WASHINGTON – Months after proclaiming the U.S. was on the verge of independence from the pandemic, President Joe Biden is set to deliver remarks Thursday on how he plans to combat the spread of a contagious variant of COVID-19 that's driving up daily new cases and once again overwhelming hospitals.
The speech, which will include a "six-pronged strategy" focused on containing the delta variant and boosting vaccination rates in hesitant corners of the country, is a tacit acknowledgement that efforts have so far fallen short of Biden's campaign promise to bring the pandemic under control.
At least 75% of adults in the U.S. have received at least one COVID-19 vaccine dose, a milestone that has helped prevent vaccinated Americans from hospitalization and death as the delta variant persists. But tens of millions of Americans remain unvaccinated, threatening to continue disrupting classrooms, vacations and even plans for the holidays – a frustrating reality after a summer that saw the pandemic wane before a return to mask mandates and delayed return-to-office timelines.
The president's speech, public health experts say, comes at a critical point when the White House can refocus its strategy on restricting life for the unvaccinated and clearly lay out how it plans to bring the pandemic to an end after 18 months. While Biden has had to juggle a hyper-partisan pandemic response, resistance to a federal vaccine requirement and a focus on the return to normalcy set up unrealistic expectations, experts say.
"Risk communication during a pandemic is extremely challenging, and the longer it goes on the harder it gets," said Richard Besser, president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. "In this current climate it's harder than ever."
More Americans appear to be unclear about the administration's path forward on COVID-19. A July Gallup poll found that 41% of respondents disagree that the CDC has communicated a clear plan of action on COVID-19 compared with 32% who agree.
The same poll found Americans divided over whether Biden has communicated clearly on the pandemic, with 40% saying he has while 42% disagree. The survey marks the first time Americans have not been more positive than negative about Biden's communication on the virus since he was a presidential candidate.
Shifting to mandates
White House press secretary Jen Psaki said the six-pronged plan would include new steps aimed at both the public and private sectors, requiring more COVID-19 vaccinations, boosting testing measures and making it “safer to go to school.”
Biden, who met with members of his White House COVID-19 response team Wednesday, is expected to focus on schools as children return to in-person learning this fall amid rising fears that classrooms could lead to a surge in cases.
Psaki also said the plan would build on recent actions from the administration including: requiring federal workers to attest to being vaccinated or face routine testing and other mitigation requirements; conditioning federal funding for nursing homes on vaccination of staff; and encouraging private companies to institute vaccine mandates. The Pentagon and the Department of Health and Human Services are also requiring military members and staff to be vaccinated.
“We have more work to do, and we are still at war with the virus and with the delta variant,” Psaki said, adding that the pandemic is “front of mind” for Americans.
Juliette Kayyem, a former Obama administration homeland security official who's called for the Biden administration to restrict unvaccinated people from boarding flights, said vaccinated people should no longer carry the burden for those resisting rolling up their sleeves.
"Public health messaging undervalued the urgency in getting the unvaccinated two shots in a favor of a process of trying to educate them and understand them," she said. "What I'd like to see from the White House is for it to pivot from begging and cajoling to demanding – because the vaccinated have feelings too."
The White House has so far resisted calls for more broadly mandating that Americans get vaccinated, arguing the president does not have the legal authority. But Kayyem points to recent polling from the Kaiser Family Foundation that found a vast majority of those who said they would "only get vaccinated if required" remain unvaccinated, underscoring the argument for a mandate, even if it leads to legal challenges.
She also noted polling that shows the majority of Americans favor requiring people to show proof of a vaccination for air travel, dining in a restaurant or to go to their office, according to Gallup. An AP/NORC poll found that the majority of American adults want vaccination mandates for sports, concerts, movies and other crowded events.
"The polling suggests that the American public is not only getting impatient with the unvaccinated but is getting impatient with the failure to simply move on from the unvaccinated," she said.
Roughly 2 in 3 Americans – parents and non-parents alike – are in favor of schools or states implementing mask mandates for teachers and students, according to a recent USA TODAY/Ipsos poll. Respondents are similarly in favor of requiring teachers and other school employees to be vaccinated against COVID-19: 65% of all participants – and 56% of parents – say they support such mandates, the poll found.
That frustration is felt by public health officials, according to Besser, who struggle to overcome the politicization of the pandemic and vaccines, as well as the misinformation and mistrust of government.
"Meeting people where they are is part of it, but then I think also restricting what people can do – if they're not vaccinated – is also a legitimate strategy."
An early declaration?
The president used his Fourth of July speech to declare the U.S. had lived through some of its darkest days but was "about to see our brightest future." That prospect has dimmed as the summer draws to a close and the U.S. has notched more than 40 million COVID-19 cases since the pandemic began. More than 650,000 people have died in the U.S. and daily infections and deaths are much higher than they were a year ago. Reports of more children falling ill are raising alarm as students return to in-person learning.
"I think one of the big communication challenges from the administration was premature declaration of independence from the virus," Besser said Biden's Fourth of July speech. "Because in reality, we don't get to say when we're free of the virus, the virus will show us when we're free of that."
Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, said while the country is much better off than a year ago, public health officials probably made missteps around preparation for the delta variant, which tore through other countries as the U.S. told vaccinated Americans they could return to some semblance of normalcy and attend large gatherings unmasked.
"We all probably should have realized that the delta variant is coming and we're going to have to get through that," he said.
In the months since, the delta variant has fueled a spike that's led to roughly 150,000 cases and nearly 1,500 deaths per day – even as vaccines are widely available.
Part of that problem, according to Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, is the Biden administration's "continual optimism" that began under the Trump administration.
"The best thing that we could have possibly done in a pandemic from a messaging perspective – without creating panic – is plan for the worst and hope for the best," he said. "Unfortunately we keep planning for the best and finding what actually happens is worse than what people and what our officials are saying or expecting."
Mina said the Biden administration should set better expectations about what we expect from vaccines and be clear that they do not limit the spread. Mandates that require either vaccination or routine testing incorrectly equate the two.
Julie Morita, a pediatrician and member of Biden's transition COVID-19 advisory board, contends it was completely appropriate to hone in on vaccines as evidence shows the majority of those who are hospitalized or dying are unvaccinated.
"We knew heading into this, and I think everyone anticipated there would be some people who would either choose not to get vaccinated or have challenges getting vaccinated," she said. "And yet to reach those groups requires a strong public health infrastructure, which we did not have prior to the pandemic."
Morita, executive vice president of RWJF and a former a commissioner for the Chicago Department of Public Health, said a gutted health system was part of Biden's challenge in blunting the spread of the virus.
"If the scaffolding was very weak to begin with – and the infusion of funding right now will help strengthen it – but it won't be as strong as it needs to be or should be in the long term," she said.
But one of the most difficult challenges, experts say, is the messaging as the colder months ahead drive more Americans indoors and raise the threat of delta thriving.
The Biden administration is preparing to offer booster shots for vaccinated Americans, though it's unclear when exactly that will begin. The president initially announced Sep. 20 as the target date, but health officials have warned that they may need more time to examine data. The U.S. Food and Drug Administration is scheduled to meet Sep. 17 to review booster shot data.
Mina and others hope Biden's speech will clarify some of the undefined guidance and provide a clearer picture of the months ahead.
"The pandemic is an information problem, and we should recognize it as such," he said.
Contributing: Joey Garrison, USA TODAY