The Morning Dispatch: Getting the Vaccines to the People

Happy Tuesday! Today would have been William F. Buckley’s 95th birthday. As good a day as any to read Alvin Felzenberg on the founding editor of National Review’s “crusade against the John Birch Society.”

Quick Hits: Today’s Top Stories

• Emily Murphy, head of the Government Services Administration, sent a letter to President-elect Biden yesterday authorizing him and his team to begin a formal transition process. President Trump accepted the move, saying that—while he still believes he will “prevail”—he is “recommending that Emily and her team do what needs to be done with regard to initial protocols.” Several hours later, however, he added that his legal fights are “moving full speed ahead” and he “will never concede.”

• A steady stream of Republicans continued to publicly accept the reality of the election results yesterday. Sen. Rob Portman wrote in an op-ed that “there is no evidence as of now of any widespread fraud or irregularities that would change the result in any state.” Fox News’ Laura Ingraham told viewers, “Unless the legal situation changes in a dramatic and frankly unlikely manner, Joe Biden will be inaugurated on January 20.” Trump’s top backer on Wall Street—Blackstone CEO Steve Schwarzman—told Axios “the outcome is very certain today, and the country should move on.” Sen. Shelley Moore Capito wrote that, “at some point, the 2020 election must end” and “if states certify the results as they currently stand, Vice President Joe Biden will be our next president.” Sen. Lamar Alexander said “it seems apparent that Joe Biden will be the president-elect” and encouraged President Trump to concede: “When you are in public life, people remember the last thing you do.”

• Michigan’s State Board of Canvassers on Monday certified President-elect Joe Biden’s victory in the state by a vote of 3-0, with one Republican board member abstaining. 

• President-elect Biden has reportedly selected former Federal Reserve Chairwoman Janet Yellen as his nominee for Treasury Secretary. He also announced on Monday his intent to nominate Alejandro Mayorkas to lead the Department of Homeland Security, Avril Haines as his Director of National Intelligence, Jake Sullivan as National Security Adviser, and John Kerry as his administration’s “international climate envoy,” a new post.

• In a sign the business community is preparing for a Biden presidency, General Motors (GM) announced it is withdrawing its support from the Trump administration’s efforts to prevent California from setting its own—stricter—fuel economy standards. In a letter to environmental leaders, GM CEO Mary Barra encouraged other automakers to follow her company’s lead.

• Hong Kong democracy activists Joshua Wong, Agnes Chow, and Ivan Lam pled guilty on Monday to charges of unlawful assembly stemming from their participation in mass street protests in 2019. Wong said he expected to go to jail for potentially five years, although he and the other activists have avoided the life sentence penalty that Hong Kong’s new security law created because their crimes happened before the law was enacted.

• The Justice Department unsealed an indictment yesterday against 15 individuals connected to the South Philadelphia and Southern New Jersey La Cosa Nostra criminal organization, or mafia. The defendants—including “Tony Meatballs,” “Joey Electric,” and “Louie Sheep”—face charges of racketeering conspiracy, illegal gambling, loansharking, extortion, and drug trafficking. There are no charges expected for bad nicknames.

• The United States confirmed 186,148 new cases of COVID-19 yesterday per the Johns Hopkins University COVID-19 Dashboard, with 10.3 percent of the 1,801,682 tests reported coming back positive. An additional 905 deaths were attributed to the virus on Monday, bringing the pandemic’s American death toll to 257,651. According to the COVID Tracking Project, 85,836 Americans are currently hospitalized with COVID-19.

Approval, Prioritization, and Distribution, Oh My!

AstraZeneca and the University of Oxford announced yesterday that data from late-stage clinical trials found their COVID-19 vaccine to be between 62 and 90 percent effective depending on the dosage. The vaccine candidate joins two others—one from Pfizer, and one from Moderna—that have reported even higher efficacy figures. Pfizer has already applied for emergency use authorization with the Food and Drug Administration, and Operation Warp Speed scientific adviser Dr. Moncef Slaoui said over the weekend Americans could begin receiving a COVID-19 vaccine as early as December 11 or 12.

With vaccine approval at this point just weeks away—which, we’ll say again, is nothing short of a medical miracle—it’s time to start talking about logistics: How will the vaccine make its way from a lab somewhere into the fleshy part of our upper arms?

Once a vaccine gets the go-ahead from the FDA, the Advisory Committee on Immunization Practices (ACIP) will hold a public meeting to determine the appropriate nationwide prioritization scheme for vaccine distribution. Shortly after Dr. Robert Redfield—director of the Centers for Disease Control (CDC)—signs off on the recommendations, the distribution process will begin.

And it will be a process. Slaoui told CNN over the weekend that—given the vaccine candidates’ efficacy—approximately 70 percent of the population will need to be vaccinated to reach something resembling herd immunity. Dr. Anthony Fauci said on CBS News Sunday that “we need to get as many people as possible vaccinated.”

That’s a tall order in a country of 330 million people. The efficacy of Pfizer, Moderna, and AstraZeneca’s candidates all rely on two doses being administered, days or weeks apart. “If they’re two dose vaccines, that’s 660 million doses of vaccines,” said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University Medical Center. “Nobody’s ever even dreamed of doing something like that before.”

Regarding vaccine prioritization, there is almost universal agreement among public health officials that healthcare workers, first responders, and those who work in nursing homes will be among the first to receive the vaccine, which will likely be administered before the end of this year.

The second wave of immunizations will likely cover at-risk individuals who are more subject to severe infection, including those 65 and older, people with underlying illnesses, and minority populations with disproportionately high infection and death rates. But widespread vaccination of the general public is unlikely to occur until the spring of 2021. “If you’re a kid who wants to get immunized so you can go on spring break and party, good luck with that,” John P. Moore—a professor of microbiology and immunology at Weill Cornell Medical College—told The Dispatch. “That’s well down the pecking order.”

Prioritization schemes aside, state health departments have already submitted their plans for vaccine distribution to the CDC. States will have to take into account the leading vaccine candidates’ different shipping constraints, storage protocols, and minimum purchasing requirements when planning safe distribution. The Pfizer vaccine, for example, must be stored at a frosty minus-70 degrees Celsius (minus-94 Fahrenheit). 

Though most doctors’ offices, clinics, and pharmacies are equipped to refrigerate vaccines, most are not equipped to keep vaccines frozen at dry ice temperatures. “Once you take a vial of that Pfizer vaccine out, you’d better have enough people ready to get the vaccine, because it deteriorates quickly,” Schaffner said. Storage facilities will have to remain hyper-vigilant about power failures, premature defrosting, and fluctuating demand to prevent severe wastage. Moderna’s vaccine does not require temperatures as frigid; minus-20 degrees Celsius will do the job. Meanwhile, AstraZeneca’s offering, which is not built around the same mRNA technology as the other two, holds up fine under regular refrigeration temperatures of 2 to 8 degrees Celsius.

Given the particular storage and safety protocol for each vaccine, medical providers will likely only offer one vaccine at a time. Should Americans become preoccupied with the type on hand? “Assuming that all of the vaccines are deemed safe,” Moore said, “it really doesn’t matter which one you get.”

Dr. George Rutherford, an epidemiologist at the University of California-San Francisco, agreed. “It doesn’t matter,” he said. “As long as you get two doses with the same vaccine—this isn’t a mix and match situation.”

It’s worth noting that the two-dose requirement for all of the vaccines so far adds a significant level of complexity to distribution logistics. “We will have to have a record-keeping system that tells us very precisely who you are, when you got your first dose, [and] which vaccine you received so that we can confidently give you the second appropriate dose,” Schaffner said. Some people may not return to the same provider for their second dose, meaning record-keeping systems should be electronic and part of the state immunization registries to ensure accuracy.

When it comes to achieving herd immunity, Dr. Art Reingold—Division Head of Epidemiology and Biostatistics at the University of California-Berkeley—cited three main factors that will affect our national timeline. “One is the efficacy of the vaccines, two is the extent to which the vaccines prevent infection and block transmission rather than simply protecting the vaccinated person against disease, and third is what proportion of people are vaccinated,” Reingold said.

When vaccines are approved and being distributed next month, demand is going to exceed supply significantly. The pharmaceutical companies involved have been ramping up manufacturing for months in anticipation of this moment—thanks in large part to direct funding and purchase guarantees from Operation Warp Speed—but the leading candidates will not be able to provide a vaccine to everyone who wants one until spring 2021 at the earliest. Pfizer said it expects to have 50 million doses (enough for 25 million people) available globally by the end of 2020. Moderna said it will be able to produce 20 million doses over the same time horizon. Tens of millions of Americans will continue to be vaccinated each month, likely bolstered by school and workplace requirements. 

But demand will plateau at some point: Although willingness to receive a vaccine has rebounded in recent weeks according to Gallup, about 40 percent of Americans still remain skeptical. The question, Rutherford says, is how many receive the vaccine before that stalling out occurs. “Will enough people be vaccinated for herd immunity? Or are we going to have to wait and keep persuading a subset of the population to get vaccinated, meanwhile everybody has to wear masks around?” he asked. 

Until herd immunity is reached, don’t expect mask-wearing to go anywhere. In the meantime, proof of immunization may become a new requirement to enter many public places. “What I suspect will happen is that you’ll have some get-out-of-jail-free card on your cell phone,” Rutherford said. “So if you want to go to the movies, you have something that says you’ve been vaccinated.”

Biden’s National Security Team Starts to Come Into Focus

President-elect Joe Biden announced his picks for several key national security positions yesterday, indicating a desire to return to establishment-driven foreign policy with his list of career public servants. But the lineup also had a handful of firsts. If confirmed, Alejandro Mayorkas would be the first Latino and first immigrant to head the Department of Homeland Security; Avril Haines would be the first woman to serve as Director of National Intelligence.

Among the six candidates put forth, all worked in the Obama administration in some capacity. Antony Blinken, the longtime frontrunner to be Biden’s Secretary of State, previously served as deputy secretary of state and deputy national security adviser under Barack Obama. Many observers view his nomination as a restoration of Obama-Biden era multilateralism: Blinken is, for example, expected to return the United States to the Paris Climate Accord, the World Health Organization, and the Iran nuclear deal.

Biden’s pick for National Security Adviser, Jake Sullivan, played a key role in crafting the Joint Comprehensive Plan of Action — the Iran deal — and is likely to push for its revival. Sullivan advised Biden during his tenure as vice president and during the Biden-Harris campaign, making him a natural choice for the position. 

The announcements satisfied some on both the left and the right. “Solid choice. Leaders around the world will assume that when Blinken speaks, he speaks for Biden,” Bernie Sanders’ 2020 campaign manager Faiz Shakir said of the Secretary of State nominee. Conservative columnist and radio host Hugh Hewitt called Blinken, Sullivan, and Biden’s nominee for Ambassador to the United Nations Linda Thomas-Greenfield “smart, mainstream, competent professionals.”

In a statement on Monday, House Speaker Nancy Pelosi applauded Biden’s slate of experienced candidates. “Together, this national security team will chart a forward-looking strategy focused on meeting the challenges of the 21st Century—from crushing the coronavirus, to combating the climate crisis, to defeating transnational terrorism, to achieving nuclear nonproliferation, and to taking the lead on the technologies of the future,” she said. “We urge the Senate to follow precedent and hold hearings on these nominees in January before the inauguration. In the mission to safeguard our national security, we cannot accept any delay.”

Reporters asked Biden yesterday if he expects Republicans to block any of his nominees if they maintain control of the Senate. “Are you kidding me?” Biden responded. They also asked why he announced his national security team first. “Because it’s national security.”

Although most onlookers have hailed Biden’s initial Cabinet nominations as uncontroversial, there’s reason to expect some pushback against the transition team from the Democratic party’s progressive bloc. In an open letter earlier this month, prominent liberal groups urged Biden to exclude “corporate executives, lobbyists, and prominent consultants” from consideration in order to “remedy longstanding and intertwining ills—like corporate concentration and structural economic inequities, systemic racism, the climate crisis, endless wars, and more.”

Senator Elizabeth Warren echoed that sentiment in a tweet following the election. “Americans have made it clear: The last thing they want is for Washington to again hand over the keys to giant corporations and lobbyists.”

Following the conclusion of the Obama presidency, Blinken and Biden’s favored pick for Defense Secretary—Michèle Flournoy—co-founded WestExec Advisors, a DC-based consulting firm that “offers unique geopolitical and policy expertise to help business leaders make the best decisions in a complex and volatile international landscape.” Haines, Biden’s choice for Director of National Intelligence, also worked for the firm, as did Jen Psaki, who is aiding the Biden transition team. Because the company provides “strategic consulting” rather than “lobbying,” it does not have to disclose client lists. But Cabinet nominees will need to submit financial disclosure forms prior to their confirmation hearings. And Republicans asked to provide advice and consent would be wise to insist on full transparency from those involved in WestExec Advisors, particularly as it relates to skid-greasing for clients with foreign interests.

The Biden transition team released an ethics plan a few months back mandating that “persons who have registered as federal lobbyists within the last 12 months may only serve as Transition team members with advance approval of the General Counsel.”  

Republicans kept mostly mum on the Biden team’s announcements, not tipping their hand one way or another regarding upcoming confirmation hearings. Some Democrats are worried about extended vacancies if Republicans control the Senate after the January runoffs in Georgia, but several GOP senators—Mitt Romney, Susan Collins, Lisa Murkowski—have recently indicated a willingness to confirm Biden’s Cabinet.

A “president ought to be able to pick his or her Cabinet barring someone who is out of the mainstream of either party,” Romney told Politico last week. 

“All presidents have a right to their Cabinet,” Murkowski added. “Our job, our role is to make sure that he selects folks that are … within the mainstream. And are good, qualified credible candidates. And if he does that, sure, I am going to work with him.”

Biden seemed to hit that mark with his reported plan to nominate former Federal Reserve chair Janet Yellen to the position of Treasury Secretary. 

“While Dr. Yellen and I had our fair share of disagreements during her tenure as chair of the Federal Reserve, I have no doubts about her integrity or technical expertise,” Sen. Pat Toomey, member of the Senate Banking Committee, told The Dispatch yesterday. “As I consider her nomination, I look forward to discussing with her a variety of issues, especially the legal requirement for CARES Act temporary emergency lending facilities to shut down by year-end and remain shut down, absent further congressional action.”

Stephen Moore, one of President Trump’s outside economic advisers, emailed reporters yesterday saying Yellen “has been a budget hawk and that is what is needed in the years to come.”

And Yellen’s plaudits on Monday did not just come from the right. Warren—who was herself at points rumored for the Treasury job—applauded the pick as well. “Janet Yellen would be an outstanding choice for Treasury Secretary,” Warren tweeted on Monday. “She is smart, tough, and principled. As one of the most successful Fed Chairs ever, she has stood up to Wall Street banks, including holding Wells Fargo accountable for cheating working families.”

A cliché in Washington is that personnel is policy. The nominees announced yesterday would of course not be chosen by a Republican president, but they’re a far cry from the Ilhan Omar, Rashida Tlaib, Elizabeth Warren, Bernie Sanders Cabinet some on the right feared. If Democrats had secured a solid Senate majority, maybe things would be different. But as things stand, if yesterday’s announcements are any indication, Biden may have actually meant all that talk about center-left moderation during the campaign.

Worth Your Time

• Scott Keller—the former solicitor general of Texas (and Sarah’s husband!)—argues in The Wall Street Journal that federal judges should be able to issue nationwide injunctions blocking actions by the executive branch. Courts issued “three times as many nationwide injunctions against the Trump administration in four years as they did throughout all eight years of the Obama administration,” he notes. “Courts should issue nationwide injunctions sparingly,” Keller continues. “When an agency’s action is lawful in some circumstances but not others, courts shouldn’t block the policy categorically across the country. But a court should have the power to enter a nationwide injunction against a federal agency’s action when it is categorically unlawful in all circumstances.”

• Erstwhile Remnant guest Amy Walter’s latest analysis for The Cook Political Report argues that those decrying the recent failure of pollsters are “missing the bigger picture: Trump’s all-base-all-the-time strategy was a failure.” While the Trump campaign succeeded in its goal of turning out just about every Trump supporter possible, it wasn’t enough to get him over the 50 percent line in Pennsylvania, Michigan, Wisconsin, or Arizona. In the absence of a significant third party candidate this time around, Biden’s improvements on Hillary Clinton’s performance was enough to carry the former vice president—in those states and in the Electoral College. “Yes, the battleground states were close,” Walter concludes. “But, the bottom line was that Trump’s approach turned off more voters than it attracted. And, even improving margins among Latinos in the border counties of Texas didn’t make much of an improvement in Trump’s overall showing in the state.”

• In a piece for Slate, Dan Kois grapples with the very dilemma many of you were discussing in the comments yesterday: How families should think about the holiday season this year. We’re all “weighing risks and emotions at the same time and struggling with how they interact,” he writes, “trying to cope with the inability of our institutions to keep us safe while still attempting to live a life that seems non-terrible.” Visiting relatives for Thanksgiving or Christmas is “a hard decision, no matter how many people try to tell you it’s easy, and the conversations we have to initiate in order to make it are hard, too.”

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Toeing the Company Line

• Sens. Kelly Loeffler and David Perdue are heavily favored to win their Senate runoffs in early January, which would cement Republicans’ Senate majority under a Biden administration. Before then, however, the two senators have to walk a difficult messaging line: Selling themselves as a last line of defense against Biden to voters who would rather see them fighting to prevent Biden from taking office in the first place. Andrew spent a few days in Georgia reporting on this bizarre phenomenon, and you can read his piece over at the site today.

• Sarah and David were originally slated to be off this week for the holiday, but there was just too much legal news! On Monday’s emergency episode of Advisory Opinions, they bring us up to speed on the Trump legal team’s latest election litigation, which can fairly objectively be referred to as a clown show. Plus, Scott Keller joins the show to spar with David about nationwide injunctions.

Let Us Know

Do you care which vaccine candidate you are given? And will you get it as soon as you’re able to?

Reporting by Declan Garvey (@declanpgarvey), Andrew Egger (@EggerDC), Audrey Fahlberg (@FahlOutBerg), Charlotte Lawson (@charlotteUVA), James P. Sutton (@jamespsuttonsf), and Steve Hayes (@stephenfhayes).

Photograph by Paul Hennessy/NurPhoto/Getty Images.