President Donald Trump had “rolled back progress” made under his predecessor Barack Obama to strengthen the nation’s health security, said Mr Biden, adding that the nation needs “leadership that builds public trust, focuses on real threats, and mobilizes the world to stop outbreaks before they reach our shores.”
Nearly four years later, President Biden has been in office for the majority of the public health crisis that exploded under his predecessor, whose administration compromised the nation’s response. But the Biden administration has struggled with a population that has refused to take the pandemic seriously, and been accused of failing to take it seriously itself, while the virus spreads, mutates and threatens to evade the tools to combat it.
For candidate Biden, the Covid-19 pandemic was an urgent priority. It is now his volatile political minefield, with a response undermined by Republican hostility, conspiracy theories, and Democratic indifference and willful blindness, while officials and Americans are mistakenly eager to return to a “normal” that might not ever arrive , ignoring guidance in service of the economy.
A mass mobilising campaign to vaccinate millions of Americans gave way to this winter’s abysmal booster uptake. An urgent warning about depleting funds for future vaccines and community testing efforts hit a wall in a preoccupied or politically antagonistic Congress. When his administration asked lawmakers for billions of dollars to keep fighting the pandemic last fall, the president falsely declared that it was “over”.
The future of the administration’s response to the ongoing emergency, and whether it will continue to be named an emergency at all, depends on whether the president – and officials across the US – heed persistent warnings from experts closely studying the pandemic.
After entering office two years ago, the president who once warned that the nation wasn’t prepared for a pandemic faces the prospect of having fewer tools and health precautions than when he started, losing a battle against widespread disinformation and a radically reshaped federal judiciary that has repeatedly ruled against his health authorities.
Investments in next-generation vaccines and testing – the tools on which the country has relied for the last few years – could soon disappear.
“The White House doesn’t have the appetite for that fight in Congress, and Congress is simply not going to give it to them,” according to Lawrence O Gostin, professor and director of the O’Neill Institute for National and Global Health Law at Georgetown Law and director of the World Health Organization Collaborating Center on Public Health Law & Human Rights.
“Covid is kind of now on the back burner, and the administration just doesn’t seem to have the political appetite to put all of its muscle behind Covid funding,” he told The Independent.
“One thing that’s absolutely clear is that Covid has not gone away, and the other thing that’s clear is that it’s going to keep mutating and becoming more efficient … in transmitting infection, and so we’re going to see wave after wave after wave,” according to Mr Gostin. “And we might begin to see a stronger correlation with hospitalisations and deaths over time, simply because people will either refuse to or just do not bother getting another vaccine because they just don’t think it’s worth it.”
Ongoing infections “are going to be a persistent albeit not necessarily front-of-mind problem for the foreseeable future,” Tulane University epidemiologist Dr Susan Hassig told The Independent.
“At what level, I don’t know,” she said. “It really is all dependent on the virus.”
While daily deaths from Covid-19 have declined, “400 people a day is still going to be 100,000 people a year from a preventable cause,” she told The Independent.
At the start of 2023, new hospital admissions for Covid-19 reached their fourth-highest rate during the pandemic, according to the US Centers for Disease Control and Prevention, after falling over the summer and steadily rising throughout the fall and winter.
Case counts are still likely vastly underreported as people are more likely to avoid testing if they know they’re sick or use at-home tests that are not reported to local health authorities, according to Dr Hassig. Infection rates are likely 10 to 20 times higher than what is currently measured by health providers, she told The Independent, leaving the US without an accurate picture of the scale of infections outside of hospitalisations and deaths.
The administration has struggled to convince Americans to get an updated shot to protect against variants; Fewer than 16 per cent of eligible Americans have received the latest vaccine, according to the CDC.
A “vaccine-only focus” has undermined the administration’s own messaging about the spread of disease and risk of infection, while masks disappearing from public health guidance and the CDC’s color-coded system of community transmission levels were a “signal that they’re not really trying to prevent infection,” according Dr Hassig.
“That’s not how you control an infectious disease,” she told The Independent. “That’s not what vaccines do. They keep people from dying.”
Americans with disabilities or who are acutely at risk of severe disease or long-term health issues, the extent of which we have yet to fully understand, are effectively hearing “you’re on your own” when it comes to Covid-19, Mr Gostin told The Independent.
“When nobody’s wearing a mask, when fewer and fewer people are being vaccinated, and when Congress won’t lift a finger to provide a dime for prevention and preparedness, that’s exactly what we’re telling people right now,” he said.
Such decisions also are being made while there is a lack of clarity about longer-term impacts of even mild coronavirus infections, including the outlooks for long Covid and post-Covid conditions, such as potential cardiovascular and neurological complications that could be a “ticking time bomb,” according to Dr Hassig.
Rather than boost funding for therapeutics, mitigation efforts, masks, tests and future vaccines to protect against constantly mutating disease, Republicans in Congress are launching an investigative committee about the origins of Covid-19.
Republicans also vowed to investigate Dr Anthony Fauci, the now-retired infectious disease expert targeted by far-right conspiracy theories and an anti-vaccine movement that continues to frustrate doctors and public health officials.
Questions about the emergence of the disease and its impacts have opened a vacuum exploited by bad-faith actors. Online misinformation watchdog NewsGuard has identified more than 600 websites publishing Covid misinformation. Under Elon Musk, Twitter effectively abandoned its health disinformation policy, and other social media platforms have struggled to combat waves of false and misleading claims.
Congressional hearings are likely to accelerate false claims that “erode trust in science and public health,” according to Mr Gostin.
“I think that the fact that we don’t have those answers … gives a negative space for misinformation and disinformation to flourish and to fill that void,” Dr Hassig said.
Meanwhile, a brutally successful reshaping of the federal judiciary by Republican officials, including a supermajority on the US Supreme Court, has struck down nearly every Biden-era regulation.
“I think we may rue the day that we are handcuffing federal public health agencies,” Mr Gostin told The Independent. “One day, we’re going to get an overwhelming health emergency, and we’ll look for the federal government to protect us, and they’ll have their hands tied behind their backs, unable to do anything.”