Biden builds out his Covid response

Presented by American Hospital Association

With Tucker Doherty, Brianna Ehley, Mohana Ravindranath and Rachel Roubein

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Quick Fix

— President Joe Biden will sign a series of executive orders laying the foundation for his Covid-19 response.

— More than a dozen states are encountering a new vaccine distribution roadblock: not enough shots to go around.

— The lengthy search for Biden’s FDA chief could land on a candidate who’s been at the agency this whole time.

WELCOME TO THURSDAY PULSE — where in less than a year, the NBA has gone from pandemic poster child to traveling super-spreader event.

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Driving the Day

BIDEN BUILDS OUT HIS COVID RESPONSE — The Biden White House will spend its first full day assembling the pandemic operation that will determine the trajectory of its next 99, starting with another round of executive orders, POLITICO’s Alice Miranda Ollstein reports.

The 10 directives read like a public health expert’s wish list for ending the Covid-19 surge: Biden will more liberally make use of the Defense Production Act to produce more medical supplies, create a panel dedicated to boosting testing, launch new vaccination initiatives and order more extensive guidance for safe school reopenings, among other actions.

That will feed into the White House’s broader blueprint for the response, which is laid out in a 21-page pandemic plan set to be released this morning.

FOR STATES WRESTLING WITH THE PANDEMIC, the help couldn’t come too soon. One year ago today, the CDC confirmed the first U.S. Covid-19 case. Since then, the virus has ravaged the nation’s economy and killed more than 405,000 people, while exposing the government’s deep deficiencies and reshaping American life.

The Biden administration’s new plan will “fundamentally change the course of the pandemic,” White House Covid coordinator Jeff Zients told reporters Wednesday, selling it as the key to “get us back to our lives and loved ones.”

THERE’S ONLY ONE PROBLEM: The plan so far is just a broad sketch — and it’s the details that will determine the administration’s success. That leaves Biden waiting on Congress to help flesh those out, POLITICO’s Heather Caygle, Sarah Ferris and Caitlin Emma report.

Democrats on Capitol Hill still aren’t sure how to tackle the White House’s requested $1.9 trillion Covid package, with lawmakers debating various strategies for quickly getting legislation to the floor.

— One option on the table: Employing a budgetary maneuver that would allow Democrats to evade a Senate filibuster, clearing the way for a package with minimal GOP support. But that would be a divisive first move, given that the White House has insisted it’s committed to unity, and it would also necessarily limit the scope of the bill.

— Another avenue would be to narrow the package’s focus, and start with a bipartisan bill that would just fund vaccine distribution and send stimulus checks to Americans. Still, such a bill would total far less than the figure Biden has sought – and would leave large parts of his much-touted pandemic plan without the funding it needs.

Either way, Democrats caution, speed isn’t Congress’ forte. Lawmakers are already eyeing a deadline for the relief package of March 14 — nearly two months from now.


STATES RUN LOW ON VACCINES — More than a dozen states say they are starting to run outof Covid-19 shots as they ramp up the pace of vaccinations, POLITICO’s Rachel Roubein and Brianna Ehley report.

It’s the latest hitch in an inoculation effort that’s run into obstacles across the nation. New York City canceled at least 23,000 vaccination appointments as supplies dwindled for first doses. Some states, like Colorado and Oregon, are scaling back eligibility for vaccinations or rejecting the outgoing Trump administration’s new, more expansive federal guidelines so they can ration scarce shots.

The dilemma represents a stark contrast from the early troubles of the vaccine rollout, when some states’ shots sat unused on the shelves.

— It’s also one of the first Covid challenges Biden will inherit. State health officials say they need better estimates from the federal government for how much vaccine they’ll receive and when, so that they can plan to distribute shots across mass vaccination sites and smaller clinics.

And yet, only about half of the nearly 36 million doses distributed so far have been administered, CDC data shows — though federal officials caution that could be an undercount because of lengthy reporting lags.

Building the Biden Administration

SEARCHING FOR BIDEN’S FDA COMMISSIONER — Acting Commissioner Janet Woodcock has emerged as the frontrunner for the permanent job, boosted by her credibility among the FDA’s career staff and her work over the last several months on the development of Covid-19 vaccines and drugs, POLITICO’s Sarah Owermohle, Adam Cancryn and Joanne Kenen report.

A longtime regulator, Woodcock is also viewed as easily confirmable — a key factor, since she would be part of the second wave of nominations to move through the Senate.

— Also in the mix: Former Obama FDA official Josh Sharfstein and principal deputy commissioner Amy Abernethy. But with Woodcock already at the helm in the interim, the coming days could functionally be her tryout for the permanent job, rather than a stopgap appointment.

BIDEN’s THROWBACK HEALTH TEAM — The new administration’s initial slate of health appointments is largely a collection of old hands and familiar faces. Those hires include a slew of former Obama health officials, such as Dawn O’Connell, a former HHS senior counselor who is now the senior counselor for the Covid response. She’ll be joined by fellow Obama alumni AJ Pearlman, who will be the response effort’s chief of staff, and Kathryn Alvarez, who will be deputy chief of staff.

— Among the other returning staffers: Deputy general counsel Lisa Barclay, a former FDA official, and Deputy Assistant Secretary for Public Engagement Joshua Peck, who has done stints at both CMS and HHS.

— They’ll join a handful of newer appointees, including Sean McCluskie, a longtime aide to HHS secretary nominee Xavier Becerra, who will be HHS chief of staff. Anne Reid, a former Elizabeth Warren staffer who worked on the Biden transition, is the new deputy chief of staff.

— Biden’s team has asked JEROME ADAMS to stay on. The outgoing surgeon general will stay on as an adviser during the administration’s early days, Zients told reporters. Biden earlier sought Adams’ resignation from his role as the nation’s top doctor, bringing an abrupt end to his tenure.

BIDEN TAPS FORMER ONDCP OFFICIAL AS ACTING DRUG CZAR — Regina LaBelle will be the acting head of the White House Office of National Drug Control Policy, which coordinates the federal response to the drug addiction epidemic, POLITICO’s Brianna Ehley scooped.

LaBelle was chief of staff at ONDCP during the Obama administration, and was most recently the director of the Addiction and Public Policy Initiative at Georgetown Law School’s O’Neill Institute. She returns to the agency amid soaring drug overdose deaths fueled by the pandemic.

— The search for the White House drug office’s permanent chief is still ongoing. Among the names that have been floated for the role are Rahul Gupta, the senior vice president and chief medical officer at March of Dimes, former Rep. Patrick Kennedy (D-R.I.) and former American Medical Association President Patrice Harris.

MICKY TRIPATHI TAKES TOP HEALTH IT SPOT — The health information exchange veteran was named Biden’s national coordinator for health IT as part of Biden’s Day One appointments, where he’ll continue a massive data-sharing overhaul that’s stretched across presidential administrations, POLITICO’s Mohana Ravindranath reports. Tripathi most recently headed partnerships at population health software company Arcadia.

— What DON RUCKER hopes he’ll do: In an interview, the outgoing coordinator emphasized the importance of continued efforts to free up patient data.

“What COVID showed is that we really have to move beyond mandated [static] reports to every federal agency and every state agency,” Rucker said. “We need to move to the use of health information that changes, getting the data live operationally, and then federal and state local agencies [can] then access that data.”

Providers

SHARED SAVINGS PARTICIPATION HITS NEW LOW — The number of accountable care organizations taking part in the Medicare Shared Savings Program has fallen to a five-year low, according to recently released data from CMS.

Just 477 ACOs were participating in the program at the beginning of 2021, compared with a peak of 561 participants in 2018. It’s a drop that provider groups argue was driven by the Trump administration’s “Pathways to Success” reforms, which they contend discouraged participation by increasing downside risks. An advisory group convened by the Biden campaign last summer proposed a broad reversal of those efforts.

What We're Reading

The world’s mass vaccination effort isnot just about ending this pandemic — it’s also key to suppressing Covid-19 before it mutates into something worse, The New Yorker’s Lawrence Wright writes.

California’s Covid surge is forcing hospitals torelax traditionally stiff limits on nurse workloads, KQED’s April Dembosky reports.

An American Sign Language interpreter who translated coronavirus updates for deaf Hawaiianshas died of complications related to Covid-19, The New York Times’ Concepción de León writes.