COVID-19 infection rates and hospitalization rates are reaching new daily records, and deaths now have exceeded 240,000. The present surge in cases is the product of misguided state actions either to downplay the seriousness of the pandemic or to reopen commerce too soon.
Here are six priority actions that President-Elect Biden should undertake:
REASSERT FEDERAL LEADERSHIP WITH A COORDINATED NATIONAL RESPONSE TO THE PANDEMIC Mr. Biden has taken promising steps by convening a new Coronavirus Task Force populated with scientists and physicians, and a Special COVID Transition Team to coordinate efforts with state and local health officials. However, the Centers for Disease Control and Prevention (CDC) must regain its preeminent stature as the national leader working in conjunction with state and local departments of public health. In addition, because rural health care providers have been hardest hit by the pandemic, they urgently need to receive federal funding to help them meet the service needs of their communities.
FOLLOW THE SCIENCE, NOT THE MONEY Mr. Biden openly supports science-based principles and methods, and he is attuned to the advice of leading epidemiologists and infectious disease experts. He also must continue to resist calls to relax pandemic mitigation measures. Restoring the economy to pre-pandemic levels is desirable, but not at the expense of failing to contain the virus in the absence of effective vaccines and therapeutics. Effective vaccines are on the way, but we all must be patient while evidence-based decision making determines their approval and dissemination to all Americans.During this urgent time, the Affordable Care Act (ACA) protections regarding pre-existing conditions must be maintained and extended to individuals infected with COVID as well as to individuals who have lost their health insurance.
IMPOSE MORE STRINGENT MITIGATION MEASURES More stringent mitigation measures should be imposed and enforced, including a national mask-wearing mandate; physical distancing at least 6 feet apart; prohibition of gatherings greater than 10 people; and reversal of many steps taken to reopen local economies, beginning with efforts to close bars, gyms, health clubs, and movie theatres, and to limit restaurant dining to pick-up and delivery only.Mr. Biden has indicated the need to strengthen testing and contact tracing capacities across the nation, and to focus on communities where non-compliance has been a problem. Mitigation measures will be highly unpopular, but they are necessary to control the pandemic.
FIX AND STRENGTHEN THE SUPPLY CHAIN FOR PERSONAL PROTECTIVE EQUIPMENT (PPE) AND VITAL SUPPLIES Additional incentives should be offered to US firms to manufacture necessary supplies and equipment to manage COVID, and the Defense Production Act should be employed more aggressively to assure an adequate supply of PPE, ventilators, and other key equipment.The Strategic National Stockpile should be reorganized, replenished, and used to strategic advantage. By working with state and local leaders (governors, mayors, and public health officials), Mr. Biden appears poised to coordinate the distribution of supplies and equipment to “hot spots” and communities in greatest need.
AUGMENT OPERATION WARP SPEED TO DEVELOP EFFECTIVE VACCINES AND THERAPEUTICS Operation Warp Speed should be augmented with additional resources, and federal policymakers should be encouraged to work more closely with biopharmaceutical firms that have products in development, guided by well-established scientific principles and methods inherent in vaccine development trials.The Food and Drug Administration should be protected from political pressures when making decisions regarding the safety and effectiveness of vaccines and therapeutics. Decisions should be based on evidence from properly designed and executed clinical trials. Once a product is approved, it should be distributed equitably and effectively, based on criteria and procedures jointly developed by the CDC and the National Academy of Medicine.
DEVELOP A NEW NATIONAL STRATEGY AND INFRASTRUCTURE FOR RESPONDING TO FUTURE PUBLIC HEALTH EMERGENCIES Emergency preparedness plans developed under the Bush 43 and Obama administrations should be reviewed and evaluated, with an eye toward devising a new national strategy for dealing with emerging diseases and other public health threats and creating the necessary infrastructure within the Department of Health and Human Services to support it. It will be essential to secure Congressional appropriation of necessary federal funds to support the new strategy and infrastructure.Many more actions will be necessary to stop the pandemic’s advance, but these are among the most urgent.
Alan B. Cohen, Sc.D. is a Research Professor in the Markets, Public Policy and Law Department of the Questrom School of Business, and Professor of Health Law, Policy and Management in the BU School of Public Health. He also is Editor of The Milbank Quarterly, a leading multidisciplinary journal of population health and health policy. He served as national program director for the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research Program from 2013 to 2018, and also directed the Robert Wood Johnson Foundation Scholars in Health Policy Research Program from 1992 to 2016. At BU since 1994, he directed the Questrom School’s Health Care MBA Program for nine years (1994-2003), and the Boston University Health Policy Institute for ten years (2003-2013). His current research interests include: national health policy and health system reform; comparative health care systems; and evaluation of quality improvement initiatives. Earlier in his career, Dr. Cohen held faculty positions at Johns Hopkins University and Brandeis University, and spent eight years at the Robert Wood Johnson Foundation, serving as Vice President for Research and Evaluation for five years. He is principal author of Technology in American Health Care: Policy Directions for Effective Evaluation and Management (Michigan, 2004); co-editor of Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care (Oxford, 2015); and co-editor of "The Politics and Challenges of Achieving Health Equity," a special issue of the Journal of Health Politics, Policy and Law (Duke, 2017). Dr. Cohen is an elected member of the National Academy of Social Insurance and a former editorial board member of Health Affairs, Inquiry, and the Journal of Health Organization and Management. He served as a member of the Advisory Panel on Improving Healthcare Systems for the Patient Centered Outcomes Research Institute (PCORI) in 2013-2015, and currently is a member of the International Scientific Advisory Group for the National Health Service's Collaboration for Leadership in Applied Health Research and Care (CLAHRC) in the West Midlands of the United Kingdom. He received his B.A. in psychology from the University of Rochester, and his M.S. and Sc.D. in health policy and management from the Harvard School of Public Health.