It鈥檚 in the nature of presidential candidates and new presidents to promise big things. Just months after his 1961 inauguration, President John F. Kennedy to send a man to the moon by the end of the decade. That pledge was kept, , such as candidate Bill Clinton鈥檚 promise to provide universal health care and presidential hopeful George H.W. Bush鈥檚 guarantee of no new taxes.
Now, during a once-in-a-century pandemic, incoming President Joe Biden has promised to provide 100 million covid-19 vaccinations in his first 100 days in office.
鈥淭his team will help get 鈥 at least 100 million covid vaccine shots into the arms of the American people in the first 100 days,鈥 Biden during a Dec. 8 news conference introducing key members of his health team.
When first asked about his pledge, the Biden team said the president-elect meant 50 million people would get their two-dose regimen. The incoming administration has since updated this plan, saying it will release instead of holding back some of that supply for second doses.
Either way, Biden may run into difficulty meeting that 100 million mark.
鈥淚 think it鈥檚 an attainable goal. I think it鈥檚 going to be extremely challenging,鈥 said , executive director of the Association of Immunization Managers.
While a pace of 1 million doses a day is 鈥渟omewhat of an increase over what we鈥檙e already doing,鈥 a much higher rate of vaccinations will be necessary to stem the pandemic, said , executive vice president for health policy at 麻豆女优. (KHN is an editorially independent program of 麻豆女优.) 鈥淭he Biden administration has plans to rationalize vaccine distribution, but increasing the supply quickly鈥 could be a difficult task.
Under the Trump administration, vaccine deployment has been much slower than Biden鈥檚 plan. The rollout began more than a month ago, on Dec. 14. Since then, 12 million shots have been given and 31 million doses have been shipped out, according to the .
This sluggishness has been attributed to a lack of communication between the federal government and state and local health departments, not enough funding for large-scale vaccination efforts, and confusing federal guidance on distribution of the vaccines.
The same problems could plague the Biden administration, said experts.
States still aren鈥檛 sure how much vaccine they鈥檒l get and whether there will be a sufficient supply, said , chief medical officer for the Association of State and Territorial Health Officials, which represents state public health agencies.
鈥淲e have been given little information about the amount of vaccine the states will receive in the near future and are of the impression that there may not be 1 million doses available per day in the first 100 days of the Biden administration,鈥 said Plescia. 鈥淥r at least not in the early stages of the 100 days.鈥
Another challenge has been a lack of funding. Public health departments have had to start vaccination campaigns while also operating testing centers and conducting contact tracing efforts with budgets that have been critically underfunded for years.
鈥淪tates have to pay for creating the systems, identifying the personnel, training, staffing, tracking people, information campaigns 鈥 all the things that go into getting a shot in someone鈥檚 arm,鈥 said , director of global health & HIV policy at 麻豆女优. 鈥淭hey鈥檙e having to create an unprecedented mass vaccination program on a shaky foundation.鈥
The latest covid stimulus bill, signed into law in December, allocates almost $9 billion in funding to the CDC for vaccination efforts. About $4.5 billion is supposed to go to states, territories and tribal organizations, and $3 billion of that is slated to arrive soon.
But it鈥檚 not clear that level of funding can sustain mass vaccination campaigns as more groups become eligible for the vaccine.
Biden released a last week to address covid and the struggling economy. It includes $160 billion to create national vaccination and testing programs, but also earmarks funds for $1,400 stimulus payments to individuals, state and local government aid, extension of unemployment insurance, and financial assistance for schools to reopen safely.
Though it took Congress almost eight months to pass the last covid relief bill after Republican objections to the cost, Biden seems optimistic he鈥檒l get some Republicans on board for his plan. But it鈥檚 not yet clear that will work.
There鈥檚 also the question of whether outgoing President Donald Trump鈥檚 impeachment trial will get in the way of Biden鈥檚 legislative priorities.
In addition, states have complained about a lack of guidance and confusing instructions on which groups should be given priority status for vaccination, an issue the Biden administration will need to address.
On Dec. 3, the health care personnel, residents of long-term care facilities, those 75 and older, and front-line essential workers should be immunized first. But on Jan. 12, the CDC shifted course and recommended that everyone over age 65 should be immunized. In a speech detailing his vaccination plan, he said he would stick to the CDC鈥檚 recommendation to prioritize those over 65.
Outgoing Health and Human Services Secretary Alex Azar also that states that moved their vaccine supply fastest would be prioritized in getting more shipments. It鈥檚 not known yet whether the Biden administration鈥檚 CDC will stick to this guidance. Critics have said it could make vaccine distribution less equitable.
In general, taking over with a strong vision and clear communication will be key to ramping up vaccine distribution, said Hannan.
鈥淓veryone needs to understand what the goal is and how it鈥檚 going to work,鈥 she said.
A challenge for Biden will be tamping expectations that the vaccine is all that is needed to end the pandemic. Across the country, covid cases are higher than ever, and in many locations officials cannot control the spread.
Public health experts said Biden must amp up efforts to increase testing across the country, as he has suggested he will do by promising to establish a national pandemic testing board.
With so much focus on vaccine distribution, it鈥檚 important that this part of the equation not be lost. Right now, 鈥渋t鈥檚 completely all over the map,鈥 said 麻豆女优鈥檚 Kates, adding that the federal government will need a 鈥済ood sense鈥 of who is and is not being tested in different areas in order to 鈥渇ix鈥 public health capacity.
Today marks the launch of , which monitors the 100 most important campaign promises of President Joseph R. Biden. Biden listed the coronavirus and a variety of other health-related issues among his top priorities. You can see the entire list 鈥 including improving the economy, responding to calls for racial justice and combating climate change – . As part of KHN鈥檚 partnership with PolitiFact, we will follow the health-related issues and then rate them on whether the promise was achieved: Promise Kept, Promise Broken, Compromise, Stalled, In the Works or Not Yet Rated. We rate the promise not on the president’s intentions or effort, but on verifiable outcomes. PolitiFact previously tracked the promises of and .
