Biden plan ‘pretty comprehensive’ but lacks direction on surveillance, testing, treatment
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President Joe Biden announced a six-pronged plan last week to combat a national rise in COVID-19 cases brought on by the delta variant.
The plan announced federal vaccine mandates for tens of millions of American workers and reaffirmed the administration’s commitment to offer booster shots of COVID-19 vaccine once they have been authorized by the FDA.
“I think that the six-point plan was pretty comprehensive,” Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security, told Healio. “There are things I think that I have issues with, but in general, I think it covered the aspects of the problems that we're having in the United States now, and really squarely laid the blame where it belongs — on the unvaccinated. I think that was very welcome.”
The plan also addressed keeping schools open safely, increasing testing and requiring masking, protecting the recovery of the economy, and improving care for patients with COVID-19. We asked Adalja and several experts what was missing.
Boosters
On Aug. 18, the Biden administration announced plans to offer third doses of COVID-19 messenger RNA vaccines to all fully vaccinated Americans beginning Sept. 20.
Under the plan, people would be eligible to receive the booster shot beginning 8 months after the date they received their second dose of the vaccine. The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet Friday to discuss the need for booster shots in the general public (third doses are already authorized for immunocompromised patients).
However, experts — including some from the FDA — have argued that there are no published data clearly supporting the need for booster doses in the general public.
“The one area I have grave doubts about is [the] plan for boosters,” Lawrence O. Gostin, JD, director of the O’Neill Institute for National & Global Health Law at Georgetown University, told Healio.
“The White House announced boosters before [Biden’s] key public health agencies had signed off,” Gostin said. “That is a fundamental error and has alienated career scientists at the FDA and CDC. His booster plan will face a rocky reception by FDA and CDC advisory committees. The White House should never get ahead of his public health agencies.”
After the CDC’s Advisory Committee on Immunization Practices (ACIP) unanimously voted in favor of recommending a third booster dose for moderately or severely immunocompromised people, CDC Director Rochelle P. Walensky, MD, MPH, made it clear that the recommendation was for a small percentage of patients, representing only about 3% of American adults.
A vote by the VRBPAC on Friday would be followed by an FDA decision on boosters for everyone else. If they are authorized, the ACIP would vote on clinical recommendations.
“I realize that Biden has a political obligation to save American lives, but he could have done it in a smarter way,” Gostin said. “I would have limited U.S. boosters to health and residential care workers and to the elderly and most vulnerable. The scientific data on boosting younger, healthier people are not established.”
Testing and surveillance
The White House plan aims to make at-home COVID-19 tests more available and affordable. Biden announced that retailers like Amazon, Walmart and Kroger will begin selling tests for up to 35% less for the next 3 months. However, this still falls short of what is needed, Adalja said.
“In Europe, there are many different types of rapid tests that are available, and they're very cheap — maybe the equivalent of $2,” Adalja told Healio.
“In the United States, we have a few manufacturers that have had rapid tests approved, and they're expensive, maybe $25 for two. That's not conducive to people using them everywhere as a way to know their status,” he said. “I'd like to see [the administration] calling on the FDA to allow very cheap antigen tests to be on the market, and to flood the market so people can have these everywhere they go.”
Infectious Disease News Editorial Board Member Jeanne Marrazzo, MD, MPH, director of the division on infectious diseases at the University of Alabama at Birmingham School of Medicine, said she would like to see the U.S. do a better job tracking cases and variants.
Currently, the delta variant makes up 99.4% of all U.S. COVID-19 cases. However, the new Mu variant is on the rise, accounting for 0.1% of all cases in its first week on public record.
“It was great to hear the president passionately endorse the need for increased uptake of SARS-CoV-2 vaccination. His question of ‘What else do you need?’ really resonated — as we watch helplessly as previously healthy unvaccinated young people literally die needlessly of COVID daily,” Marrazzo told Healio. “What I wish had been mentioned was the need to prioritize good surveillance to track emergent variants.”
Marrazzo said the plan also should have prioritized “the development of novel antivirals — especially oral agents we can employ to keep people out of hospitals — aggressive research to understand long COVID, and the trajectory of COVID-19 illness in fully vaccinated persons, or breakthrough infections.”
Support
Included in Biden’s plan was an order for the Department of Defense to doubly deploy military health teams to increase support of hospitals that are burdened with COVID-19 cases.
However, according to Bruce Y. Lee, MD, MBA, a professor of health policy and management at the City University of New York Graduate School of Public Health & Health Policy, Biden’s plan lacks ways to ease the burden and stress of doctors and health care professionals.
“There's mention of hospitals, but there needs to be more attention paid to the backbone of the health care system in the U.S. — the people working in health care,” Lee told Healio. “The pandemic has uncovered many of the underlying problems with the U.S. health care system that need to be addressed. One of these is physician and other health care professional burnout.”
References:
CDC. Variant proportions. https://covid.cdc.gov/covid-data-tracker/#variant-proportions. Accessed Sept. 15, 2021.
The White House. Path out of the pandemic. https://www.whitehouse.gov/covidplan/. Accessed Sept. 15, 2021.
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