WASHINGTON — Never, in the country’s nearly 250-year history, has a president inherited a pandemic on the scale of Covid-19.
President-elect Joe Biden, who the Associated Press projected as the winner of the 2020 election on Saturday, will assume office on Jan. 20. He will likely do so amid surging coronavirus cases and increased deaths, and with no end in sight. Instantly, he will shoulder several herculean tasks, including a massive testing scale-up, restoring the credibility of government scientists, and overseeing the eventual distribution of hundreds of millions of vaccine doses. Perhaps most daunting, in a country plagued by apathy and misinformation: Biden will need to earn the buy-in of the American public.
Much of the work has already begun. In interviews with STAT, several Biden health advisers described a forthcoming effort to court skeptical mayors and governors, select and vet leaders for key public health agencies, and set a new tone for the nation’s pandemic response, even in the 10 weeks before he takes office. Many in the president-elect’s brain trust spoke on the condition that the conversations remain private until Biden was declared the winner.
“There are some things he’s going to do right off the bat,” said Nicole Lurie, a Biden campaign adviser who served as the Obama administration’s top pandemic-preparedness official. “He will reach out to Tony Fauci. He will declare his intent to be an active participant in the WHO and in the world. And I believe that in very short order, he’ll be in touch with governors and mayors around the country, listening to what it is that they’ll need to pivot this response.”
The pandemic may have proved a decisive factor in Biden’s win. In the months before the election, polls consistently showed that voters believed Biden would respond to Covid-19 more effectively than Trump. In one exit poll, a majority of voters said they favored pandemic containment measures even at the economy’s expense. Two in 10 voters listed the pandemic as their top deciding factor, though one-third of voters said their top issue was the economy.
In the campaign’s closing weeks, Trump urged Americans to return to their everyday lives, misleadingly downplayed the risks of coronavirus infection, and pledged to fire Fauci, the federal government’s top infectious diseases researcher. Biden, meanwhile, campaigned on choosing “science over fiction,” and has said he will ask governors to quickly issue statewide mask mandates — and ask Fauci to continue his service in government.
But many Democrats, who entered Tuesday widely expecting to win a Senate majority, were disappointed by a series of losses in red-leaning states. As of Wednesday, key races in Georgia and North Carolina remained too close to call, but Sen. Mitch McConnell (R-Ky.) was all but assured to remain majority leader.
McConnell and other Republicans, in recent years, have displayed intense opposition to confirming Democratic presidents’ nominees, including to some health care posts. Biden advisers widely expected that if he won, a Democratic Senate would easily confirm his picks for health care agencies. Under McConnell, however, it’s likely that many Biden nominees would face significant resistance from conservative and combative GOP lawmakers, potentially posing a significant complication to Biden’s transition effort.
Biden’s allies also indicated that as an institutionalist, the former vice president will be hesitant to wield the bully pulpit of the White House before he formally assumes office. He may exercise caution, therefore, before directly challenging Trump on the federal government’s pandemic-response efforts between now and Inauguration Day.
“He can’t make policy decisions,” Lurie said. “But he and his team can certainly signal what they think is appropriate, because he’s going to be very focused on helping to prevent people from dying.”
Others, like Andy Slavitt, who served as acting chief of the Centers for Medicare and Medicaid Services during the Obama administration, argued it is Biden’s job “to get people to take the temperature down” on widespread resistance to mask use or following social distancing guidelines. If the outgoing Trump administration doesn’t provide Americans guidance as the holiday season approaches and infections continue to rise, he said, the inaction might force Biden’s hand.
“There’s one government at a time, and I think that’s always been the proper rule,” Slavitt said. “But if there is a void, then I think Biden will have very credible people out there talking and setting up the right processes to communicate with the public as soon as they can.”
Biden allies also indicated the president-elect’s transition team is unlikely to rely heavily on outgoing Trump administration staff at the Department of Health and Human Services, as is typical in a presidential transition. Instead, incoming Biden health aides plan to lean on career civil servants and, separately, on political appointees who left HHS when President Obama left office in early 2017.
One Biden adviser, speaking on the condition of anonymity, said the president-elect’s health care advisers have already conducted some under-the-radar outreach to career staff at those agencies in the weeks prior to Election Day, in an effort to jumpstart a potential transition.
Several members of Biden’s health care team also acknowledged there will likely be unprecedented pressure to name the officials he intends to appoint for public health posts before Jan. 20. Nominees for those agencies typically come weeks or months into a president’s first term: Trump, for example, did not nominate an Food and Drug Administration commissioner until nearly two months after his inauguration, and he did not appoint a Centers for Disease Control and Prevention director until July of his first term. Obama, who was far more focused in the first months of 2009 on the ongoing economic crisis, did not appoint Tom Frieden as CDC director until May of that year.
“He’s gotta put together a task force that’s actually gonna manage [the pandemic], and then there are going to be sub-task forces in each area,” said Zeke Emanuel, a top health care adviser to the Obama administration and the Biden campaign. Emanuel cited testing, contact tracing, and vaccines as among the areas that might warrant a specific working group, and stressed that the Biden transition will aim to quickly announce picks to run the FDA and CDC.
The task force is likely to draw on the existing cast of pandemic advisers who have regularly briefed Biden throughout 2020 and helped to formulate the Covid-19 plan his campaign published in March. That group includes Emanuel; Lurie; Vivek Murthy, the former surgeon general; Marcella Nunez-Smith, a Yale physician-researcher; and David Kessler, the former FDA commissioner.
Biden health advisers also said they expect Ron Klain, who formerly served as Biden’s chief of staff and as the Obama administration’s “Ebola czar,” to serve in a high-profile administration role — potentially, though not necessarily, as White House chief of staff.
Outside public health officials said that restoring the stature and credibility of federal public health and scientific agencies should rank high on the incoming administration’s priority list, especially given the potential that a Covid-19 vaccine will be authorized in the coming weeks or months.
To successfully beat back the pandemic, the Biden administration will need to convince Americans to take a Covid-19 vaccine when one is approved — a task made vastly more difficult by plummeting trust in vaccine safety and the scientific agencies overseeing the vaccine development process.
A plummeting share of Americans say they will seek to receive a Covid-19 vaccine once one becomes available. A STAT-Harris poll in October showed just 58% of the public would seek a vaccine immediately, down from 69% in mid-August.
“We’ll get a vaccine and we’ll roll it out, but then we have to get people to take it,” said Krutika Kuppalli, a physician and professor at the Medical University of South Carolina. “They have to feel confident in it, and I think that’s going to be another big challenge for the Biden-Harris camp.”
Ashish Jha, the dean of the Brown University School of Public Health, said Biden’s first task is to level with the public, even if it means delivering blunt guidance in the leadup to Thanksgiving and the winter holidays.
“I would begin with an honest conversation with the American people about the state of the pandemic and where we are, and how the next few weeks and months are going to be incredibly hard,” he said. “It won’t go away by Inauguration Day, and it won’t go away by spring. But it will get better, and he should walk people through what he’s going to do to make it better.”