Former Biden Advisers Urge a Pandemic Strategy for the ‘New Normal’

In a striking critique, six prominent health experts who advised President Biden’s transition team called for an entirely new domestic coronavirus strategy.,

In a striking critique, six prominent health experts who advised President Biden’s transition team called for an entirely new domestic coronavirus strategy.

WASHINGTON — On the day President Biden was inaugurated, the advisory board of health experts who counseled him during his transition officially ceased to exist. But its members have quietly continued to meet regularly over Zoom, their conversations often turning to frustration with Mr. Biden’s coronavirus response.

Now, six of these former advisers have gone public with an extraordinary, albeit polite, critique — and a plea to be heard. In three opinion articles published on Thursday in The Journal of the American Medical Association, they called for Mr. Biden to adopt an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely, not to wiping it out.

The authors are all big names in American medicine. Several, including Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration, and Dr. David Michaels, a former head of the Occupational Safety and Health Administration now with George Washington University’s School of Public Health, have held high-ranking government positions. Dr. Ezekiel Emanuel, an oncologist, medical ethicist and University of Pennsylvania professor who advised former President Barack Obama, organized the effort.

Like any White House, Mr. Biden’s prizes loyalty and prefers to keep its differences in house; in that regard, the articles are an unusual step. The authors say they wrote them partly because they have not made headway talking directly to White House officials.

“From a macroperspective, it feels like we are always fighting yesterday’s crisis and not necessarily thinking what needs to be done today to prepare us for what comes next,” Dr. Borio said.

The authors shared the articles with White House officials before they were published, but it was unclear whether the administration would adopt any of their suggestions. Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, declined to comment on the articles.

The White House press secretary, Jen Psaki, told reporters she had not read the articles, and dismissed a question about whether the president “is coming around to accepting” that Covid-19 is here to stay, even though several recent media accounts suggested that the administration was beginning to operate under that assumption. Mr. Biden’s recent emphasis on keeping schools open and businesses running even when cases are soaring also suggests a recalibration, as does a recent decision by the Centers for Disease Control and Prevention to recommend that people with Covid isolate for five days instead of 10.

“The president’s goal is to defeat the virus,” Ms. Psaki said, adding, “The president’s focus and objective now is to save as many lives as possible.”

Outlining their ideas for the “new normal” strategy, Dr. Emanuel and two co-authors — Michael T. Osterholm, an epidemiologist at the University of Minnesota, and Dr. Celine Gounder, an infectious disease expert at New York University — pointedly noted that in July, Mr. Biden proclaimed that “we’ve gained the upper hand against this virus,” which in retrospect was clearly not the case.

Now, with the Omicron variant fueling an enormous new surge, they wrote, the United States must avoid becoming stuck in “a perpetual state of emergency.” The first step, they wrote, is recognizing that the coronavirus is one of several respiratory viruses circulating, and developing policies to address all of them together.

To be better prepared for inevitable outbreaks — including from new coronavirus variants — they suggested that the administration lay out goals and specific benchmarks, including what number of hospitalizations and deaths from respiratory viruses, including influenza and Covid-19, should prompt emergency mitigation and other measures.

In addition to urging the administration to adopt a longer view, the authors took pointed issue with some of Mr. Biden’s current policies and stances — especially on political lightning rod issues. They called for more aggressive use of vaccine mandates, which have drawn fierce opposition from Republicans, and said the nation needed a digital verification system for vaccination — so-called vaccine passports — which Mr. Biden has resisted in the face of Republican attacks on the concept.

“Relying on forgeable paper cards is unacceptable in the 21st century,” wrote Dr. Borio, Dr. Emanuel and Dr. Rick Bright, the chief executive of the Rockefeller Foundation’s Pandemic Prevention Institute.

The most surprising thing about the articles is that they were written at all. Several of the authors said in interviews they were dismayed that the administration seemed caught off guard by the Delta and Omicron variants. Dr. Bright, who helped write two of the pieces, recalled the warning he issued when the advisory board had its last meeting on Jan. 20, 2021.

“The last thing I said,” he recalled, “is that our vaccines are going to get weaker and eventually fail. We must now prepare for variants; we have to put a plan in place to continually update our vaccines, our diagnostics and our genomics so we can catch this early. Because the variants will come, and we should never be surprised and we should never underestimate this virus.”

Mr. Biden published a pandemic strategy when he came into office, and Dr. Emanuel said the administration “executed very well on it through June,” until the Delta variant brought a new surge of cases. The president recently released a new winter strategy, just as the Omicron variant began spreading in the United States.

Many of the steps the authors suggest — including faster development of vaccines and therapeutics; “comprehensive, digital, real-time” data collection by the C.D.C.; and a corps of “community public health workers” — are already part of Mr. Biden’s plans.

He has taken steps to control the spread of Omicron and to ensure that hospital systems do not get overwhelmed. He has sent military troops to states including Wisconsin and Indiana to help out at hospitals, and has opened new testing sites in New York and elsewhere. He has insisted there will be no lockdowns, and has repeatedly pleaded with Americans to get vaccinated.

“I honest to God believe it’s your patriotic duty,” Mr. Biden said recently.

But Dr. Bright said such language was turning off Americans, including many Trump voters, who are resistant to vaccines.

“The message continues to berate unvaccinated people and almost bully unvaccinated people,” said Dr. Bright, who led a federal biomedical agency during the Trump administration but quit the government after being demoted for complaining about political interference in science. “There are so many reasons people are unvaccinated; it’s not just because they follow Trump.”

The authors say the administration needs to look past Omicron and acknowledge that it may not mark the end of the pandemic — and to plan for a future that they concede is unknowable. They also make clear that the current rate of Covid hospitalizations and deaths, an average of more than 1,300 lives lost each day in the United States, is unacceptably high.

In the three articles — one proposing a new national plan, the others suggesting improvements to testing, surveillance, vaccines and therapeutics — the authors also make more specific suggestions.

They call for next-generation Covid vaccines that would target new variants or perhaps take new forms, like nasal sprays or skin patches, that would be easier to distribute; for a “universal coronavirus vaccine” that would combat all known coronaviruses; and for major upgrades to public health infrastructure. And while they said the president’s pledge to buy 500 million rapid coronavirus tests and distribute them free was “an important step,” they wrote that “many more are needed.”

The authors also said that vaccine mandates should be imposed more broadly, including for schoolchildren, and that N95 masks should be made free and readily available to all Americans, as should oral treatments for Covid. (Mr. Biden has imposed several vaccine mandates on workers, but they are tied up in court.)

Dr. Gounder said she had been disappointed by the administration’s “single-minded focus on vaccines” and with its decreasing emphasis on mask-wearing. Dr. Borio said she had been “very frustrated” that there was no federal system linking testing to treatments, so that people who tested positive and were at high risk for Covid complications could get prescriptions on the spot for new antiviral medicines.

Dr. Emanuel — brother to Rahm Emanuel, Mr. Obama’s first chief of staff and Mr. Biden’s ambassador to Japan — echoed that sentiment. If the distribution of new therapies is left to “the usual health care system,” he said, only “rich, well-connected people” would have access.

The articles reflect both their frustrations and their desire to help, the authors said. They recognize that they have the luxury of taking a 30,000-foot view while administration experts are slogging it out in the trenches.

“But at the same time,” Dr. Bright said, “we think a lot of work still needs to be done.”

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