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Analysis

Biden has delivered vaccines, but the hard part is getting people to take them

Nurse Practitioner Tabe Mase gives President-elect Joe Biden his first dose of the coronavirus vaccine on Dec. 21, 2020, as part of a growing effort to convince the American public the inoculations are safe.

JONATHAN NEWTON/THE WASHINGTON POST

By ANNIE LINSKEY | The Washington Post | Published: April 27, 2021

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WASHINGTON — Joe Biden offered voters a promise when he campaigned for the White House: He would do a better job on the coronavirus pandemic than President Donald Trump.

Accepting the Democratic presidential nomination in August, he pledged that "the first step I will take will be to get control of the virus that's ruined so many lives." Declaring victory three months later, he said, "I will spare no effort — or commitment — to turn this pandemic around."

Now, 100 days into his presidency, Biden can point to a host of figures showing that he has kept his promise, from plunging death rates to soaring vaccination numbers. But the hard part may be just beginning as the mission switches from churning out vaccines to getting people to actually get them — especially the reluctant, the remote and the disadvantaged.

"We're in a volatile period that is delicate, dangerous and requires special care," said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. "We moved from a scarcity of vaccines to abundance of vaccines, but they're now going unused because of hesitancy and refusal."

If the first challenge was logistical, the second is societal. It will require Biden to battle false information, challenge political divisions and overcome prejudices. How well he succeeds could determine the course of his presidency.

Biden sees a loftier purpose in conquering the virus - showing that government can work. That would not only reassure Americans who are cynical about politics, he says, but also show the world that democracies can protect their citizens better than populist authoritarians.

To achieve that, public health experts say, Biden must do more to address the pandemic globally. The United States has stockpiled the rights to millions of extra vaccines while other countries remain desperate to get them.

On Monday, Biden took a step in that direction, offering to share 60 million doses of the AstraZeneca vaccine with other countries.

"The fact that we're going to have this massive feast — and then have another feast in the fridge just in case we're still hungry after the first one — while the rest of the world starves is not appropriate," said Craig Spencer, director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center. "We need more clarity into what those decisions are going to be."

Still, after 100 days, Biden can cite some notable mileposts.

More than half of American adults have received at least one dose of vaccine. Some weeks, the United States has administered more than 3 million shots a day. Daily deaths from COVID-19, the disease caused by the coronavirus, have plummeted to a daily average of about 720, from 4,400 on the day Biden took office.

Biden also has delivered resources, muscling through Congress a $1.9 trillion economic stimulus package, one of the largest domestic spending measures in history, that includes significant funding to combat the virus.

Polls suggest that most voters approve of Biden's handling of the pandemic.

"It restores some faith in the government, compared with the Trump regime where he was questioning everything that the CDC said," said Mimi Hanna, 65, of Wisconsin, referring to the Centers for Disease Control and Prevention. She voted for Biden, she said, but viewed him at the time as a vehicle to get rid of Trump rather than an inspiring choice.

But his performance has raised her estimation. Now, she says, Biden would "have to make a big blunder" to lose her support.

Still, a definitive end to the pandemic remains elusive. The United States is at an inflection point because many who have been clamoring for a vaccine now have access to one. The harder job is selling the shots to the roughly 20% of Americans who say they do not want to be vaccinated.

The crucial goal of reopening schools also remains a challenge. Data suggest that Biden will succeed in opening most K-8 public schools within his first 100 days, as he has promised, but the prospects for the fall are less clear, with many experts saying public schools probably will not return to normal by then.

Although Biden gets most of the credit or blame for the course of the pandemic, many of the critical decisions are made by governors and mayors. And local leaders in both major political parties are now seeking urgently to avoid more shutdowns and mandatory distancing, even as more-dangerous variants of the virus emerge.

"We're out of the astronomical winter surge," Morrison said in a recent interview. More than 50,000 new infections per day are occurring in the United States, and he added: "We've got to get to 10,000."

To the extent that Biden has hit his key markers, it's largely a result of detailed planning, according to experts and White House officials. Biden set up a transition staff in April 2020 that started planning for the pandemic, months before he was even the Democratic nominee.

Among Biden's earliest announcements was that Jeff Zients, a bureaucratic fixer with a history of tackling big programs, would coordinate his pandemic response. Biden instructed him to "overwhelm the problem and prepare for contingencies," and "never plan to do just enough," Zients recalled in an interview.

When he took office, Biden issued a flurry of long-planned executive orders on the coronavirus. He used the Defense Production Act to break through bottlenecks. Pfizer chief executive Albert Bourla said Biden "significantly aided our effort" by using his authority to free up raw materials and equipment.

Biden also deployed more than 1,000 troops to vaccination sites and secured hundreds of millions of additional doses.

"He really pushes us on the details, the implementation and execution, the cases, the numbers, the operational detail," Zients said.

At the same time, Biden has worked to change the public conversation, with mixed results. He offers a far more empathetic tone than Trump, who at times seemed to imply that getting the coronavirus — or wearing a mask to avoid it — reflected weakness.

Biden repeatedly asks Americans to wear masks as a "patriotic duty" and rarely appears without one. "They brought down the temperature," Morrison said.

Biden did inherit some successes from Trump, taking office with two vaccines ready to go and the outline of a vaccine distribution program already in place.

His efforts hit a glitch this month when officials paused distribution of the Johnson & Johnson vaccine after extremely rare cases of blood clotting were reported.

That remains a potential setback, though some experts praised the administration's response. "I can only imagine what that would have been like if the Trump administration had been in place," Spencer said. "It wouldn't have been done in the same type of science-based, calculated, boring way that it was done."

Trump immediately criticized the pause. "The Biden administration did a terrible disservice to people throughout the world," he said, claiming that the decision was made for political reasons but citing no evidence.

The pause also showcased the administration's efforts to ease the minds of Black Americans, a group that initially was highly reluctant to receive the vaccine.

Within hours, Biden's team had contacted thousands of local opinion leaders. That included Matifadza Hlatshwayo, a clinical instructor at the Washington University School of Medicine in St. Louis.

"It could have been a huge hit in the head for some people, a huge hit for overall vaccine confidence," she said of the suspension. "As a person who's been asking for transparency and honesty for communities of color that have valid mistrust, this was a big step toward earning that trust."

Distribution of the Johnson & Johnson vaccine is now being resumed with a warning label.

The administration is having a harder time bridging the partisan divide when it comes to the vaccine. An NPR/PBS News Hour/Marist poll taken in March showed that nearly half of Republican men said they would choose not to be vaccinated.

As for global need, officials say that as more Americans get vaccinated, the United States will help other countries with supply. For now, they say, the nation's rights to hundreds of millions of additional doses could still be needed here as booster shots are developed, younger children begin qualifying and unforeseen obstacles arise.

And they acknowledge that Biden's larger goal of restoring trust will not be easy.

"It doesn't happen overnight," Zients said. "We're making significant progress on showing that government can work, can solve problems — or at least contribute to making people's lives better."