ImageDr. Ezekiel Emanuel, who advised President Biden before he took office, is among the health experts who say the nation should adjust to the “new normal” of living with the coronavirus.Credit…Neilson Barnard/Getty Images for Klick Health
On the day President Biden was inaugurated, the advisory board of health experts who counseled him during the presidential transition officially ceased to exist. But its members have quietly continued to meet regularly over Zoom, their conversations often turning to frustration with Mr. Biden’s coronavirus response.
Now, six of these former advisers have gone public with an extraordinary, albeit polite, critique — and a plea to be heard. In three opinion articles published on Thursday in the Journal of the American Medical Association, they are calling for Mr. Biden to adopt an entirely new domestic pandemic strategy — one that is geared to the “new normal” of living with the virus indefinitely, not to wiping it out.
The authors are all big names in American medicine; several, including Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration and Dr. David Michaels, a former head of the Occupational Safety and Health Administration, have held high-ranking government positions. The driving force behind the articles is Dr. Ezekiel Emanuel, an oncologist, medical ethicist and University of Pennsylvania professor who advised former President Barack Obama.
They say the first thing the administration needs to do is take a broader vision, by recognizing that Covid-19 is here to stay. In one article, Dr. Emanuel and two co-authors — Michael T. Osterholm, an epidemiologist at the University of Minnesota, and Dr. Celine Gounder, an infectious disease expert at New York University — pointedly note that in July, Mr. Biden proclaimed that “we’ve gained the upper hand against this virus,” which in retrospect was clearly not the case.
Now, with the Omicron variant fueling a dramatic new surge, they write, the United States must avoid becoming stuck in “a perpetual state of emergency.” The first step, Drs. Emanuel, Osterholm and Gounder wrote, requires recognizing that the coronavirus is one of several respiratory viruses circulating, and developing policies to address all of them together.
To be better prepared for inevitable outbreaks, they suggest that the administration lay out goals and specific benchmarks, including what number of hospitalizations and deaths from respiratory viruses, including the coronavirus, that should trigger emergency measures.
“From a macro perspective, 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,” Dr. Borio said in an interview.
Mr. Biden published a pandemic strategy when he came into office, and recently released a new winter strategy to battle the coronavirus, just as the Omicron variant began spreading in the United States. Many of the steps the authors suggest — including faster development of vaccines and therapeutics; “comprehensive, digital, real-time” data collection by the Centers for Disease Control and Prevention; and a corps of “community public health workers” — are already part of his plans.
But the authors say the administration needs to acknowledge that Omicron may not mark the end of the pandemic — and to plan for a future that they concede is unknowable. They also make clear that the current rate of Covid hospitalizations and deaths is unacceptably high.
The White House had no immediate response. Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, declined to comment in an interview Tuesday night.
In the three articles — one proposing a new national plan, the others suggesting improvements to testing, surveillance, vaccines and therapeutics — the authors also make more specific suggestions.
They call for every person in the United States to have access to low-cost testing, saying the Biden administration’s purchase of 500 million rapid tests is not enough; for next-generation Covid vaccines that would target new variants or perhaps take new forms, like nasal sprays or skin patches; for a “universal coronavirus vaccine” that would combat all known coronaviruses, and for major upgrades to public health infrastructure.
The authors also said that vaccine mandates should be imposed more broadly, including for schoolchildren, and that N95 masks should be made free and readily available to all Americans, as should oral treatments for Covid. (Mr. Biden has ordered several vaccine mandates on workers, but they are tied up in court.) The authors called, as well, for a broad “electronic vaccine certification platform,” which Mr. Biden has resisted.
In interviews, the authors said they had made their views known to Biden officials, but had sometimes felt unheard. The articles reflect both their frustrations and their desire to help, they said. They also recognize that they have the luxury of taking a 30,000-foot view while administration experts are slogging it out in the trenches.
“We understand that they have their hands full and are working to try to do everything right to get through this surge,” said Dr. Rick Bright, the chief executive of the Rockefeller Foundation’s Pandemic Prevention Institute, who led a federal biomedical agency during the Trump administration and co-wrote two of the pieces. “But at the same time, we think a lot of work still needs to be done.” Dr. Gounder said she has been disappointed by the administration’s “single-minded focus on vaccines” and with the decreasing emphasis on mask-wearing. Dr. Borio said she has been “very frustrated” that there is no federal system linking testing to treatments, so that people who test positive and are at high risk for Covid complications, can get prescriptions on the spot for new antiviral medicines.
Dr. Emanuel echoed that sentiment, saying in an interview that if distribution of new therapies is left to “the usual health care system,” only “rich, well-connected people,” would have access to therapies.
The most surprising thing about the articles is that they were written at all, and that the authors are airing their criticisms so publicly. Several said in interviews they were dismayed that the administration seemed caught off guard by the Delta and Omicron variants. Dr. Bright recalled the warning he issued when the advisory board had its last meeting on Jan. 20, 2021.
“The last thing I said,” he said, “is that our vaccines are going to get weaker and eventually fail, we must now prepare for variants, we have to put a plan in place to continually update our vaccines, our diagnostics and our genomics so we can catch this early, because these variants will come.”