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January 7, 2022

Former Biden advisers: It's time for a new pandemic playbook

Daily Briefing

    In three opinion pieces published in JAMA, six health experts who served on President Biden's transition team criticized aspects of the government's Covid-19 response to date and offered recommendations for a "new normal" of living with the coronavirus.

    While each piece credited a different set of authors, among the pieces the participants included:

    • Luciana Borio, a former acting chief scientist at FDA
    • Rick Bright, CEO of the Rockefeller Foundation's Pandemic Prevention Institute
    • Ezekiel Emanuel, a medical ethicist and professor at the University of Pennsylvania
    • Celine Gounder, an infectious disease expert at New York University
    • David Michaels, former head of the Occupational Safety and Health Administration
    • Michael Osterholm, an epidemiologist at the University of Minnesota

    Resource library: How health care organizations can navigate the post-pandemic world

    Living with, rather than eliminating, Covid-19

    In one of the pieces, Emanuel, Osterholm, and Gounder asserted that Covid-19 will never be eliminated. "The goal for the 'new normal' with Covid-19 does not include eradication or elimination, e.g. the 'zero Covid' strategy," they wrote.

    The authors noted that, in July 2021, Biden stated the United States had "gained the upper hand against this virus" and that CDC had relaxed mask wearing and socializing guidance. "By September 2021, the delta variant proved these steps to be premature, and by late November, the omicron variant created concern about a perpetual state of emergency," they wrote. In creating a national strategy for Covid-19, "humility is essential," the authors added.

    The authors argued the United States should recognize that Covid-19 is one of many respiratory viruses circulating throughout the country, including influenza, respiratory syncytial virus, and others. The country should develop an "appropriate risk threshold" for deaths, hospitalizations, and community viral presence for respiratory diseases based on "high-severity years," they wrote.

    The United States also should develop "a modern data infrastructure that includes real-time electronic collection of comprehensive information on respiratory viral infections, hospitalizations, deaths, disease-specific outcomes, and immunizations with sociodemographic and other relevant variables," the authors wrote.

    Improvements to testing, air filtration, and masks

    In another of the pieces, Michaels, Emanuel, and Bright wrote that improvements to Covid-19 testing need to be made in the United States. Specifically, "[e]very person in the U.S. should have access to low-cost testing," and both federal and state governments "need to ensure these tests are in plentiful supply, free to individuals with Medicaid coverage, and free or low cost to the rest of the population."

    Improvements to ventilation and air filtration systems should also be a focus, the authors wrote. "These systems will need to be implemented in offices, schools, public transportation, and other congregate workplace and social settings, such as restaurants and bars."

    The public should also have better access to high-quality filtering facepiece respirators (FFRs), such as N95s or KN95s as opposed to cloth and surgical masks, the authors wrote. "[T]here needs to be a national initiative to sustainably produce domestic FFRs and ensure they are readily available to all U.S. residents for free or very low cost," the authors wrote.

    Vaccines and Covid-19 treatment

    In the final piece, Borio, Bright, and Emanuel argue the United States should develop "an electronic vaccine certificate platform" and utilize vaccine mandates.

    "[P]roposed vaccine requirements for government employees and contractors, health care and long-term care workers, and employees of businesses with 100 or more employees will be necessary to achieve levels of coverage to return to pre–Covid-19 life expectancy and social and economic vitality," they wrote.

    The authors also advocated for developing "next-generation Covid-19 vaccines that match circulating [coronavirus] variants," as well as for a "focused research program" to determine "what constitutes an optimal vaccine combination and schedule."

    The government should also help to accelerate the development of a universal coronavirus vaccine to protect against all known coronaviruses, the authors wrote. "A more broadly protective vaccine would allow the world to limit the effects of emerging variants and nimbly react to novel coronaviruses that are likely to emerge in the future," they wrote.

    The authors added that the "rapid development of efficacious oral antiviral treatments" for Covid-19 is needed, and that outpatient treatments for Covid-19 should be "made widely available at no cost … for anyone testing positive for [coronavirus] infection and meeting FDA indications."


    The authors of the pieces said they partly wrote them because they hadn't made progress directly speaking to the White House, the New York Times reports.

    "From a macroperspective, it feels like we are always fighting yesterday's crisis and not necessarily thinking what needs to be done today to prepare us for what comes next," Borio said.

    "We're trying to take the next steps, to anticipate where we need to be in the next three to 12 months," Emanuel said, adding the articles are an "outline of a national strategy … to find a new normal."

    In a news briefing, White House press secretary Jen Psaki emphasized that Biden's "ultimate goal continues to be to defeat the virus."

    "Right now, our approach is to … continue to press for what we know has worked to date, which is to get people more vaccinated, get people boosted, [and] wear masks when recommended by the [CDC]," Psaki said. (Stolberg, New York Times, 1/6; Weixel, The Hill, 1/6; Diamond, Washington Post, 1/6; Emanuel et al., JAMA, 1/6; Michaels et al, JAMA, 1/6; Borio et al., JAMA, 1/6)

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