The middle of a pandemic might seem an odd time to evaluate President Biden’s performance on COVID. But infectious disease is a force of death and destruction as old as humanity, and President Biden understands as well as anyone that he needs to learn as he goes, alter plans when the facts change, and prepare for the next pandemic.
Overall, President Biden deserves very high marks. His guiding principle of calm competence and reliance on science have stood up to a new set of COVID challenges. His record is strong enough that no comparison to a former president nor other world leaders is required.
Moving onto his senior personnel choices. The decision to keep senior leaders at NIH and FDA was wise. New White House and agency leaders were bold and a clear improvement.
In the face of controversy, President Biden has assiduously followed public health data by trying vaccination first through “nudges” and communication. Once those tools plateaued in effectiveness, he pivoted to mandates. There are three notable mandates: federal employees and contractors, health care workers and employees in firms with more than 100 employees.
There is overwhelming evidence that vaccination dramatically lowers the risk that people will be hospitalized or die from COVID. Legal authority for such mandates is strongest for federal employees and health care workers. This is true, in large part, because protecting workers from risks is a well-established government role. Safeguarding patients also is linked to preventing exposure to disease from health care workers.
The harder questions are those related to large employers. The application of a broad mandate to al employers of more than one hundred people — while justified in a public health emergency — is unprecedented. President Biden deserves credit for seeking to use this tool. If implemented, it will represent the single biggest step a President can take to stop the spread of COVID.
But if the federal courts stop the large-employer mandate, the president should move to act on an industry-by-industry basis, including transportation (interstate air, train, bus), and other sectors which pose substantially higher health risks for workers or to the general public.
In cases where vital industry sectors will be disrupted by non-compliance with a vaccine mandate, the aggressive enforcement of a frequent testing regime should be in place…