Consider This from NPR - Joe Biden Could Take Office During The Worst Of The Pandemic. What's His Plan?

Episode Date: November 9, 2020

In 2008, then President-elect Obama and President Bush set up a join task force to help the incoming administration deal with the financial crisis they were about to inherit. Brown University's Ashish Jha tells NPR a similar effort is needed now to deal with the coronavirus. But so far, there's no sign of any cooperation from the Trump administration.President-elect Biden has established his own task force of scientists and physicians to work on his administration's response to the pandemic. Task force member Dr. Nicole Lurie tells NPR one goal of their effort will be to convince Americans the virus is the enemy — not each other. The Biden administration will also inherit Operation Warp Speed, the government's vaccine development program. Gus Perna is the Army general in charge. He explains how vaccine distribution might work. The pandemic won't be the only public health challenge facing the Biden administration if millions of people lose their health care coverage. That's what could happen if the Supreme Court strikes down the Affordable Care Act, explains Erin Fuse Brown with Georgia State University's College of Law. In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

The president-elect of the United States of America, Joe Biden. In just over two months, president-elect Joe Biden will take office with a huge list of challenges. On Saturday night, he told the country what's at the top of that list. Our work begins with getting COVID under control. We cannot repair the economy, restore our vitality, or relish life's most precious moments, hugging our grandchildren, our children, our birthdays, weddings, graduations, all the moments that matter most to us until we get it under control. On Monday, the Biden transition team named a board of scientific advisors to help prepare

his administration to take action in January. But so far, those advisors do not appear to be working with the current administration. The model that we should be following is the 2008 financial crisis model when President Bush and incoming President Obama set up a joint task force to work together during the transition. Brown University's Ashish Jha told NPR, with the president refusing to concede the election, there's no sign the Trump administration is helping to ease the transition.

But he says right now, with the country setting daily records for coronavirus cases and hospitals filling up in many places, the U.S. needs more cooperation, not less. I mean, I think it would save tens of thousands of lives, literally, because we could start enacting policies that are going to eventually be enacted anyway, but a couple of months earlier and really during the months when things are going to be so bad. Consider this. Joe Biden is trying to show the U.S. will be in better hands with his coronavirus response. But out of his hands, whether the Trump administration transition team cooperates and whether the health care for millions of Americans survives the latest test at the Supreme Court.

From NPR, I'm Adi Kornish. It's Monday, November 9th. The news moves fast. Listen to the NPR News Now podcast to keep up. We update stories as they evolve every hour. So no matter when you listen, you get the news as close to live as possible on your schedule. Subscribe to or follow the NPR News Now podcast. It's Consider This from NPR. We do have breaking news.

You probably heard about this Monday morning. Pfizer announcing that early data from its human vaccine trial has shown it to be more than 90% effective. A vaccine with 90% efficacy would be a huge deal. But this is an early result from just one company. Experts are still waiting for the underlying data, and there's a few weeks more of study and testing needed before the approval process could begin. President-elect Biden said in a statement, quote, today's news is great news. But he also said, even if a vaccine meets the most optimistic timelines, quote, America will have to rely on masking, distancing, contact tracing, handwashing and other measures to keep themselves safe well into next year.

I think, first of all, that everybody's clear that we need to unite around a common goal. Dr. Nicole Lurie is a physician. She also worked on pandemic preparation when she was in the Obama administration. She's also been advising the Biden transition on its coronavirus response. And one of the new administration's goals, she told NPR, will be convincing Americans that the virus is the enemy, not each other. There needs to be a single source of truth and it needs to be communicated clearly. It's not public health versus the economy. It's all of us together versus the virus.

And everybody in this country needs to do their part. Lori said one thing the administration will focus on, setting new national standards and guidelines. Guidelines that will be more specific on how different communities should handle their outbreaks. President-elect Biden has also released a COVID plan that includes more federal investment in testing. It would partner thousands of public health workers with local organizations around the country doing contact tracing and other work with populations at high risk for COVID-19. We need to get a stimulus bill passed. We need to get the resources into communities to be ready for a vaccination campaign, to support people financially if they're sick so that they actually do stay home from work.

All of those other pieces that are going to be essential to reopening the economy. So let's talk more about vaccines. There's still lots of hurdles to clear before any vaccine is authorized by the FDA, before enough doses can be produced. Then there's the task of getting those doses out to people. And that task is so big and so complicated, the Trump administration is leaning on the military to do it. It's all about just integrating, synchronizing and expanding capability and capacity.

It's not about ownership. It's not about I'm in charge. It's about checking egos, focusing on our purpose, which is delivering safe and effective vaccine to the American people. Gus Perna is the four-star general overseeing the logistics of getting a vaccine from manufacturers into people's arms. His official title is Chief Operating Officer of Operation Warp Speed. Perna spoke about how the operation is going with NPR's Mary Louise Kelly. One of their challenges, how to transport

millions of doses of a vaccine. Take Pfizer's, he said, which would have to be stored at negative 80 degrees. So what Pfizer has done is they've created ultra-cold capability that they can put the vaccine into a container and then it's filled with dry ice, which sustains the vaccine at the required temperature of minus 80. Do we have enough dry ice to get millions of doses out there? We do. Numerous companies make dry ice. Because I know governors were warned last month that in some rural areas that could be tricky. Yes. And so what we got to do is work the planning of that. We went out and found,

we did surveys about finding ultra cold refrigeration and that capability exists at reasonable prices. So all that was passed to the territories so that they could go purchase ahead of the requirement. So coupled with buying actual freezers, freezers that exist, and the dry ice capability that Pfizer has developed, really, I think we're in a good place there. All right. Once somewhere down the road, you have managed to transport everything and kept it cold and kept it safely stored. Where do people go? Is this going to be a vaccine we roll up to our local CVS or Walgreens and get? Are there going to be mass vaccination sites set up for this? So eventually, I do believe it'll be the CVS and Walgreens, Walmart. It won't be that initially, but I think it'll transition quickly too. Each state slash jurisdiction is telling us where they would like the vaccine. That's where we're going to deliver it to.

Some are going to go right to brick and mortar and working with CVS and Walgreens. Some are going to utilize their hospitals. But it'll expand rapidly as more vaccine becomes available. And then another question just on the details, because it's so important for people to understand quite what an undertaking this is. The Pfizer vaccine and the Moderna vaccine require two shots, and you have to take them weeks apart. Is there a plan for keeping track of who's taking what? Say I get a dose at my CVS here in Washington, D.C., and then I have to travel to New York, so I'm in a different state. Will there be a centralized tracking system? Yeah. So not centralized, but what we're working with is all the states and their capabilities. Each of the states have a very, very detailed plan on how they're going to track people to that end,

because what we want to do is just make sure they get the right shot when their time is up. The key, the real challenge, quite frankly, until we get into the right cadence, is making sure the second dose is available for everybody. Right, that you don't get one and then the second one isn't available. That's right. So, you know, when we have initial doses up front, what we're going to do is we're going to deliver the first doses and we're going to hold the second dose. And then for Pfizer, 28, one days later, we'll deliver the second dose.

For Moderna, it's 28 days later, we'll deliver the second dose. That way there's no potential for them to over administer and it won't overwhelm their local storage capabilities. So last question, and it's the very basic one. When might a vaccine, your best guess, be available that is effective and safe and available to every American who wants it? I think safe and effective vaccine will be available initially in December at tens of millions of doses, and will expand rapidly January, February, March, April for the toll of American people.

That was General Gus Perna with NPR's Mary Louise Kelly. Managing that vaccine operation is a huge public health challenge. It's also not the only one the Biden administration could face next year if millions of people lose their health insurance. So the stakes couldn't be higher because millions of people could lose coverage and the entire health care system could be altered fundamentally. Erin Fusay-Brown, a health law expert at Georgia State College of Law, is talking about what will happen if the Supreme Court rules that the Affordable Care Act is unconstitutional. The court, newly remade with a conservative majority, hears a case on that question this Tuesday.

The state of Texas is basically arguing that since Congress stripped the law of a key pillar, the individual mandate that everyone purchase health insurance, the rest of the law is now unconstitutional. Erin Fusay-Brown and I spoke about that argument and what could happen if the Supreme Court finds it persuasive. Legal experts from both sides of the political spectrum have argued that this is a very, very weak argument because the presumption in most instances is that even if one part of a law is considered to be unconstitutional, the court is going to interpret it to preserve as much of the law as possible because that was what Congress would have wanted. And here the idea is, can we separate the individual mandate, if it turns out to be unconstitutional, from the rest of this sprawling 1,000-page Affordable Care Act.

There's some irony here because I remember covering Congress when the law was passed, and that actually was the argument from Democrats. Without the individual mandate, the whole thing doesn't work. The individual mandate was considered very critical in the beginning. The thing that we've been surprised to find is that the individual mandate isn't exactly necessary. Since 2019, we actually haven't had a functioning individual mandate, and people are still buying insurance. What happens if this law is struck down? Give us the what if. So the what if, even if, you know, this is a legally weak argument, we are here at the Supreme Court. So there is a possibility, albeit small, that the Supreme Court could strike down the entire law. And if that happens, then utter chaos

will follow. If the entire law is struck down, I think one of the biggest immediate implications is that over 21 million people are going to lose their health insurance. And so, you know, about half of those... But why is that? Is the idea that all the insurers will just say, you know what, we've been making a ton of profit on this, but now we don't have to do it anymore, so good luck, everyone. Right. No, these are the people who actually gained coverage under the Affordable Care Act. So if you are someone who shops for insurance on healthcare.gov and gets subsidies, valuable payments to help make that coverage affordable, all of that subsidy would go away, healthcare.gov would disappear, the products themselves may not be there anymore. So all of those people would lose coverage. In addition, the Affordable Care Act also expanded Medicaid.

Medicaid's covered a lot, many, many millions of people. And so about 12 million people would lose their Medicaid coverage if the Affordable Care Act were to be struck down in its entirety. How would this affect people, though, who don't use the exchanges or get the subsidies? I mean, what would that mean to, I guess, the private market? If you have employer-based coverage, one of the big things that the Affordable Care Act did was to make it illegal for these plans to limit annual or lifetime benefits. And so for people who have employer-based or private insurance coverage, this is really an important protection. If you have cancer, if you have a chronic illness,

if you have really expensive health needs, then this is a huge protection. We've been here before, as you've said. I mean, also even looking at 2012 when the court kept the law intact. Congress has since kind of whittled away at it, even though they've never made it to a full repeal. Do you think that this is the end of this conversation? No, I don't think this is the end of the conversation. I think in some ways, you know, Congress still has a huge role to play. And the fact that Congress has been chipping away at the Affordable Care Act doesn't mean the Affordable Care Act has been eliminated. In fact,

the only thing Congress was able to successfully eliminate was this penalty for the individual mandate. And one of the things that this could open up, though, is future congressional fix. And so if the Supreme Court, for example, were to decide that this is the individual mandate is not severable, or that the parts of the act have to be struck down, then it's really in Congress's hands at that point to fix it. Erin Fusay-Brown, Associate Professor of Law at Georgia State University. It's Consider This from NPR. I'm Adi Cornish.