Vial and syringe.

A Timeline of Biden’s Pandemic Response, Part 2: A Pandemic of the Unvaccinated (May – Sept. 2021)

This series, which will run in four parts, has been adapted from “A year in, how has Biden done on pandemic response?” which was originally published on January 5, 2022 on Medium. Read the first part here.

By Justin Feldman

Framing vaccination as a way to opt out of the pandemic, and understanding the unvaccinated to be political enemies, has helped absolve the Biden administration of its responsibilities to protect the public’s health and facilitated the relentless push to restore “normalcy” (i.e., full economic activity).

The administration knows better: In September 2020, while the vaccines were still being tested, key figures in Biden’s orbit warned that it was unlikely vaccination alone could sufficiently control the pandemic.

Anthony Fauci highlighted the importance of continuing non-pharmaceutical interventions unless there was a near-perfect vaccine, giving the example of the MMR vaccine’s protection against measles. Another figure was Andy Slavitt, who would go on to become a special advisor to the White House COVID task force during the first 100 days of the administration. Slavitt warned that a key danger in re-electing Trump was that it would lead to an insufficient, vaccine-only response to the pandemic, whereas Biden would promote other needed public health measures as well.

But, in November 2020, a few weeks after the election, Pfizer announced results of its phase 3 trial: the Pfizer-BioNTech vaccine had an unexpectedly high efficacy of 95% against severe disease. These results almost certainly influenced the Biden transition team’s approach. The Biden administration came into office with a pandemic management plan that included many non-pharmaceutical interventions, but never promoted the legislative agenda that would have enabled the plan.

As far as I can tell, from January 2021, the key players in the administration’s pandemic response policy (Jeffrey Zients, as well as White House Chief of Staff Ron Klain) planned to phase out any remaining support for public health measures once all adults were eligible for vaccination.

The marked policy shift came in mid-May, 2021, a few weeks after all adults were eligible for vaccination. The move that received the most attention was a revision to CDC guidance: the agency no longer suggested that fully vaccinated people wear masks in indoor public places, with very limited exceptions.

The science on the vaccines’ ability to reduce transmission was unclear at the time. But more than that, the guidance led to an entirely predictable response by businesses as well as state and local governments to remove mask requirements. And even if they were to strictly adhere to the new guidance, there was no practical way for most institutions to enforce rules differently by vaccination status.

The second shift, which received virtually no media attention, was the White House’s decision to abandon an OSHA regulation that would have protected most workers nationally. The agency had proposed requirements for masking, testing, and paid quarantine and isolation, among other provisions, but had become the target of various business groups. Instead, the administration went forward with a narrower rule restricted to health care workers.

May 2021 also marked a shift in language in federal public health messaging: Personal responsibility and the individual choice to get vaccinated became the central themes. “Your health is in your hands,” Walensky told the public on May 13th. This would be followed with the refrain commonly invoked by the administration, “the pandemic of the unvaccinated” in July.

The narrative of a pandemic that can be pinned on the irresponsibility of unvaccinated people is so pervasive and powerful that I find it important to assess here. When the mid-May 2021 policy shift occurred, many unvaccinated Americans were not ideologically opposed to being vaccinated. Throughout the month of May, more than a million doses continued to be administered daily. There were also various social, cultural, and economic barriers that made it difficult to receive vaccination in a timely way, such as not having paid time off from work to recover from potential side effects. Large racial inequalities in vaccination rates also remained in May — as of May 20, only about 22% of Black people had received their first dose, compared to 33% of whites. There have also been minimal federal efforts to coordinate vaccine community outreach beyond simply making vaccines physically available. In the summer of 2021, Biden gave a speech implying forthcoming federal efforts to go “door to door” with vaccines. To the limited extent this ever happened, it was not federally coordinated, but carried out by some local governments and non-governmental organizations.

Who remained unvaccinated by late 2021? While the media often highlights the notable partisan divide in vaccination rates, it’s also notable that half of unvaccinated adults didn’t vote for Trump — many did not vote at all. The unvaccinated are largely low-income, uninsured, pregnant, incarcerated, and children (including those under 5, for whom vaccination has not been authorized). While vaccination rates are high for people ages 65 and up, those in their late 70s and older have lower vaccination rates than younger seniors, suggesting a lack of autonomy (i.e., needing to rely on others to access health care) may play a role. And while racial gaps in vaccination rates have narrowed considerably, huge inequalities in COVID death rates remain. By my own calculations, age-adjusted COVID mortality rates in the U.S. between August 1, 2021 and December 4, 2021 were 30% higher for Black and Latino people, 100% higher for American Indians/Alaska Natives, and 340% higher for Pacific Islanders compared to non-Hispanic whites.

Finally, the Biden administration has exaggerated the proportion of hospitalizations and deaths attributed to the unvaccinated. For instance, Fauci claimed in July 2021 that only 1% of COVID deaths were among vaccinated people, but CDC’s data for the previous week showed the actual figure was 17%. By December 2021 when Zients assured vaccinated Americans that they had “done the right thing” and “will get through this,” the share of vaccinated deaths had increased to 28%. Vaccines continue to provide powerful risk reduction for severe illness, but they are not a panacea. Amid high viral transmission levels, more than a thousand vaccinated people will continue to die each week (particularly those who are older, immunocompromised, or otherwise high-risk).

Let’s get back to the timeline. When we left off, it was mid-May and the Biden administration had abandoned a comprehensive OSHA workplace regulation for COVID risk.

By June 2021, Biden’s major pandemic economic policy ­– expanded unemployment ­insurance — was coming under attack. For background, the 2021 unemployment expansion added $300 per week to the normally paltry jobless benefits. For many workers receiving the benefits, they were earning more from unemployment than they had on the job. Workers who have traditionally been restricted from the unemployment system, such as freelancers or the self-employed, were made eligible. The benefit also did not count against income limits for Medicaid eligibility, so many were able to enroll in the public health insurance program. Major reasons for remaining unemployed were, and continue to be, well-grounded fears of exposure to the virus in unsafe workplaces as well as needing to stay home due to childcare arrangements that changed as a result of the pandemic, even as schools are largely reopened.

Between May and August 2021, Republican governors in what would ultimately be 26 states ended their participation in the pandemic unemployment programs before their federal expiration date in early September. There were multiple options the Biden administration could have pursued to keep the benefits going in these states, ranging from lawsuits to transferring responsibility for administering benefits. While success was not guaranteed, officials did not even make an attempt. Why not? I think the most plausible explanation is that, as argued by the authors of this comprehensive Bloomberg Law analysis: “A war with GOP governors would carry significant political risk for the administration as it tries to sell more than $2 trillion in infrastructure spending and a massive families-focused legislative package.”

Then in early September 2021, amid a steep increase in deaths from the highly transmissible Delta variant, the pandemic unemployment programs expired at the federal level. The Biden administration was not in favor of renewing the benefits, and in August had told Congress, “the boost was always intended to be temporary and it is appropriate for that benefit boost to expire.” There were growing concerns among businesses that the expanded jobless benefits were fueling a worker shortage and, depending on who you asked, either ‘holding back an economic recovery’ or increasing wages. The programs’ expiration had little immediate effect on job participation rates, but workers are gradually burning through their savings, which suggests an increased need to reenter full-time employment regardless of occupational hazards or living situation. Towards the end of 2021, Secretary of Labor Marty Walsh told journalists that the administration continues to believe allowing jobless benefits to expire was a good idea, saying, “The president made it clear [letting benefits expire] was part of his reopening plan.”

On September 9th, 2021, days after federal unemployment benefits expired, Biden delivered a speech prompted by the Delta variant’s mounting death toll. This speech would mark the next major policy shift — an embrace of vaccine mandates. According to unnamed insiders interviewed by the Washington Post, the administration had eschewed mandates up until September because they feared the political repercussions, particularly an electoral challenge by Florida Governor Ron DeSantis. One effort that Biden announced was a regulation that would require vaccination for health care workers at facilities that accept Medicaid or Medicare reimbursement. Another was not technically a mandate: an OSHA regulation (much narrower in scope than the proposal abandoned by the White House in May) would require larger employers to ensure workers were vaccinated or, if not, that they were tested weekly. Workers could be obligated to pay for their tests, however, so there would be a strong incentive for vaccination. These initiatives could not take effect immediately. Predictably, they had to go through regulatory processes at their respective federal agencies, and both were then subject to legal challenges by industry groups. The Supreme Court is set to hear arguments on both issues on January 7th, 2022.

Justin Feldman

Justin Feldman, ScD is a social epidemiologist and a research fellow at the Harvard FXB Center for Health and Human Rights. His research focuses on police violence as well as economic and racial health inequities.

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