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Comparing Trump and Biden on COVID-19

Published: Sep 11, 2020
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Issue Brief

Introduction

The first cases of a novel coronavirus were reported by the World Health Organization (WHO) in early January. Since then, the COVID-19 pandemic has become the worst health crisis facing the global community in more than a century. It has also taken a particular toll on the United States. Although the U.S. only represents 4% of the global population, as of early September, it accounts for 23% of all COVID-19 cases and 21% of all deaths, and ranks number one among high-income countries as measured by cases per capita.  In addition, most states in the U.S. are considered “hotspots”, with ongoing, widespread community transmission; shortages of testing and other needed supplies also continue. COVID-19 has significantly affected daily life in America, including the economy and school closures, and has emerged as an important factor in the 2020 Presidential election.  Polling data indicate that a majority of voters disapprove of President Trump’s handling of the outbreak and prefer Democratic candidate Joe Biden when it comes to tackling the pandemic. To gain a better understanding of how the candidates differ on their approach to addressing COVID-19, this document compares Trump’s record with Biden’s proposals. It starts with a broad overview of each candidate’s approach, followed by a detailed, side-by-side comparison.

Donald Trump

To date, in place of a coordinated, national plan to scale-up and implement public health measures to control the spread of coronavirus, the Trump Administration has chosen to rest the main responsibility for the COVID-19 response with the states, with the federal government serving as “back-up” and “supplier of last resort.” While this in part reflects federalism and the decentralized nature of U.S. public health, the lack of a national plan and strong federal guidelines have significantly contributed to a patchwork of policies, supplies, and outbreak trajectories across the country, and worsening community spread.

Early on, the President’s initial response to the new outbreak was focused on sealing U.S. borders and preventing entry of the virus.  President Trump moved to suspend entry from China on January 31, followed by others since. However, with community transmission already underway in the U.S., and challenges with screening arriving passengers,  travel restrictions were not effective in curtailing spread in the U.S. Meanwhile, the federal government was slow in bolstering public health capacities, such as testing and contact tracing, at the time the virus began to circulate domestically. As cases and deaths escalated, the gulf between what was needed and what was available grew quickly.

By mid-March, facing growing case numbers and seeing what had happened in other countries, several U.S. state and local jurisdictions began implementing stay-at-home orders and other social distancing policies. After conflicting messages from the President, who minimized the threat of the virus, the White House issued federal social distancing guidelines on March 16 for a 15-day period. Soon after, the President began pushing toward reopening, tweeting on March 22, for example, that “We cannot let the cure be worse than the problem itself. At the end of the 15 day period, we will make a decision as to which way we want to go!” and saying he hoped the country would reopen by Easter, with “packed churches.” The White House  extended the social distancing period through the end of April, and issued reopening guidelines for states on April 16. Still, even before the end of April, the President began encouraging Governors to reopen, although key reopening metrics were not yet met in most places. The President has also pushed for schools to re-open in-person even though community transmission has remained high in many places, and is much higher than it was in other countries that moved to re-open in-person schooling.

There have been ongoing challenges with COVID-19 testing in particular. These started with an early, faulty test developed by the Centers for Disease Control and Prevention (CDC) that resulted in a significant delay in scaling-up testing as coronavirus spread quickly in the U.S. They have continued through to the present with ongoing shortages of critical testing supplies; significant delays in turn-around times for results; and shifting and sometimes confusing federal guidelines that have been reported to be subject to political pressure. Yet the President said in March that “Anybody that wants a test can get a test,” and in May, “As far as Americans getting a test, they should all be able to get a test right now.” More recently, while Administration officials have continued to say that anyone who needs a test could get one, they have acknowledged the need to reduce turn-around times and continue to work to increase testing capacity.

Throughout the pandemic, and even as cases and deaths increased, the President has downplayed the threat of COVID-19. For example:

  • On January 22, in response to a question about whether he was worried given the first report of known U.S. case, he said, “No. Not at all. And– we’re– we have it totally under control. It’s one person coming in from China, and we have it under control. It’s—going to be just fine.”
  • On February 2, “We pretty much shut it down coming in from China.”
  • On February 25, “We have very few people with it.”
  • On April 28, “But I think what happens is it’s going to go away. This is going to go away.”
  • On June 17, he said it was “fading away.”
  • On July 19, “I think we’re gonna be very good with the coronavirus. I think that at some point that’s going to sort of just disappear. I hope.”
  • On August 5, “It’s going away. Like things go away. No question in my mind that it will go away, hopefully sooner rather than later.”

The President has also given conflicting messages and conveyed misinformation about coronavirus and has sometimes been at odds with public health officials (including those in the government) and scientific evidence. For example:

  • He has touted the use of the drug, hydroxychloroquine to treat COVID-19, despite the lack of evidence of its effectiveness, warnings of potential harms, and even after federal COVID-19 treatment guidelines recommended against its use.
  • He suggested that applying ultraviolet light to or inside the body, or injecting disinfectant, could combat coronavirus.
  • He has attributed rising COVID-19 cases to increased testing, despite the fact that this claim is not backed up by the data.
  • He has questioned the use of face masks, and given inconsistent messages about their use, even after CDC guidelines recommended them. It was only in July that he began to wear one in public at times and talk about their importance.
  • In pushing schools to re-open in person, he has said that children are “almost immune” and “don’t have a problem,” despite evidence to the contrary.
  • He called the FDA’s issuance of an emergency use authorization for convalescent plasma, a potential treatment for COVID-19, “historic” and a “breakthrough,” even though the FDA itself said it “may be effective” and the National Institutes of Health COVID-19 treatment guidelines panel concluded that there were insufficient data to recommend either for or against it and at this time, it “should not be considered standard of care for the treatment of patients with COVID-19.”

President Trump and White House officials often publicly disagreed with the recommendations being made by federal officials and public health scientists. The CDC, which in previous national public health emergencies was very much in the public eye, did not give press conferences. The President has also publicly criticized Dr. Anthony Fauci, who has been the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health since 1984, and generally not appeared in public with him recently, unlike earlier in the pandemic.

Even as the administration’s primary strategy was to rely on states, it has taken a number of actions to address the pandemic. The President established a White House COVID-19 Task Force on January 27, even before the WHO had declared COVID-19 to be a Public Health Emergency of International Concern (PHEIC) (although leadership of the Task Force has shifted and its public-facing and internal activities have diminished). Three federal emergencies have been declared, enabling the authorization of funds and allowing the mobilization of resources and enhanced flexibilities to respond, as follows: HHS declared a public health emergency (PHE) on January 31 (renewed since then) and the President declared national emergencies under the Stafford Act and the National Emergencies Act, on March 13.

The President has also signed four emergency spending bills passed by Congress, which provide trillions to address COVID-19 and offer new flexibilities and relief for individuals, businesses, states, and localities.  He has activated the use of the Defense Production Act (DPA) to expand production, prioritize, and allocate supplies in the U.S., if needed, and this authority has been used in select cases. The Food and Drug Administration (FDA) has provided emergency use authorization for hundreds of tests and other devices and the CDC has issued more than 170 guidance documents on COVID-19. In addition, the U.S. has launched “Operation Warp Speed”, a significant initiative to expedite research, development, and distribution of coronavirus vaccines. Finally, numerous other federal agencies have acted to help ease the burden of COVID-19, such as granting state Medicaid programs additional flexibilities, accelerating Medicare payments to hospitals and other health care providers, instituting new protections for nursing home residents, and issuing a strategy for “Accelerating Progress Towards Reducing COVID-19 Disparities and Achieving Health Equity.”

These measures are taking place against the backdrop of other non-COVID-19 specific Administration actions that could significantly affect the response, such as a continued push before the Supreme Court to overturn the Affordable Care Act (ACA), which has provided millions of Americans with insurance coverage and expanded access to health care.

On the global front, two of the emergency spending bills included funding for other countries, and the Administration had already begun sending international assistance to countries in need before the bills were passed. Following a more general foreign policy approach of “America First”, the Administration has chosen not to participate in several high-level international efforts to address COVID-19, has ended funding for the WHO, and has announced its intent to withdraw from WHO membership, actions that mark a significant departure from the role the U.S. has historically played, including its major role in combating the 2014 Ebola outbreak.

As part of his second term agenda, the President recently released the following goals for his proposal to “eradicate COVID-19”:

  • “Develop a Vaccine by The End Of 2020.”
  • “Return to Normal in 2021.”
  • “Make All Critical Medicines and Supplies for Healthcare Workers in The United States.”
  • “Refill Stockpiles and Prepare for Future Pandemics.”

Joe Biden

Former VP Biden has outlined a number of proposals for how he would address the coronavirus pandemic as President. VP Biden was also part of the Obama Administration’s response to the 2009 H1N1 outbreak, the 2014 Ebola outbreak, and 2016 Zika outbreak.  During his tenure, the Obama Administration played a lead role in creating the “Global Health Security Agenda,” a multilateral initiative that aims to serve as “a catalyst for progress toward the vision of attaining a world safe and secure from global health threats posed by infectious diseases.” In addition, as follow-up to the 2014 Ebola outbreak, the Obama Administration established the Directorate for Global Health Security and Biodefense at the National Security Council (NSC) to lead the federal government’s pandemic response (the Directorate was disbanded by the Trump Administration in 2018).

VP Biden has put forth the following principles for his proposed response to COVID-19:

  • “Restoring trust, credibility, and common purpose”.
  • “Mounting an effective national emergency response that saves lives, protects frontline workers, and minimizes the spread of COVID-19”.
  • “Eliminating cost barriers for prevention of and care for COVID-19”.
  • “Pursuing decisive economic measures to help hard-hit workers, families, and small businesses and to stabilize the American economy”.
  • “Rallying the world to confront this crisis while laying the foundation for the future”.

VP Biden’s plan states that “The federal government must act swiftly and aggressively” and that “Public health emergencies require disciplined, trustworthy leadership grounded in science.” His approach calls for the federal government, not the states, to assume primary responsibility for many aspects of the COVID-19 response, including for scaling up testing and contact tracing, providing and managing the distribution of critical supplies, and setting strong national standards. For example, VP Biden has said he would call on all Americans to wear masks and work with governors and mayors to mandate mask wearing. He would appoint a “Supply Commander” to oversee national supply chain of essential equipment, medications, protective gear, directing distribution of critical equipment as cases peak at different times in different states or territories, and make more aggressive use of the DPA to direct companies to produce needed supplies. Additionally, in recognition of the disproportionate toll COVID-19 has taken on racial and ethnic minorities in the U.S.,  VP Biden would establish a “COVID-19 Racial and Ethnic Disparities Task Force”.

VP Biden has also called for adopting measures that go beyond what have been passed by Congress or supported by the Administration to further extend fiscal relief to individuals, schools, and businesses, provide enhanced insurance coverage, support states in providing COVID-19 related services, and eliminate cost-sharing for COVID-19 treatment. For example, VP Biden would reopen enrollment for marketplace plans and cover COBRA at 100% for those who lose their jobs and health insurance due to COVID-19. In addition, VP Biden would further expand paid leave for sick workers and those caring for family members, among others, due to COVID-19, and provide additional pay for frontline/essential workers. On vaccine pricing, he would authorize the federal government to approve the price of any COVID-19 vaccine developed with federal resources, in contrast to the Trump Administration, which has said it does not want to pursue price controls. On schools, a key difference between Biden and Trump is Biden’s emphasis on the need to get the virus under control before reopening in-person education. More broadly, VP Biden proposes to expand and protect the ACA.

On the global front, VP Biden would “re-embrace international engagement,” leadership, and cooperation. His platform states that “Even as we take urgent steps to minimize the spread of COVID-19 at home, we must also help lead the response to this crisis globally. In doing so, we will lay the groundwork for sustained global health security leadership into the future.” He would act to restore the Directorate for Global Health Security and Biodefense at the NSC and work to help create a Global Health Emergency Board to harmonize crisis response for vulnerable communities around the world. Finally, he would restore funding to and fully resource the WHO and reverse the Trump Administration’s decision to withdraw from WHO membership.

Sources

Unless otherwise noted, the following are the primary sources for this side-by-side:

President Trump:

Vice President Biden:

Table: Side-by-side

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Federal Emergency Power

TrumpBiden
The Trump Administration has declared three federal emergencies:
  • HHS declared a public health emergency (PHE), under Section 319 of the Public Health Service Act, on January 31 (renewed on April 21and July 23)
  • The President declared a national emergency under Section 501(b) of the Stafford Act, on March 13, and hasapproved major disaster declarations for all 50 states and 4 territories.
  • The President declared a national emergency under the National Emergencies Act, on March 13.

Travel Restrictions

TrumpBiden
Travel restrictions and limitations put in place include the following:
  • Suspended entry of foreign nationals from:
    • China on January 31
    • Iran on February 29
    • The European Schengen Area on March 11
    • The UK and Ireland on March 14
    • Brazil on May 24
  • Suspended entry of those on immigrant visas on April 22 (extended on June 22), designed to protect the U.S. labor market
  • Limited non-essential travel by foreign nationals into the U.S. through ports of entry on the land borders with Canada and Mexico.
  • Suspended entry of individuals traveling from Canada or Mexico to the U.S. (regardless of country of origin) who would otherwise be held in a congregate setting (e.g., those seeking asylum); this has included unaccompanied minors, some of whom have been held in hotels vs authorized holding facilities.
  • ICE has implemented policies to reduce COVID-19 risk among detainees, but has continued certain enforcement actions and taken limited steps to release individuals from detention.
  • Established screening and quarantine requirements for all persons—including U.S. nationals, lawful permanent residents, and their immediate family members—arriving in the U.S. within 14 days after having been in mainland China.

Emergency Spending Bills

TrumpBiden
Congress passed and the President signed four emergency spending bills:
  • The Coronavirus Preparedness and Response Supplemental Appropriations Act (L. 116-123), enacted March 6.
  • The Families First Coronavirus Response Act (Families First; L. 116-127), enacted March 18.
  • The Coronavirus Aid, Relief, and Economic Security Act (CARES Act; L. 116-136), enacted March 27.
  • The Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139), enacted April 24.

Coordinating a Federal Response

TrumpBiden
Establish a White House COVID-19 Task Force on January 27.Biden has said that, as President, “the first step I will take will be to get control of the virus that’s ruined so many lives….We will never get our economy back on track, we will never get our kids safely back to school, we will never have our lives back, until we deal with this virus.” He would implement a national strategy on day one of his Presidency.

Federal Social Distancing and Reopening Guidelines

TrumpBiden
The White House:
  • Issued federal social distancing guidelines on March 16 for a 15-day period, extended through the end of April.
  • Issued reopening guidelines on April 16.
Biden:
  • Has said that “Social distancing is not a lightswitch. It is a dial” and that he would direct CDC to provide specific evidence-based guidance for “how to turn the dial up or down relative to the level of risk and degree of viral spread in a community, including when to open or close certain businesses, bars, restaurants, and other spaces; when to open or close schools, and what steps they need to take to make classrooms and facilities safe; appropriate restrictions on size of gatherings; when to issue stay-at-home restrictions.”
  • On April 12, issued a plan to re-open America safely, focused on controlling the virus.
  • On May 11, criticized the White House for presenting a “false choice” between health and the economy.
  • On August 21, said he would shut down the country again if scientists recommended it.

Reopening Schools

TrumpBiden
  • President Trump began encouraging schools to re-open in person in July and has suggested he would tie emergency funding for schools to in-person schooling. As recently as mid-August, the President has focused on the importance of reopening schools.
  • CDC issued school re-opening guidance on July 23, emphasizing the importance of in-person schooling. It has since updated and modified that recommendation.
  • The CARES Act includes $13 billion for elementary and secondary schools.
  • The President has called for Congress to pass $105 billion – $70 billion of which is for K-12 schools – to provide financial assistance and incentives to help schools implement safety measures in their resumption of in-person classes.
  • The President has put forward eight recommendations to guide schools on reopening safely:
    1. Ensure all students, teachers, and staff understand the symptoms of COVID-19 and its risk factors.
    2. Require all students, teachers, and staff to self-assess their health every morning before coming to school; if they are symptomatic, they should consult their physician.
    3. Encourage frequent handwashing or hand sanitizing during the school day
    4. Minimize large indoor group gatherings; hold large gatherings outdoors whenever possible.
    5. Maintain high standards of hygiene and ventilation within all classrooms
    6. Require students, teachers, and staff to socially distance around high-risk individuals.
    7. Encourage the use of masks when social distancing is not possible.
    8. Liberally post instructions regarding hygiene and social distancing around the school.
  • On re-opening schools, Biden has said that “Creating the conditions to make it happen should be a top national priority” and that “the decision about when to reopen safely should be made by state, tribal, and local officials, based on science and in consultation with communities and tribal governments. It should be made with the safety of students and educators in mind. And, it should be made recognizing that if we do this wrong, we will put lives at risk and set our economy and our country back.”
  • He has issued a five-step roadmap for reopening schools:
    1. Getting the virus under control before reopening.
    2. Setting National Safety Guidelines with objective criteria for local decision-making. Decisions on re-opening should be tied to level of risk and spread and when schools have sufficient PPE, masks and other supplies.
    3. Providing emergency funding for public schools and child care providers, including through passage of the HEROES Act, which includes approximately $58 billion for local school districts; through renewable fund for state, tribal, and local governments; through a separate emergency package to provide $30 billion for child care providers and public schools and $4 billion to upgrade technology and broadband.
    4. Mobilizing a Department of Education effort to develop, adopt, and share the latest tools and best practices to ensure high-equality learning
    5. Close the COVID-19 Educational Equity Gap through a White House-led initiative to identify evidence-based policy solutions; launching a COVID-19 Educational Equity Gap Challenge Grant and other measures.

Scaling up COVID-19 Testing and Contact Tracing

TrumpBiden
Under President Trump:Biden proposes to:
  • Ensure all who need a test can get one.
  • Provide daily public White House report on number of tests conducted.
  • Establish Pandemic Testing Board to scale up and oversee provision of diagnostic and antibody tests, including surge production of test kits and lab supplies; coordinate distribution to every state, tribe, and territory; identify testing sites and personnel; ensure adequate lab capacity and swift reporting of results; and provide clear guidance on who needs a test.
  • Double the number of drive-through facilities per state.
  • Build a National Contact Tracing Workforce by creating a U.S. Public Health Jobs Corps which would mobilize at least 100,000 people.

Addressing the Costs of COVID-19 Testing, Prevention, Treatment and an Eventual Vaccine

TrumpBiden
Congress has passed and the President has signed emergency relief measures eliminating costs for testing, preventive services, and an eventual vaccine (but in most cases, not for treatment) as follows:Biden would work to eliminate cost-barriers (co-payments, deductibles, surprise billing) for all COVID-19 services and commodities, including testing, preventive services, treatment, and an eventual vaccine, for both those who are insured and uninsured, by:
  • Requiring all private plans (employer plans and individually purchased) to immediately cover all testing, treatment, and preventive services related to COVID-19, and for an eventual vaccine, and ensure that testing is free to everyone regardless of immigration status. On vaccine pricing, Biden would provide explicit authority for HHS Secretary to approve the commercial price of vaccines that are developed in conjunction with federally funded research.
  • Applying the same requirement to public plans including Medicare, Medicaid, the Children’s Health Insurance Program, Indian Health Service, Veterans Affairs, DoD’s TriCare program and the Federal Employees Health Benefits (FEHB) Program.
  • Fully funding and expanding authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related treatment costs not directly covered by health insurance for the insured as well as uncompensated care incurred by uninsured and underinsured populations. 

Health Insurance Coverage During the Emergency Period

TrumpBiden
In response to COVID-19, the Administration has:
  • Issued an emergency regulation extending COBRA election period (but has not provided subsidies).
  • Extended the time people have to sign up for marketplace coverage if they lose other coverage during the emergency period. However, declined to reopen ACA enrollment to all individuals during the emergency period.
  • Signed legislation increasing Medicaid FMAP by 6.2 percentage points from January 1 through the end of the quarter in which the public health emergency ends.
  • Approved Medicaid emergency authorities to help states address the COVID-19 emergency.
  • Immigrants remain subject to restrictions on eligibility for federal health and financial relief provided in response to COVID-19, as well as to health coverage more generally, that could leave them facing barriers to testing and treatment.
In response to COVID-19 specifically, Biden proposes to:
  • Cover COBRA at 100% for those who lose their job due to COVID-19.
  • Reopen ACA enrollment during the emergency period.
  • Increase Medicaid FMAP by at least 10 percent for all states during the crisis, with upward adjustments for states that are facing particularly high unemployment rates.
  • Ensure that immigrants also have access to free testing and work to reverse the Trump Administration’s public charge rule, which has made immigrant families more fearful of accessing health programs and services.

Helping Workers/Workplaces

TrumpBiden
Under President Trump:
  • Congress passed and the President signed legislation establishing emergency paid sick and family leave due to COVID-19, through the end of the year as follows:
    • Employers with fewer than 500 employees and all public employers are required to provide up to two weeks of fully-paid sick leave for eligible employees unable to work due to quarantine or isolation, or symptoms of coronavirus, and up to two-thirds pay for employees unable to work in order to care for someone in quarantine or whose child’s school or day care is closed.
    • Employers with fewer than 500 employees and all public employers are required to provide two-thirds pay for up to an additional 10 weeks for employees unable to work because their child’s school or day care is closed.
    • Employers receive refundable tax credits to cover costs of providing emergency paid leave.
    • Employees of private businesses with 500 or more employees are not eligible for emergency paid sick leave, totaling at least 69 million workers, including 8 million health care workers subsequently exempted by Department of Labor guidelines.
    • Employees of private businesses with 500 or more employees and most federal employees are not eligible for emergency paid family leave. Additionally, employers with fewer than 50 employees may be exempt from providing this benefit.
  • Congress passed and the President signed legislation creating new unemployment compensation programs for those affected by the pandemic, including a federally-financed $600/week supplement to state unemployment benefits that expired in late July. By executive order, the President temporarily extended a portion of the federal unemployment supplement in states that could share in the cost. No additional pay for frontline/essential workers, specifically, has been provided.
  • The CARES Act also provides a “recovery rebate” (a refundable tax credit) of up to $1,200 for eligible individuals ($2,400 for joint filers), and an additional $500 for each qualifying child. This benefit is limited to people filing taxes, leaving out some immigrant workers and their spouses.
  • The President has activated the DPA to direct domestic industry to expedite and expand supply of medical countermeasures, in the context of a national emergency. The DPA has been used to expand access to PPE, ventilators, and testing.
  • OSHA has issued standards and requirements to prevent occupational exposure to COVID-19.
Biden would work to:
  • Expand emergency paid sick and family leave to include all workers regardless of industry, sector, or employer size.
  • Reimburse employers when employees use emergency paid leave benefits.
  • Include a refundable tax credit for employers’ extra costs of providing full health benefits to all workers during periods of work hour reductions due to COVID-19.
  • Ensure all essential workers have priority access to PPE, testing, childcare assistance, and other emergency COVID-19 support.
  • Ensure additional pay for frontline/essential workers.
  • Expand emergency unemployment compensation and ensure that workers receive payments quickly by issuing funds electronically or by prepaid debit cards.
  • Expand the use of the DPA to increase production of masks, face shields, and other PPE, and ensure equitable distribution in at-risk communities, particularly those with vulnerable populations.
  • Establish and enforce health and safety standards in workplaces including:
    • An Emergency Temporary Standard to give employers and frontline employees enforceable guidance.
    • Finalize permanent infectious disease standard to require health facilities and certain other high exposure workplaces to permanently. implement infection control programs to protect workers.
    • Double number of OSHA investigators.

Helping Hospitals/Health Care Facilities & Providers

TrumpBiden
Under President Trump:
  • The Army Corps of Engineers and National Guard constructed temporary hospitals and medical centers, and the Navy’s two hospital ships, the USNS Mercy and USNS Comfort, were deployed.
  • Congress passed and the President signed the CARES Act and the Paycheck Protection Act which together provide $175 billion in grants to health care providers.
  • CMS accelerated $100 billion in Medicare payments to hospitals, physicians, and other entities that participate in Medicare to minimize the effects of revenue shortfalls due to COVID-19, and the CARES Act significantly expanded this authority. The CARES Act also increased Medicare payments to hospitals for the treatment of Medicare inpatients diagnosed with COVID-19 by 20%.
  • Based on new waiver authority included in the Coronavirus Preparedness and Response Supplemental Appropriations Act (and amended by the CARES Act), the Administration has temporarily broadened access to telehealth benefits under Medicare during the emergency period.
  • The Administration has waived or modified requirements under Section 1135 of the Social Security Act to allow, for example, out-of-state providers with equivalent licensing to practice in other states.
  • The Administration has issued numerous guidance to and recommendations for Medicare and Medicaid certified nursing facilities to address COVID-19 outbreaks, including: restricting visitors, except for compassionate care circumstances; guidance on screening all staff, residents, and visitors for symptoms and other risk factors; requiring nursing homes to report COVID-19 cases weekly; forming an independent commission to conduct a comprehensive assessment of facility response to COVID-19; providing a one-time procurement of rapid diagnostic tests to nursing homes in COVID-19 hotspots; and requiring LTC facilities to test all residents and staff.
  • CDC collected data from hospitals and maintained a dashboard, activities which have since been shifted to HHS
Biden proposes to:
  • Prepare to stand up multi-hundred-bed temporary hospitals in any city on short notice by deploying existing Federal Medical Stations in the strategic national stockpile and preemptively defining potential locations for their use as needed.
  • Direct DoD to prepare for potential deployment of military resources, both the active and reserve components, and work with governors to prepare for potential deployment of National Guard resources, to provide medical facility capacity, logistical support, and additional medical personnel if necessary, including by activating the Medical Reserve Corps and deploying additional surge capacity, including U.S. Department of Veterans Affairs/DOD medical equipment and HHS Disaster Assistance Medical Teams.
  • Direct and assist hospitals to surge care for 20% more patients than current capacity through flexible staffing, use of telemedicine support, and delaying elective procedures.
  • Instruct CDC to establish real-time dashboards tracking (1) hospital admissions related to COVID-19 (2) supply chain information for essential equipment and PPE.
  • Expand CDC sentinel and other surveillance programs to offer tests broadly, especially to vulnerable populations like nursing home patients and people with underlying medical conditions.
  • Establish testing capacity so that long-term care residents could safely see at least one visitor every week.
  • Create “State and Local Emergency Fund” with resources to be allocated according to a formula: 45% to state governments; 45% to local governments; and 10% reserved for special assistance for “hot-spots” of community spread. Can use for medical supplies, critical health infrastructure, hiring of health care and other workers, and other services and supplies.

Building the Strategic National Stockpile & Critical Supplies

TrumpBiden
Under President Trump:
  • The President activated the DPA to respond to COVID-19 which has been invoked for ventilators and respirators, to prevent hoarding and price gauging and in other select cases.
  • The White House launched “Project Airbridge,” an effort to procure and transport critical supplies and equipment from overseas to the U.S.  Millions of supplies, including N95 respirators, surgical masks, and gowns, arrived in the US through this effort, which was shut down at the end of June.
  • The White House announced a restructuring of the federal Strategic National Stockpile (SNS) to improve predictive analytics of supply and demand, ensuring a 90-day supply of critical items, and fostering more domestic production and less reliance on foreign suppliers. According to the Administration, the role of the SNS is to supplement state supplies during public health emergencies, a revision from how it had previously been described.
  • HHS has announced new partnerships, for example between the Biomedical Advanced Research and Development Authority (BARDA) and private sector companies, to ensure the supply of critical medicines and pharmaceutical ingredients.
Biden proposes to:
  • Undertake a 100-day review upon taking office to identify critical national security risks across America’s international supply chains and ask Congress to enact a mandatory quadrennial Critical Supply Chain Review to institute this process permanently.
  • Sign an Executive Order to inventory U.S. supply chain vulnerabilities.
  • Appoint Supply Commander to oversee national supply chain of essential. equipment, medications, protective gear.
  • Increase federal stockpiles of medical supplies and other critical goods through regulation and other measures.
  • Direct distribution of critical equipment as cases peak at different times in different states or territories.
  • Use the DPA to manufacture critical products, including those immediately needed to respond to the COVID-19 pandemic in near term and create process to determine the best way forward over the mid- and long-term.
  • Work with businesses to expand production of critical supplies and incentivize greater supplier production, including committing, if necessary, to large scale volume purchasing and removing all relevant trade barriers to their acquisition.
  • Task the Department of Justice with combating price gouging for critical supplies.
  • Use BARDA to spur medical production to ensure adequate production of vaccines and other medical countermeasures to address COVID-19.
  • Leverage federal purchasing power to encourage pharmaceutical companies to make key drugs, drug inputs, and medical devices in the U.S. while ensuring fair and transparent pricing.
  • Ensure the U.S. tax code encourages on-shoring of pharmaceutical supply chains.

Research & Development/ Treatment and Vaccine Distribution

TrumpBiden
Under President Trump:
  • Congress passed and the President signed emergency legislation providing additional funding for vaccines, therapies and diagnostics totaling an estimated $9 billion.
  • In June, the White House announced “Operation Warp Speed” with the goal of delivering “300 million doses of a safe, effective vaccine for COVID-19 by January 2021” through “investing in and coordinating countermeasure development.”
  • HHS announceda task order to advance domestic manufacturing capabilities for vaccines and therapeutics.
  • DoD and HHS announceda $138 million contract for more than 100 million syringes for future vaccines.
  • HHS and DoD announced a joint effort to increase domestic manufacturing capacity for vials.
  • As part of Operation Warp Speed, US agencies, including CDC and DoD, developing portfolio of distribution options for eventual COVID vaccines.
  • The White House decided not to participate in the WHO-led international R&D collaborative that was launched in April.
Biden proposes to:
  • Establish a New Emerging Infectious Disease Clinical Trial Network.
  • Scale-up National Institutes of Health-funded COVID-19 pediatric research partnerships to help address gaps in understanding of how the virus affects children and generate evidence-based guidance.
  • Invest $25 billion in a vaccine manufacturing and distribution plan, and plan for the effective, equitable distribution of treatments and vaccines.
  • Be part of coordinated global approach to develop a safe, effective vaccine and the manufacturing capacity for the doses and related materials like syringes that we will need at home and around the world.
  • The following 3 principles should guide vaccine development:
    • Put scientists in charge of all decisions on safety and efficacy.
    • Publicly release clinical data for any vaccine the FDA approves.
    • Authorize career staff to write a written report for public review and permit them to appear before Congress.

International Cooperation and Global Health Security

TrumpBiden
Under President Trump:
  • An “America First” approach has guided foreign policy.
  • The National Security Council’s Directorate for Global Health Security and Biodefense (charged with overseeing pandemic response) was dissolved in 2018.
  • The first National Biodefense Strategy was released in 2018, and first U.S. Global Health Security Strategy was released in 2019, both required by Congress.
  • Supported the extension of The Global Health Security Agenda (GHSA) for another five-year period (2019-2024).
  • The President signed legislation providing $3.2 billion for global COVID-19 response efforts, to assist governments, international efforts and non-governmental organizations.
  • The U.S. announced it would not participate in the WHO-led global research and development initiative for drugs and vaccines.
  • The White House suspended funding for the World Health Organization (WHO) and announced its intention to withdraw the U.S. from WHO membership.
Biden proposes to:
  • Re-embrace international engagement and alliances.
  • Restore the National Security Council’s Directorate for Global Health Security and Biodefense, created under the Obama Administration.
  • Empower the State Department to ensure the U.S. plays a major role in all global decisions about COVID-19.
  • Direct USAID, in coordination with State, DOD, HHS, and CDC, to mobilize an international response to assist vulnerable nations.
  • Help create a Global Health Emergency Board to harmonize crisis response for vulnerable communities, including to offset the cost of an eventual vaccine, with leadership from the U.S., G7 partners, and other countries in support of WHO.
  • Bolster CDC and DOD’s disease detection and protection programs overseas.
  • Re-launch and strengthen USAID’s “PREDICT” program.
  • Revitalize, elevate, expand Global Health Security Agenda GHSA including by fully staffing all federal agencies and advisory groups focused on global health security, establishing an Assistant Secretary at the State Department to oversee an office of Global Health Security and Diplomacy, and prioritizing sustained funding for global health security.
  • Call for creation of a Permanent Facilitator within the Office of the United Nations Secretary-General for Response to High Consequence Biological Events.
  • Fully resource WHO and reverse Trump Administration decision to withdraw from WHO membership.
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