If you watched the presidential debates, you could be forgiven for thinking former Vice President Joe Biden’s COVID-19 containment plan boils down to “not Trump’s.”
When asked during the final debate on Oct. 22 how he would respond to the next phase of the pandemic, Biden spent much of his allotted two minutes attacking President Donald Trump, arguing that “anyone who’s responsible for that many deaths”—about 220,000—”should not remain as President of the United States of America.” Biden flicked at his own plan, which he said would encourage masking, increase investments in rapid testing and produce clear national reopening standards, but the response was light on details.
“The President thus far still has no plan,” Biden argued. But does Biden?
Biden gave a speech on his COVID-19 plan on Oct. 23, and he and running mate Senator Kamala Harris have circulated a seven-point plan for “beat[ing] COVID-19 and get[ting] our country back on track.” It is, experts say, what they’ve asked for since the pandemic began—but “the real devil’s in the details,” says Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. Everything comes down to execution and specifics. And on that front, it’s too early to say how things would go if Biden is elected.
Most of the Biden/Harris plan is unlikely to ruffle feathers among health experts. The seven points include:
- Testing as many people per day as are currently tested per week by doubling the number of testing sites in the U.S.; investing in rapid and at-home tests; creating a Pandemic Testing Board to oversee test production; and building out a 100,000-person national contact tracing workforce that would collaborate with community groups.
- Ramping up production of personal protective equipment like masks and face shields.
- Working with the U.S. Centers for Disease Control and Prevention to produce clear guidance for businesses, schools and other facilities trying to reopen, accompanied by government funding for businesses, schools and state and local governments.
- Creating (and investing $25 billion in) a vaccine production-and-distribution plan that ensures free and equitable access, while allowing scientists to clearly communicate progress with the public.
- Protecting vulnerable populations like the elderly and people of color, including through a COVID-19 Racial and Ethnic Disparities Task Force, and publishing a real-time data dashboard that provides local information about the outbreak.
- Restoring the White House office responsible for monitoring global health risks, which Trump disbanded in its original form in 2018, and rejoining the World Health Organization, among other efforts to strengthen the U.S.’ global health response.
- Encouraging universal masking by urging governors and local lawmakers to enforce mandates.
Reading the plan, “I couldn’t stop thinking, ‘What if we had this all along during the pandemic?’ What a different place we would be in,” says Dr. Leana Wen, a professor of health policy and management at the George Washington University Milken School of Public Health.
Toner agrees that the plan is solid, but says he’d like more specificity. It’s great to establish task forces and promise vaccine distribution, Toner says, but it’s hard to judge their efficacy without knowing exactly how they’ll work.
Dr. Howard Forman, who has advised the Biden campaign and is the director of the Yale University School of Public Health’s health care management program, says the plan is good overall, particularly with respect to its focus on coordination between states and the federal government, but agrees that it’s just “a broad outline at this point.”
The vaccine-distribution plan, in particular, needs to be far more detailed than what Biden’s campaign website currently offers, Forman says. “The logistics of getting all these entities involved and then the coordination of the final mile is going to be very challenging,” he says. Actually distributing a vaccine is hard enough, but a Biden administration would also have to convince people to get one—and potentially come back for a second dose, depending on which type of vaccine is approved. “A vaccine could be very effective but if the vaccination program is not, it’s not effective,” Forman says. “Period.”
A Biden campaign adviser who spoke with TIME says it’s difficult to predict the vaccine situation a possible Biden administration would inherit in January. “The trajectory of the virus, the advances of the trials and the work that the [current] administration is doing or not doing to lay the groundwork for an efficient, equitable distribution of the vaccine are all unknowns for us right now,” the adviser says.
Ensuring the safety and efficacy of a vaccine, and depoliticizing the development process, are top priorities, the adviser says. While vaccine trials continue, the campaign is also considering where Americans will be able to get vaccinated while adhering to social-distancing restrictions and working with community leaders who can help build public trust.
Toner says Biden’s seven-point plan doesn’t do enough to address how his administration would fulfill those responsibilities. “The most important thing that a President Biden could do is really communicate strongly and effectively the public health message,” Toner says. During Trump’s first term, decisions that should have been purely about public health—like wearing a mask—became political statements, Forman says, and it will take a strong, clear communications push to help reverse that.
A potential Biden Administration should push for daily press briefings from credible public-health experts and partner with a diverse roster of celebrities, influencers and community leaders who can push out accurate scientific information, Toner says. “They should really have a communication campaign that looks like a political campaign,” he says. “They should be flooding social media and the airwaves with public health messages.”
Biden plans to do all of that, the campaign adviser says. “You don’t know how much you miss it—basic, honest communication between a government and its citizens—until it’s gone,” the adviser says.
The plan’s final point, about universal masking, is likely to be its most controversial, given how polarized mask-wearing has become. There’s science to support a mask mandate—recent estimates suggest universal masking in the U.S. could save about 60,000 lives by February 2021—but people would likely chafe at the idea of a mandate. Biden has said he would mandate face coverings on all public interstate transportation and in federal buildings, but the bulk of the policy would likely entail asking governors and mayors to implement mandates at the state and local levels—a U.S. president likely can’t actually enforce a full national mandate.
The question is whether those governors and mayors would hear a presidential plea—and whether constituents would even listen to a local mandate. “I’m very concerned that large swaths of this country will not only not heed the guidance from a new administration, but will openly rebel against the guidance because it’s from this administration,” Wen says. “They need to win the hearts and minds of the American public by enlisting the most trusted messengers.”
Without that trust, Biden’s plan—if he gets a chance to use it—may stall before it starts.