISTED, according to state and federal officials briefed on distribution plans. The Txxxx administration had already begun shipping out what was available beginning at the end of December, taking second doses directly off the manufacturing line.

Now, health officials across the country who had anticipated their extremely limited vaccine supply as much as doubling beginning next week are confronting the reality that their allocations will not immediately increase, dashing hopes of dramatically expanding eligibility for millions of elderly people and those with high-risk medical conditions. Health officials in some cities and states were informed in recent days about the reality of the situation, while others are still in the dark.

Unquote.

A message from our local doctors:

Untitled

Dear SMG Patient,

Recent eligibility changes for the COVID-19 vaccine have created a massive spike in demand for the vaccine. AT THIS TIME WE ARE NOT ABLE TO ACCOMMODATE ADDITIONAL VACCINE APPOINTMENT REQUESTS.

The volume of appointment requests via phone and through our patient portal is limiting our ability to care for patients who need both sick and well visits. 

We will contact eligible patients as soon as we are able to vaccinate you.

Unquote.

One reasonable theory: These bastards want millions of people to be disappointed that they can’t get a vaccination and blame the president — who will be Joe Biden five days from now.

I hope Biden puts a paragraph in his inaugural address (a “by the way, folks”) explaining that the outgoing administration claimed they’d have many millions of us already vaccinated, but they totally screwed up and then lied about it on their way out the door.