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Biden to the unvaccinated: 'Our patience is wearing thin'
00:54 - Source: CNN

Editor’s Note: Megan Ranney, MD, MPH, is an associate professor of emergency medicine and associate dean of the School of Public Health at Brown University. The opinions expressed in this commentary are their own. View more opinion on CNN.

CNN  — 

On Thursday, President Joe Biden released his much-anticipated six-part plan to stem the spread of SARS-CoV-2. Vaccine distribution matters, surely. But as we have seen so acutely over the last two months, distribution alone is insufficient to stem the spread of Covid-19. The new plan to combat Covid-19 doubles down on many of the things that we know work to reduce the spread of the virus – vaccines, testing and masking. But it also leaves some holes.

The most significant part of the plan is the widespread endorsement of vaccine mandates. The plan follows through on what many experts have been advocating for months: use of the power of the federal purse and occupational safety rules to encourage vaccination, whether for health care workers, public employees, or school and daycare staff. Now that we have a fully FDA-approved vaccine, adding it to the list of occupational safety, health care, or educational precautions is, frankly, a no-brainer. It will help keep the economy humming, by keeping workers healthy. And it will help protect patients and students.

Megan Ranney

Just as crucial is the administration’s acknowledgment that rapid testing matters. Public health practitioners and researchers across the country have described the importance of regular, rapid testing in identifying small clusters of infection before they spread. When used in conjunction with other mitigation measures, rapid testing is a critical part of our toolbox to help keep kids in school, workers out of quarantine and large gatherings (such as weddings, concerts, and conferences) from turning into super-spreader events. But to use this strategy, we need lots of tests, need for them to be easy to access and for them to be low cost. So, I’m excited about the activation of the Defense Production Act to speed up manufacturing, and by the insistence that many stores will sell them at cost. We messed up on personal protective equipment in March 2020 by dragging our feet on American manufacturing.

Rapid testing is essential to get right if we want to move back closer to normal.

The plan also has nods to equity, whether here at home or through global vaccination efforts. These are important – we can’t stop Covid-19 without talking about who’s most at risk – but in Biden’s speech it felt like an afterthought.

The other elements of the plan – on schools, small businesses, federal mask mandates on transportation, deployment of federal workers to help states in crisis mode, encouraging distribution of monoclonal antibodies – are important, as well, but not transformational. These are plans that were already in place. It is right to strengthen them, but they are not going to move the needle in the same way as the other elements of the plan.

Boosters are, of course, also a major part of this administration’s push to stop Covid-19. I and other experts disagree with this emphasis, but I’m not surprised to see it highlighted as a key part of their response.

Which brings me to what’s missing.

This plan is fabulous for stemming the surge over the next one to three months – when rapid tests get on shelves, when vaccines start to take effect. The provisions for treatment of the sick, and for helping overwhelmed health care staff, will be helpful today. But what else should we be doing in the meantime?

I wanted to hear more about masks and hear something about ventilation. These are critically important, easy, and too-often-overlooked techniques for stopping the spread of SARS-CoV-2. As virologist Ian Mackay’s “Swiss Cheese Model” of Covid-19 transmission shows, we can’t rely on just one thing – and air quality and air filtration are a critically important part of prevention.

I wanted to hear about how the administration will shift its strategy on community-centered outreach, with an eye to reducing disparities. Vaccine mandates help, but if we really want to address equity, we need more. This includes commitments to get workers sick time if they feel crummy the day after their shot, transportation to and from appointments, community-led efforts to understand and overcome common barriers to vaccination. The administration has talked about the “equity lens,” but this is where the rubber hits the road. Whatever the reason for someone’s distrust of a vaccine – politics, our health care system’s history of anti-Black racism, or belief in misinformation read on the internet – mandates alone won’t overcome it.

And I wanted to hear about messaging. I want the US Centers for Disease Control and Prevention (CDC) to update its guidelines for workers, for schools and for testing. I want our government to double down on the surgeon general’s call to combat misinformation and disinformation about this virus and its treatment. And while we’re at it, I want the administration to drop the phrase “pandemic of the unvaccinated!” We need plain, consistent, non-judgmental messaging for everyday Americans.

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    Finally, I wanted to hear about high-quality data. We are still operating in a data desert, which limits our ability to respond effectively to this or future variants. A commitment from the federal government to creating and sharing good data on school transmission, breakthrough cases and more is needed.

    Like many of us, I am so frustrated by where we are in this pandemic. The virus will create variants; but the variants don’t necessarily need to create surges. Like many others, I have been waiting to see more leadership from the Biden-Harris administration on our Covid-19 response. Thursday afternoon, for the first time in months, we saw what “more” could look like.

    Was it everything I hoped for? No. But I’ll take it.