They suggest an approach based on a ‘new normal of life with covid,’ rather than continuing efforts to eradicate the virus

By Dan Diamond

Six former health advisers to President Biden’s transition team released a series of journal articles on Thursday calling for a “new normal” in the nation’s approach to fighting the coronavirus and other viral threats.

In the articles, the advisers lay out dozens of recommendations, sometimes explicitly and often implicitly criticizing the federal response. For instance, they urge the administration to create a “modern data infrastructure” that would offer real-time information on the spread of the coronavirus and other potential threats, saying inadequate surveillance continues to put American lives and society at risk. They also suggest investments in tests, vaccines and prevention beyond what the White House has done, such as mailing vouchers to Americans that could be used to obtain free, high-quality face masks.

“We’re trying to take the next steps, to anticipate where we need to be in the next three to 12 months,” said Ezekiel Emanuel, the University of Pennsylvania bioethicist who coordinated the effort. In an interview, Emanuel characterized the advisers’ articles, which were published in the Journal of the American Medical Association, as an “outline of a national strategy … to find a new normal.”

Rather than continuing in “a perpetual state of emergency,” he and the others argue, the United States must shift to a strategy of seeking to live with the virus by suppressing its peaks, rather than attempting to eliminate it.

Asked on Thursday whether Biden believed the virus was here to stay, and whether health officials had read the JAMA articles, White House press secretary Jen Psaki said, “the president’s ultimate goal continues to be to defeat the virus.”

“Right now, our approach is to … continue to press for what we know has worked to date, which is to get people more vaccinated, get people boosted, [and] wear masks when recommended by the [Centers for Disease Control and Prevention],” Psaki said at a news briefing. She added that Biden had also taken steps to expand the nation’s treatments against the virus, including purchasing large quantities of new antivirals to keep higher-risk people from getting seriously ill.

The advisers’ effort to rethink the federal response comes amid experts’ growing realization that neither vaccinations nor infections appear to confer lasting immunity against the coronavirus. Some also express frustration the White House has squandered opportunities to contain the virus as the administration approaches its first anniversary. About 44 percent of Americans disapprove of Biden’s handling of the pandemic, according to a poll conducted between Nov. 30 and Dec. 6 by NPR and Marist College, up from 28 percent in March 2020.

“I think they have pursued a very vaccine-centric approach,” said Celine Gounder, an infectious-disease doctor at New York University who served on Biden’s advisory board, faulting the White House for not investing more in tests, treatments and other public health protections to blunt the pandemic. “No one wants to face up to the reality: You can pay for it with prevention, as we’ve outlined, or you can pay for it on the back end, which is the American way.”

In their articles, Emanuel, Gounder and their colleagues — who include Luciana Borio, the former acting chief scientist at the Food and Drug Administration, Michael Osterholm of the University of Minnesota, Rick Bright of the Rockefeller Foundation and David Michaels of George Washington University — conclude that the current response has been patchwork and sometimes shortsighted.

For instance, the advisers note that last summer, Biden announced that “we’ve gained the upper hand against this virus,” after the CDC moved to roll back masking and social distancing recommendations. “The Delta variant proved these steps to be premature,” the advisers write, calling for “humility” in crafting a national strategy that grapples with covid’s persistence as the virus evolves.

To do so, the advisers say that vast new investments are needed, such as a “real-time, opt-out digital surveillance system” that would better monitor vaccinated Americans’ immunity levels and help determine whether new boosters are needed.

“Two years into the pandemic, the U.S. is still heavily reliant on data from Israel and the U.K. for assessing the effectiveness and durability of COVID-19 vaccines and rate of vaccine breakthrough infections,” they write.

In another article, the advisers call on the federal government to help phase in new vaccines that target specific variants, a step that vaccine makers have explored but that the White House has so far suggested is unnecessary. The authors also called for a coronavirus vaccine mandate for schoolchildren, pending more risk-benefit data and formal licensure of the children’s vaccine from federal regulators.

The advisers’ articles join a chorus of critics and commentators, including other public health experts who have rebuked the CDC over its messaging, saying Americans are confused over when to wear masks, isolate or take specific steps to protect themselves. Democrats on Capitol Hill, meanwhile, have pressed the White House to more aggressively help to vaccinate the world, saying that too little has been done to tamp down the risk of virus variants emerging abroad.

The Biden administration also has been widely criticized for failing to move faster to acquire and distribute hundreds of millions of rapid coronavirus tests, passing on opportunities last year to do so.

In interviews, the advisers said that Biden officials faced considerable challenges in trying to both execute a pandemic strategy and plan for the future, adding that their recommendations were meant to complement the administration’s efforts.

“You can’t fix the New York City subway while you’re also driving the subway cars,” Gounder said.

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