“There was no national strategy or plan for vaccinations. We were leaving it to the states and local leaders to try and figure it out. And so in many ways, we’re starting from scratch on something that’s been raging for almost an entire year!”
— Vice President Kamala Harris, in an interview with Axios, Feb. 15, 2021
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“We certainly are not starting from scratch because there is activity going on in the distribution.”
— Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in remarks at the White House, Jan. 21
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Many readers have asked us to examine these apparently conflicting statements. There was even a Fox News report wondering why we had not quickly written a fact check. We had been working on a fact check on this issue even before Harris’ interview was released — regarding similar remarks by President Joe Biden — but it takes time to interview people, especially when there is a federal holiday.
On the face of it, Fauci’s statement appears to be in direct conflict with Harris’ claim. After all, he was intimately involved in battling the coronavirus pandemic during the Trump administration. But it’s not quite so simple. Few people realize that he said something more after his first comment — which might explain why he did not dispute Harris’ overall comment when he was interviewed about it on CNN a day later.
A large part of how you look at this depends on your definition of “plan” or “starting from scratch.”
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Every new administration suffers from “not-invented-here” syndrome. The Trump administration famously discarded the pandemic-response plan drafted by the Obama administration. So, after a hard-fought campaign and a delayed transition, one would expect the incoming Biden administration to view with skepticism the vaccination plans left behind by the Trump administration.
Even Biden has credited the Trump administration with fostering the conditions for the creation of a vaccine in record time. (Last March, we quoted health experts, including Fauci, as saying a vaccine would not be ready for at least a year, but that turned out to be wrong — the first vaccination was administered nine months later.)
Instead, the question is whether there was a plan to get the vaccine into people’s arms. Donald Trump more than 20 times had promised 100 million doses would be delivered by the end of 2020 — and only about 21 million had been delivered by the time Biden took the oath of office on Jan. 20.
The Trump administration in September had asked states to develop individual plans for vaccinating citizens, and the Centers for Disease Control and Prevention worked with the states to refine and develop those plans. A 75-page playbook was published and then updated at the end of October.
A former Trump administration official involved in the effort told The Fact Checker that “this was not a one-size-fits-all approach,” but one that allowed each state to develop a plan that worked for its population. Some states did better than others, but even so, he noted, vaccinations had reached a seven-day average of 980,000 by the time Biden took office — virtually the goal Biden initially set for himself.
As for suggestions that there had been no vaccination plan, the official said: “I understand why they are doing it — it’s smart politics.” But he said it is not correct, as the Biden administration embraced concepts first developed under Trump, with the exception of federally run vaccination sites such as those operated by the Federal Emergency Management Agency.
But notice how Harris framed it — “there was no national strategy or plan for vaccinations.”
Biden administration officials say that what they inherited was a system that was largely designed for the first stage — vaccinating health-care workers and people living in long-term care facilities, both of whom are at fixed sites where they could receive vaccines. “They viewed their job as vaccines, not vaccinators,” a senior administration official said.
There were many half-formed ideas, officials said, such as a pharmacy program, but little had been developed beyond concepts. “There was not one piece of paper with how you could vaccinate the entire country,” he said. “If they had a strategic plan, they never gave it to us.”
“The Trump administration vaccinated for 38 days, and on two of those days they hit 1 million shots,” said another senior administration official. “You needed a very different vaccination program” to continue to achieve more than 1 million shots once health-care workers and long-term care residents were covered. “There was no plan to vaccinate all Americans,” he said, noting that as of Feb. 12, the seven-day average was about 1.5 million while daily doses topped 2 million.
As an example, the official pointed to the plan to vaccinate people through pharmacies. The program had been announced by the Trump administration, but when Biden officials asked pharmacy officials about how it would work, pharmacy executives responded that they knew little beyond what was in the initial news release.
Drug industry officials say this is correct. “When we first started talking to the Biden team during the transition, it was unclear what the federal pharmacy partnership program was going to look like, and key details (doses, timing, etc.) were missing,” an executive at a top pharmacy chain told The Fact Checker, speaking on the condition of anonymity to avoid political ramifications. “Those details were critical for us, obviously, as we needed to be prepared to activate. What we’ve seen over the last several weeks is a clear national plan emerge.”
About 6,500 pharmacies are delivering vaccines, primarily in ethnic minority areas, an administration official said. The Biden administration thinks Americans eventually will be able to get vaccinated at more than 40,000 pharmacies across the country.
Biden officials said they also found that states appeared to be hoarding vaccine supplies because they were unaware of how much vaccine was left in the supply chain. When Biden took office, only 46% of vaccines delivered to states had been used. Now, every Tuesday, officials make a commitment to governors about how much vaccine they will receive for the next three weeks, so 75% to 80% of the vaccines are used, the official said.
In terms of cumulative vaccine doses administered per 100 people, as of Feb. 14 the United States ranked fourth in the world — the same ranking it held on Jan. 20.
Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials, said one big problem with the Trump administration’s approach was that the administration opposed providing states with the necessary resources for vaccination programs.
“There was a plan,” he said. “But there was not a plan for how it would be resourced or paid for.” State health officials became increasingly frustrated with the Trump administration’s handling of the vaccine programs, especially a failure to communicate its decisions, he said. He attributed that in part to disputes within the Trump administration, especially a rift between the CDC and the rest of the Department of Health and Human Services.
“Biden is speeding things up and putting more things in play,” Plescia said. “They have been very responsive on the funding and resourcing side of this.”
“The Biden administration didn’t start entirely from zero when it came to vaccine distribution, though they have moved to expand and improve upon the foundations laid by the previous administration,” said Joshua Michaud, the associate director for global health policy at the Kaiser Family Foundation. “While recognizing there have been improvements and expansions, it’s worth noting that state and local governments still have the bulk of the responsibility for vaccine administration under the Biden administration, just as they did under the Trump administration.”
Now let’s go back to the rest of Fauci’s comment on Jan. 21, when he said the administration was not starting from scratch: “If you look at the plan that the president [Biden] has put forth about the things that he’s going to do — namely, get community vaccine centers up, get pharmacies more involved; where appropriate, get the Defense Production Act involved, not only perhaps with getting more vaccine, but even the things you need to get a good vaccine program — for example, needles and syringes that might be more useful in that. So it’s taking what’s gone on, but amplifying it in a big way … So we are continuing, but you’re going to see a real ramping-up of it.”
That comment tracks with Fauci’s comments on Feb. 16 to CNN: “What I think the vice president is referring to is that the actual plan of getting the vaccine doses into people’s arms was really rather vague. I mean, it was not a well-coordinated plan. Getting the vaccines made, getting them shipped through Operation Warp Speed was OK. But I believe what the vice president is referring to is what is the process of actually getting these doses into people. That is something that we had to get much better organized now with getting the community vaccine centers, getting the pharmacies involved, getting mobile units involved.”
We asked Fauci’s office if he disputed Harris’ statement about starting from scratch but did not get a response. “I don’t think the objective is to bad-mouth the previous administration,” one of the Biden administration officials said. “Many of the people working [under Trump] on vaccines are career people working now” for Biden.
A third administration official noted that Harris “did not just say ‘we started from scratch.’ She said ‘in many ways’ and also gave examples of the ways. So her and Fauci’s comments are not in conflict.”
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Harris said that there was “no national strategy or plan” to deliver vaccinations across the country and that the effort had been left to state and local officials. The Trump administration approach was more state-centric, less top-down federal oversight, even to the point of not providing funding. To some extent, that reflects a philosophical difference between the two administrations.
But the vice president gets into trouble when she says “we’re starting from scratch.” The Biden administration appears to have had to fill in the blanks of the Trump plan and certainly did speed up the tempo of what the Trump administration envisioned. It has added a federal component and pushed for funding for states. Fauci said the Trump plan was “rather vague” and “not a well-coordinated plan.”
Biden administration officials may be proud of what they have accomplished, but they shouldn’t suggest that nothing was in place when they walked in the door. They have built on an existing structure left behind by the Trump team. Harris modified her comment by saying “in many ways,” but that’s not quite enough to avoid Pinocchios. She earns Two.