| | | | | |  | | By Renuka Rayasam | With help from Myah Ward 98 DAYS TO GO — On this first full day on the job, President Joe Biden reset expectations on his single biggest campaign promise: an end to the pandemic. "It's going to take months for us to turn things around," he said today. Biden had already set a low bar for early success, which he has yet to revise. He's pledged that 100 million Americans will get a vaccine dose in his first 100 days in office. "C'mon, give me a break, man," said Biden in response to a question today about whether the goal was large enough. When Biden first made this pledge, it was an ambitious goal. But now it's only a modest bump from the pace of vaccinations that he inherited, even as Biden administration officials blame the Trump administration for not leaving behind a vaccine plan. During the last week, an average of more than 900,000 doses were administered a day. Moderna and Pfizer have already pledged to deliver 100 million doses each by the end of March. At a pace of 1 million doses a day, the virus wouldn't be contained until sometime in 2022. About 2 to 3 million Americans need to be vaccinated daily to end the pandemic by September, said Peter Hotez, a vaccine expert at the Baylor College of Medicine. The sooner the better, because new variants threaten to overwhelm vaccination efforts and further boost Covid deaths. "We've blown every other opportunity," Hotez said. "This is all we have left." Yes, it's only Day 2, and the transition was a mess, but the Biden administration has yet to detail how they will solve the problems that will plague the distribution effort in the coming months. Here is a look at the big vaccine-rollout problems ahead: Within days: Vaccine supply will be the biggest bottleneck in the short term. States are expected to run out of doses of the Pfizer and Moderna vaccine within days. States have had to cancel thousands of vaccine appointments. Adding to the crunch is that hospitals have a limited supply of syringes that can extract the most doses from a single vial — up to seven doses are in one Pfizer vial and 11 doses in a Moderna vial. Biden invoked the Defense Production Act today to boost available vaccine doses and syringes, but pharma executives say they won't be able to immediately dramatically increase capacity. In a few months additional vaccine candidates, especially one from Johnson & Johnson that requires only one dose, will also help boost vaccine supply. Within weeks: This will be the largest mass adult vaccination campaign in U.S. history. And it requires two doses. There is no process to make sure that everyone who got their first dose can and will come back for their second doses. There is no central database tracking who got the vaccine and which one they got. Ideally, Hotez said, there would be one federal registry that would track that information, but right now providers largely have to depend on those who got a first dose to remember to get a second shot. Many patients are struggling to even get a first appointment and there's no guarantee that they will be able to come back a second time. "Anytime you have a two-dose regimen, some people aren't going to come back," said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security. Finding people to administer doses, especially in rural or remote locations without health care providers, is also shaping up to be a major obstacle. About 20 states, including West Virginia and North Dakota which have led the country in distributing vaccines, have activated the National Guard to help with vaccine distribution. But in order to meet the pace of 2 to 3 million doses a day, states would need a plan to bring back retired health care workers or train others to administer the vaccine. Some are doing this, even bringing on vets and dentists, but more workers are needed. The plan Biden released today lacked details about how they will solve these major "last mile" challenges, said Rob Handfield, a supply chain management expert at North Carolina State University. "It still feels a little fluffy to me," he said. But a $1.9 trillion proposal that Biden released includes $400 billion for vaccine distribution efforts and he also used an executive order to restore funding for the National Guard's pandemic work. Within months: Biden's vaccination goal in the next three months includes many people who will be easy to reach and who want to get vaccinated. But what about reaching those who don't have insurance or even homes or are undocumented or are hesitant? Anthony Fauci said today that if we want to reach something approaching normal, we need 85 percent of the people in the country to get immunized by the end of summer. That's nearly 280 million people who get two doses of the shot — at least until a one-shot vaccine is approved. The White House has only just started sorting out an answer to those questions. Some people may be anti-vaxxers who believe misinformation about the shots. But others are people in minority communities who have a legitimate mistrust of the medical community. The Biden administration should actively start combatting vaccine misinformation, including taking down anti-vaccine websites and social media feeds, Hotez said. And start a series of targeted marketing campaigns to pitch the vaccine to communities across the country. Another item on a fast growing to-do list. In the latest POLITICO Dispatch, health care reporter Alice Miranda Ollstein breaks down the details of Biden's plan to beat Covid — and looks at whether he'll be able to get vaccine rollout back on track.
| | | Welcome to POLITICO Nightly. Janet Yellen gets the Hamilton treatment. Reach out at rrayasam@politico.com or on Twitter at @renurayasam.
| | | | TRACK FIRST 100 DAYS OF THE BIDEN ADMINISTRATION: Track the first 100 Days of the Biden administration. Written for political insiders, this scoop-filled newsletter breaks big news and analyzes the initiatives, people and emerging power centers of the new administration. Subscribe today. | | | | | | 
President Joe Biden speaks during an event on his administration's Covid-19 response in the State Dining Room of the White House. | Getty Images | | | | NOT GONNA MISS MY (MOM'S) SHOT — Health care editor at large Joanne Kenen emails Nightly: Biden declared total war on the coronavirus today. "We're in a national emergency," he said on the first full day of his presidency. "It's time we treat it like one." But wars aren't won overnight — particularly when the battle wasn't truly joined for the first entire year of the pandemic. It will be months before we can hope for a degree of normalcy — and whether it's sorta normal or blessedly darn close to normal by the fall really depends on how well the Biden administration does in getting the vaccines out – and building public confidence in them — and how willing we are to take them. Fauci, almost giddy as he described how it felt to be free to speak his mind from the White House podium this afternoon, said if we want to reach something approaching normal, we need 85 percent of the people in the country to get immunized by summer. As Renu told Nightly readers a week or so ago, we're living in two parallel national vaccine universes. In one, people are spending hours refreshing websites and redialing numbers trying to get an appointment. Other people remain distrustful, whose fear of the shots outweighs their fear of a virus that has already killed 400,000 people in our country and 2 million around the world. As a health journalist, I don't trust stories based on an N of one — which is a fancy way of saying anecdote. Except when the N is my mom. And I'm writing about my mom because I, the daughter, have tried (and failed) to help her get a vaccine appointment. And while trying and failing, I, the journalist, have learned a lot about what's wrong with our vaccination program on the ground — particularly as it pertains to older Americans. My mom is 86. She's in good health for her age and is, as my kids would say, still one pretty sharp Granny. A retired sociology professor, who specialized in medical sociology, she does pretty well negotiating our crazy health care system. And if she's not as agile on the computer as her grandchildren, she can still do what she needs to do online. Except get a Covid-19 vaccine appointment. She got herself on her town and county waitlists. She thought that was enough, but hasn't heard a peep. We then got on the New Jersey state list, too. No response. I found a local news source that is updating vaccination sites in the county and nearby — a handful of pharmacies, an urgent care center, a few public health clinics, the local hospital. (Many, rightly, are in the poorer, Blacker part of her county.) We have left phone messages that have gone unanswered. I have tapped her information into a "chat" box at urgent care. We have clicked on websites that then tell me they have no vaccine and don't give her a way to get in line for one when they do get some. At the exact moment Biden became president at noon on Wednesday, I was clicking and clicking a hospital website that, the day before, had promised a new appointment-setting portal would open at that very moment. How propitious, I thought. And then the website crashed (HealthCare.gov PTSD for any health journalist!) By the time it came back up, a few hours later, and I got on, we were too late. No more vaccine. No more appointments. This isn't about line-jumping. I'm not pulling any strings. At 86, with community vaccination underway, my mom is supposed to be at the head of the line. And I see clearly how this is even harder for others. One website told people who don't have computers that they can call 2-1-1 (I don't know if that's statewide or countywide or just her town). But if someone doesn't have a computer, how are they going to see the screen directing them to call 2-1-1? The N.J. waiting list asked a whole lot of questions. My mom was able to type in the answers on the computer, but not everyone her age can negotiate a three-page form with a lot of checklists and text boxes. There's no way a set of 86-year-old thumbs (or mine for that matter) could have managed to fill in that form on a small phone screen. Making it more frustrating, we have friends elsewhere in the very same state but in different counties who are younger than my mom — and who have either been vaccinated or have appointments. Even their circumstances can be a little wacky. One friend told me his mom, in her late 60s, was getting a shot near her home while his Dad, also in his 60s, will have to drive an hour away. I'd happily drive my mom an hour. Twice. In the meantime, we wait, and we scroll, and we call and we click. My colleagues Alice Miranda Ollstein and Ben Leonard have more on Biden's "wartime" actions. Sarah Owermohle covers Fauci unchained.
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| | | | ELEPHANTS NEVER FORGET — Former President Donald Trump's supporters are mobilizing to exact revenge on the 10 House Republicans who supported impeachment last week, thrusting the GOP into a civil war just as party leaders are trying to move on from the Trump era, Alex Isenstadt writes. Pro-Trump Republicans are racing to launch primary challenges. The former president's donors are cutting off the Republican incumbents. And Trump's political lieutenants are plotting how to unseat them. Trump has split the GOP, pitting his loyalists against those who rebuked him for inciting the Capitol Hill insurrection and want to expunge him from the party. Whether the Trump-inspired insurgents succeed is far from clear. Dislodging an incumbent is notoriously difficult, and Republican leaders are expected to move aggressively to protect their members. But the early activity illustrates the degree to which Trump's staunch allies are determined to make his critics pay a price. "The stance taken by Liz was very contentious here in Wyoming," said Republican Bryan Miller, a retired Air Force officer expected to run against Rep. Liz Cheney, a House GOP leader who vocally supported Trump's impeachment. "This isn't going to be a passing thing that just goes away. It's growing and growing and growing every day across the state. People are unhappy."
| | | | KEEP UP WITH CONGRESS IN 2021: Tensions remain high on Capitol Hill as we inaugurate a new president this week. How are lawmakers planning to move forward after a tumultuous few weeks? How will a new Senate majority impact the legislative agenda? With so much at stake, our new Huddle author Olivia Beavers brings you the most important news and critical insight from Capitol Hill with assists from POLITICO's deeply sourced Congress team. Subscribe to Huddle, the essential guide to understanding Congress. | | | | | | | | PREP TIME — Senate Minority Leader Mitch McConnell is proposing to give Trump two weeks to prepare his legal case for his impeachment trial, Burgess Everett, Sarah Ferris and Heather Caygle write. McConnell told Republican senators he would propose to Senate Majority Leader Chuck Schumer that Trump have until early February to prepare his case, according to three people briefed on a conference call today. The discussion of a two-week delay comes as congressional leaders attempt to work out details of Trump's second impeachment trial, including the former president's defense against the House's charges that he incited the deadly insurrection at the Capitol earlier this month.
| | | Nightly asks you: In an executive order issued Monday, Trump listed 244 people he'd like to see honored with statues in a National Garden of American Heroes, including Muhammad Ali and Amelia Earhart. It is unlikely to get built. But if the garden were to come to fruition, which non-political figure would you like to see in it, and why? Send us your answer via our form, and we'll include select responses in Friday's edition.
| | | RICH COUNTRIES HOARD VAX — Global promises of equitable distribution of coronavirus vaccines are falling flat as the tool that was created to prevent wealthy countries from buying up the world's supply has yet to distribute a single dose. On one side are examples like the EU and the U.K., where more than 11 million doses of vaccines have already been administered. In total, the EU has signed contracts for 2.3 billion doses, while the U.K. has secured 367 million. If all those vaccines are approved, their populations will be able to be vaccinated almost three times over. But on the other side are the less wealthy nations, where national vaccination campaigns have yet to begin. COVAX, the joint effort to ensure equitable distribution of vaccines managed by the World Health Organization; Gavi, the Vaccines Alliance; and the Coalition for Epidemic Preparedness Innovations, was meant to solve so-called vaccine nationalism, but it has struggled to get off the ground. Although it has secured around 2 billion doses — with the goal of covering 20 percent of participant countries' populations by the end of 2021 — none have been delivered. And while its backers say the facility is "on track," it's still short of about $2.8 billion for 2021. Those most in need of support from COVAX are countries that can't afford to buy vaccines on their own, which total 92. These include places such as Afghanistan, Ethiopia, Uganda and Zimbabwe. However, many other countries that are paying for doses themselves, such as South Africa, had also pinned their hopes on the facility. "How can we claim that we're having equity now? We can't," said Kate Elder, senior vaccines policy adviser at Doctors Without Borders.
| | | TIPS FROM THE TOASTESS — Matt Wuerker talks to Morning Tech author Alexandra Levine , who also ghost writes non-political toasts and speeches, on what public remarks during the Biden administration will be like, and how they are likely to contrast with the off-the-cuff style of the Trump White House.
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| | | | | | | | | | WALK OF SHAME — Washington's public works department should have built an emergency system of drainage ditches, culverts and tunnels to divert into the Potomac River the torrents of praise, approval and adoration the press poured down on Biden on Inauguration Day, senior media writer Jack Shafer writes. Yeah, yeah, everyone can appreciate that the coverage was minted at the honeymoon pressworks journalists fire up for most new presidents, so in that sense the outbursts came as no surprise. For one thing, he isn't Trump, and that carries him a long way in the media precincts. Also, reporters and analysts craved something akin to normality after witnessing the Jan. 6 siege on the same steps, as they kept saying, where rioters had just gone hand-to-hand with police. And the swearing-in of a female vice president who hailed from the African and South Asian diasporas gave the occasion a genuine and deserved boost. But this doesn't excuse the rhetorical overkill that the press flung so profligately. At day's end, Rachel Maddow confessed to having worked her way through an entire box of Kleenex during the festivities and Joy Reid gushed like a partisan about the event. The Washington Post got with the program, giving Biden credit for not waiting "long to begin staffing up his administration, swearing in top White House aides," as if previous incoming presidents had dilly-dallied about taking the reins. The New York Times swallowed whole the recent myth-making that has transformed Biden from a shifty politician into a statesman, conveying his call for civility and unity and portraying him as a disciplined, restrained character when anybody who has studied his career knows he's anything but. On his Twitter feed, CNN media guy Brian Stelter actually complained that the gashouse gang at Fox News Channel were killjoying the happy day with criticisms of the coverage. Short of dosing commentators, anchors and reporters with Seconal to prevent their central nervous systems from over-reacting to Inauguration Day proceedings, maybe we could embed a house cynic on each network and newspaper to police or at least tamp down the irrational exuberance that rains down on most inaugurations. Think of the house cynic as the one trusted to stay off the sauce all night long so that when the party ends, a sober somebody is still standing to drive all the drunks home safely. Did someone forward this email to you? Sign up here. | | | | Follow us on Twitter | | | | Follow us | | | | |
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