For the last 100 days, President Joe Biden and his top advisers have mounted an urgent, wartime effort to get millions of coronavirus vaccines into the arms of Americans in order to beat back a pandemic that has upended the world for the better part of year.
The effort, described to CNN during in-depth interviews with three of the administration’s top Covid advisers and two other White House officials, has allowed the US to go from having one of the worst Covid responses in the world to being a global leader in getting shots in arms. The interviews reveal how the Biden team inherited a pandemic at its zenith with a high demand for vaccines and little supply, along with no long-term plan to vaccinate millions of Americans. The President, at times impatient, pressed his advisers harder on ways to improve the federal government’s response to the virus.
Fully aware that success or failure in getting Americans vaccinated would make or break his presidency, Biden and his team set vaccination goals and jump started the federal response to meet them, deploying active-duty military and the Federal Emergency Management Agency to help with vaccinations, establishing a federal pharmacy program and funding community health centers, all to increase vaccine access. And the $1.9 trillion American Rescue Plan helped fund the vaccination effort too. According to the White House, there are now 70,000 sites around the country where people can get vaccines.
“From day one, it’s been about urgency, overwhelm the problem, we’re at war with the virus,” said Jeff Zients, the White House Covid-19 response coordinator, in an interview with CNN’s Gloria Borger.
When Biden came into office, the country was experiencing about 3,000 deaths and hundreds of thousands of new cases per day, only about 15 million people were vaccinated and there was a scarce supply of shots. To turn it around, Biden’s team brought a fresh urgency and a desire to lean on the scientific experts who had been ignored so much in the previous year.
Ever since January 20, there has been a dispute between current administration officials and ones from the last over exactly what plans for vaccine distribution the Trump administration had left its successor.
“There was no plan to get shots into arms,” Zients told CNN. “Those early doses of Moderna and Pfizer were being drop-shipped to states.”
The Trump team disputes that there was no long-term plan, saying they handed the Biden administration the playbook.
“I have to say it’s frustrating when they spend all of their time disparaging what we did. They say we didn’t have a plan. We had 65 plans,” said Paul Mango, a former Trump administration official who helped oversee the operation. He says their approach gave local leaders more control because of the administration’s belief that they understood their communities better than the federal government ever could.
But the nation’s top infectious disease specialist – who once disputed that the Biden team was starting from scratch – now says that the Biden team deserves credit for the current state of the vaccine roll out.
“There was not really a well-articulated, long-range playbook to get the vast majority of the people vaccinated,” Dr. Anthony Fauci told CNN. “That’s where I think the full-court press of the Biden administration really, really stepped up to the plate and did it well.”
The administration points to Biden’s pressure as a major reason for the quick ramp-up.
“He’s impatient,” Fauci said of the President. “He asks specific questions, ‘Well, what about this? Why aren’t we doing this? Are we doing the best in that?’ In a non-confrontative way, but more of a way that’s positively trying to get the best out of everybody.”
The President set the goalposts – starting with the promise of 100 million shots in the first 100 days.
Maryland Gov. Larry Hogan, a Republican, said that was a low bar.
“We were already doing more than a million a day at that point. So, if he did absolutely nothing, we would have done 100 million in, in the first 100 days, even if he didn’t show up,” Hogan said.
But Biden met that goal on day 58 and upped the ante – doubling the target to 200 million shots in 100 days, and then exceeding that number as well.
He personally announced new Covid milestones, like the purchase of an additional 200 million doses from Pfizer and Moderna, the emergency use authorization for the one-shot Johnson & Johnson vaccine and a partnership between J&J and rival company Merck to speed up manufacturing.
All along the way, he set markers to explain to the American people what these announcements meant in terms of when shots would be available. First there would be enough vaccine supply for all Americans by the end of July, then the end of May. All adults would be eligible for a vaccine by May 1, then April 19.
After months of waiting, appointments for vaccines are becoming more and more available.
“We have to always start with access, making sure that people can get vaccinated in places where they are comfortable and where they trust the people who are vaccinating them,” says Dr. Marcella Nunez-Smith, chair of the White House Covid-19 Equity Task Force.
There were setbacks along the way, like ice storms in February that delayed vaccines shipments just as supply was increasing.
In April, the Food and Drug Administration and US Centers for Disease Control and Prevention recommended temporarily pausing use of the Johnson & Johnson vaccine after rare, one-in-a-million, cases of blood clots were found. The Biden team insisted this would not affect their supply or vaccination targets, and the vaccine is now back in use. But the pause did cause some initial confusion, and there were worries that it may increase vaccine hesitancy among those who were already unsure.
Fauci said the takeaway for those worried about safety should be the opposite.
“If they pulled the trigger on something as rare as one in a million, you should think that these guys and ladies out there that are making this decision, they’re taking safety very seriously. When you say something is really safe, they mean it’s really safe,” he said.
Next up: Fighting vaccine hesitancy
In 100 days, the US has gone from being heavily criticized for its Covid-19 response – with over 570,000 recorded deaths, the highest number in the world – to the envy of the world on vaccinations, with an inoculation rate more than four times the global average.
But the country is now at a tipping point. With vaccine supply secured, it’s now set to outpace demand at a critical moment, with Covid-19 variants on the rise. And the Biden administration’s success or failure in reaching the hesitant and convincing everyone to take the vaccine will be critical in determining whether the country can finally win the war against the virus and move forward.
The administration insisted it would always lead with the science, but the science has often moved too slowly for a public eager to get back to normal. Some critics have said the Biden team should have put out earlier guidance about travel and socializing after vaccination, as an incentive to get the shot.
“I don’t think that people understand what’s in it for them,” said Dr. Leana Wen, an emergency physician and visiting professor at George Washington University who is a CNN medical analyst. Wen said she also thinks the administration should have prioritized teachers for vaccination earlier in order to help schools open sooner.
More than half of adults in the US have now had at least one dose of the Covid-19 vaccine, but reaching the second half may be much harder.
Hesitancy remains a huge hurdle to reaching herd immunity, as vaccination numbers are starting to decline. Some communities of color are skeptical, vaccinations in rural areas are lagging and half of Republican men say they won’t take the vaccine.
“It’s absolutely crazy,” Hogan said of vaccine hesitancy among Republicans. “The only way we ever get life back to normal is if we get enough people to get that vaccine.”
With all American adults now eligible for a shot, the country has reached a new phase of the vaccination effort: A massive PR campaign on social media, on TV and radio and in newspapers that enlists celebrities, politicians, doctors and local community leaders to tout the benefits and safety of the vaccine, and urge people to sign up.
“We always have to make sure that messages are tailored,” Nunez-Smith said. “So that’s about saying, what are your particular concerns? What misinformation often, and disinformation have you heard? And how can we debunk that?”