Election Implications for the U.S. and Global COVID-19 Response


The U.S. – and global – response to the COVID-19 pandemic has been volatile at best. This is fair, considering that SARS-CoV-2 is a novel virus with a lethality we haven’t seen in more than a century. The question of the moment is whether the end result of Tuesday’s election will bring more or less stability to both the U.S. and global game plan.  

The aftershocks of the election, whichever way it goes, will be felt from the top-down at the Department of Health and Human Services (HHS) and beyond.  There will be implications, foreign and domestic, for the COVID-19 response. If former Vice President Joe Biden emerges with the victory, staff who haven’t already left HHS since the beginning of the pandemic (there have been at least 27 to date), will begin to exit in droves, leaving gaps at a time that couldn’t be more critical. 

“If Trump loses, you will likely see a pretty quick exodus of the non-Senate confirmed staff between November 4th and January 2021. It is likely that the Senate confirmed staff will stay through to the end to transition operations to the next leadership team,” said David Mansdoerfer, Special Assistant to the President of the University of North Texas Health Science Center and former Deputy Assistant Secretary for Health for the Trump Administration. “The new leadership team will take a few months to get a structure in place. This means more of the ‘leadership/policy’ decisions will be absorbed by the career staff in the absence of political leadership.”

What about those career staff, many of whom exist in healthcare leadership roles?  In an executive order signed by President Trump on October 21st, a new class of federal employees, “Schedule F” was created, potentially politicizing career positions such as that of Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID). 

“This action will also give agencies greater ability and discretion to assess critical qualities in applicants to fill these positions, such as work ethic, judgment, and ability to meet the particular needs of the agency,” states the text of the executive order.

Ronald Sanders, a former member and chair of the Federal Salary Council, resigned following the executive order as “a matter of conscience”, citing its potential implications.

“On its surface, the President’s Executive Order purports to serve a legitimate and laudable purpose … that is, to hold career Federal employees ‘more accountable’ for their performance...However, it is clear that its stated purpose notwithstanding, the Executive Order is nothing more than a smokescreen for what is clearly an attempt to require the political loyalty of those who advise the President, or failing that, to enable their removal with little if any due process,” wrote Sanders in a resignation letter obtained by CNN.

Dr. Fauci, the public and highly trusted face of the White House Coronavirus Task Force, has served in this role since 1984 and been an adviser to every president since Ronald Reagan. Fauci keeps his political beliefs close to the vest and has stated repeatedly that his is not a political role. President Trump has repeatedly questioned Fauci’s judgment on the pandemic response and implied that his loyalty lies with the Democratic party.  

This executive order could add to the onslaught of pressure HHS staff have been facing from the public, the media, and the carrying out of their other non-pandemic-related responsibilities.

Then there are the possible foreign implications – which could easily swing back around to become domestic in the roll-out of a potential vaccine. Despite Operation Warp Speed’s allocation of funds for manufacturing, Trump’s withdrawal from the World Health Organization (WHO) and the United States’ absence from the COVAX initiative, could provide logistical roadblocks.

“We haven’t come to the table with other countries on vaccines, and that could change the course of how things play out,” Marta Wosińska, the deputy director of Duke University’s Margolis Center for Health Policy in Durham, North Carolina, told Nature, a publication which endorsed Biden earlier this month, following Scientific American which did so for the first time in its 175-year history. Both publications cited the pandemic response in their announcements. 

Biden has committed to rejoining WHO on his first day in office if elected. 

Alternatively, America’s manufacturing capacity could hold.

“I believe the US is well-positioned domestically to role out a vaccine in conjunction with some of the corporate partners,” said Mansdoerfer.

And what of the global consequences of the election?

“He [Biden] would also re-engage the United States in international efforts to slow pandemic spread. As Biden wrote in an op-ed on COVID published [in USA Today] last January, ‘No other nation has the resources, the reach or the relationships to marshal an effective international response.’” Sherry Glied, Dean and Professor of Public Service at New York University’s Robert F. Wagner Graduate School of Public Service told BioSpace.

Testing and tracing have long been understood as key to getting a handle on the pandemic. 

“It really depends on priorities,” said Mansdoerfer. “The rhetoric from the Biden campaign has implied that they would be handling this crisis significantly different than the Trump Administration. So, if the rhetoric matches reality, it will likely cause a significant shift in prioritization and logistical execution.”

Glied shines a closer light on what this plan might entail.

“Vice President Biden has committed to implementing a national COVID-19 response, which would include expanding and subsidizing testing, making personal protective equipment more available, accelerating the development of therapeutics and diseases, and developing strategies for disseminating vaccines once they become available,” said Glied. “In his workforce plans, he’s also called for the creation of public health worker jobs, which could be used to improve contact tracing and, perhaps, for vaccine dissemination. VP Biden has also indicated that he’d be much more attuned to science in decision-making and in communications around the pandemic.”

On Friday, The Lancet became the most recent scientific publication to issue an appeal to the American Public, citing “violence against people of color, vast income inequality, immigration restrictions, and gender barriers, as well as a continuing devaluation of science.” The editorial suggests that America faces the same decision it did a century ago during the 1918 flu pandemic, between nostalgia and moving forward:

“With the election, Americans have the power to address these issues, both at home and around the world, by eschewing the falsehood of nostalgia…On Nov 3, 2020, the US will again choose whether to continue to look backward, or to take brave steps towards a new future.”

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