President Trump on Monday moved to lift restrictions imposed on travelers to the U.S. from much of Europe and Brazil that were implemented last year to slow the spread of the novel coronavirus, though the action is expected to be stopped by the incoming Biden administration.
Trump issued an executive order terminating the travel restrictions on the United Kingdom, Ireland, Brazil and the countries in Europe that compose the Schengen Area effective Jan. 26. The order came two days before Trump leaves office. President-elect Joe Biden’s team immediately signaled they would move to reverse the order.
“With the pandemic worsening, and more contagious variants emerging around the world, this is not the time to be lifting restrictions on international travel,” tweeted incoming White House press secretary Jen Psaki.
“On the advice of our medical team, the Administration does not intend to lift these restrictions on 1/26. In fact, we plan to strengthen public health measures around international travel in order to further mitigate the spread of COVID-19,” Psaki continued.
The order states that Trump’s action came at the recommendation of outgoing Health and Human Services Secretary Alex Azar. The memo cites the new order from the Centers for Disease Control and Prevention (CDC) that requires passengers traveling by air to the U.S. to receive a negative COVID-19 test within three days before their flight departs, saying it will help prevent travelers from spreading the virus.
The Trump administration’s travel restrictions on China and Iran will remain in place, however, because, the order states, the countries “repeatedly have failed to cooperate with the United States public health authorities and to share timely, accurate information about the spread of the virus” and therefore cannot be trusted to implement the CDC’s order.
“Accordingly, the Secretary has advised me to remove the restrictions applicable to the Schengen Area, the United Kingdom, the Republic of Ireland, and the Federative Republic of Brazil, while leaving in place the restrictions applicable to the People’s Republic of China and the Islamic Republic of Iran,” Trump’s order states. “I agree with the Secretary that this action is the best way to continue protecting Americans from COVID-19 while enabling travel to resume safely.”
Though Trump signed the order on Monday, the action does not take effect until six days after he leaves office and Biden is inaugurated.
The order comes as coronavirus cases and deaths continue to hit worrisome, record-high levels on a daily basis. Nearly 400,000 people in the U.S. and more than 2 million people globally have died from COVID-19. While two vaccines have been approved for emergency use in the U.S., the Trump administration has fallen far short of early targets in distributing and administering the vaccine.
The order will be one of the final actions that Trump takes with respect to the pandemic, after being widely criticized for regularly minimizing the threat posed by the virus.
Trump announced in mid-March of last year that he would impose travel restrictions on individuals entering the United States from the 26 countries that compose the Schengen Area, weeks after the first case was reported in the U.S. The move initially attracted scrutiny because it did not include the U.K. or Ireland, and the Trump administration later moved to restrict travel from those countries as well.
Trump later placed travel restrictions on Brazil at the end of May.
The executive order lifting the travel restrictions was one of several released by the White House on Monday as the final hours of Trump’s presidency wind down. Trump is also expected to grant a final slew of pardons before he leaves office on Wednesday.
Research suggests most people who recovered from covid-19 are immune for at least eight months. Yet epidemiologists are largely still urging this population to get the vaccine if it’s their turn in line.
Official guidance says vaccines should be offered regardless of whether people were previously infected.
That’s per the Centers for Disease Control and Prevention, which also says the vaccine is safe for people who have had a prior infection. Former CDC director Thomas Frieden said he’d advise most people to get the vaccine, even if they’ve had covid-19.
But Frieden added that he doesn’t think it’s wrong for someone in a low-risk group who’d already had the illness to defer if they thought someone else could use the dose.
The limits on vaccine supply bolster the argument that recovered people should let others go first.
As administration of the vaccine bottlenecks across the country, the pressure is on to get the shots in as many arms as quickly as possible.
Researchers at the University of Colorado Boulder found that prioritizing people who don’t already have natural immunity could allow health officials to get more impact from limited supplies, especially in areas where many people have already been infected, according to a modeling study that has not been peer reviewed.
The researchers found that you would need to vaccinate 1 in 5 elderly people in New York to bring death rates down by 73 percent. But you can get the same result vaccinating only 1 in 6 people if you prioritize people who don’t already have antibodies to the virus, according to Kate Bubar, a PhD student in applied mathematics and quantitative biology, who co-authored the study.
And although a previous covid-19 infection isn’t a guarantee of immunity, it’s pretty good protection on its own.Researchers have found that eight months after infection, about 90 percent of patients show lingering, stable immunity.
Still, risk can vary from person to person.
“If I were over 70 or otherwise ill, I would certainly take the vaccine even if I’d had [covid-19]. If I were 30 and healthy, I should not be getting it now (unless a health care worker), but if for some reason I did get offered it I would probably decline,” Marc Lipsitch, an infectious-disease specialist at the Harvard T.H. Chan School of Public Health, said in an email.
Some epidemiologists worry about the logistics of trying to weed out people with natural immunity.
It could complicate the process as health providers are already struggling to get the vaccine distributed quickly. So far around 6.7 million people have been vaccinated, even though 22.1 million doses have been distributed, according to a Washington Post analysis.
Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health, worried that trying to verify someone’s past illness would add bureaucratic hurdles.
“Confirming whether or not someone has had COVID already adds an unnecessary layer of red tape onto vaccine prioritization. Given that the prioritization is designed to get vaccine first to those people who are most likely to get infected and/or get very sick from infection, it makes sense to reduce the barriers to vaccinating this group as much as possible,” Murray said.
Murray also cautioned that we don’t know how long people’s natural immunity lasts and that it could vary from person to person. This uncertainty may be an added reason to encourage people to get the vaccine.
There’s also a risk that telling people who had covid-19 to hold off on getting the vaccine could end up feeding into anti-vaxxer narratives. Some experts are reluctant to discourage anyone from getting the vaccine if they are eligible, especially given that vaccine hesitancy is widespread.
There’s already a problem with people being offered the vaccine but not getting it.
In Santa Rosa County, Fla., only about 40 percent of emergency responders who are eligible to get the vaccine have gotten it or signed up to do so soon. In New York, where around 30 percent of health care workers have declined the vaccine, the state’s Gov. Andrew Cuomo (D) has threatened that anyone who skips a dose now won’t be eligible for a priority vaccine later.
The low participation rate is concerning, especially at long-term care centers.
But not everyone who turns down a vaccine is a hardcore anti-vaxxer, Frieden cautions. He says that there is a “movable middle” of people. They aren’t going to be camping out overnight to get an early vaccine, but they may be convincible if costs and other barriers are low. Frieden says it’s crucial to keep a door open for those people, for instance, seeing whether they might be willing to schedule a shot three weeks from now instead of immediately.
The slow pace of vaccinations has sparked a heated debate over how to stretch supplies.
A vocal group of experts has pushed for officials to consider giving as many people as possible the first dose of the two-shot regimen, even if it means risking a delayed second dose. President-elect Joe Biden has announced his incoming administration will take this approach, sending all doses out the door as quickly as possible instead of holding half back.
“The plan, announced Friday by the Biden transition team, pivots sharply from the Trump administration’s strategy of holding in reserve roughly half the doses to ensure sufficient supply for people to get a required second shot,” our colleagues reported.
But some epidemiologists, including Frieden, argue that distribution is a bigger problem than supply at this point. Although he said he supports releasing most vaccines, he worries that some of the debates about how to stretch supply are “distractions” from the real obstacles of administration, which he blames in part on a lack of a coordinated federal plan for getting shots into arms.
“What Operation Warp Speed has generally done is said, ‘We’re responsible for getting the drugs to the states, and after that, it’s their problem,’ ” Frieden said. “That’s a way to facilitate finger pointing; that’s neither a plan nor a solution.”
The Centers for Disease Control and Prevention reported on Monday that 2.1 million doses of coronavirus vaccines have been administered in two weeks. While this might sound like an impressive number, it should set off alarms.
Let’s start with the math. Anthony S. Fauci, the government’s top infectious-disease doctor, estimates that 80 to 85 percent of Americans need to be vaccinated to reach herd immunity. Both the Pfizer and Moderna vaccines require two doses. Eighty percent of the American population is around 264 million people, so we need to administer 528 million doses to achieve herd immunity.
At the current rate, it would take the United States approximately 10 years to reach that level of inoculation. That’s right — 10 years. Contrast that with the Trump administration’s rosy projections: Earlier this month, Health and Human Services Secretary Alex Azar predicted that every American will be able to get the vaccine by the second quarter of 2021 (which would be the end of June). The speed needed to do that is 3.5 million vaccinations a day.
There’s reason to believe the administration won’t be able to ramp up vaccination rates anywhere close to those levels. Yes, as vaccine production increases, more will be available to the states. And Brett Giroir, assistant secretary for health at HHS, argued on Sunday that the 2.1 million administered vaccines figure was an underestimate due to delayed reporting. So let’s be generous and say the administration actually administered 4 million doses over the first two weeks.
But even that would still fall far short of the 3.5 million vaccinations needed per day. In fact, it falls far short of what the administration had promised to accomplish by the end of 2020 — enough doses for 20 million people. And remember, the first group of vaccinations was supposed to be the easiest: It’s hospitals and nursing homes inoculating their own workers and residents. If we can’t get this right, it doesn’t bode well for the rest of the country.
Here’s what concerns me most: Instead of identifying barriers to meeting the goal, officials are backtracking on their promises. When states learned they would receive fewer doses than they had been told, the administration said its end-of-year goal was not for vaccinations but vaccine distribution. It also halved the number of doses that would be available to people, from 40 million to 20 million. (Perhaps they hoped no one would notice that their initial pledge was to vaccinate 20 million people, which is 40 million doses, or that President Trump had at one point vowed to have 100 million doses by the end of the year.) And there’s more fancy wordplay that’s cause for concern: Instead of vaccine distribution, the administration promises “allocation” in December. Actual delivery for millions of doses wouldn’t take place until January, to say nothing of the logistics of vaccine administration.
The vaccine rollout is giving me flashbacks to the administration’s testing debacle. Think back to all the times Trump pledged that “everyone who wants a test can get one.” Every time this was fact-checked, it came up false. Instead of admitting that there wasn’t enough testing, administration officials followed a playbook to confuse and obfuscate: They first attempted to play up the number of tests done. Just like 2 million vaccines in two weeks, 1 million tests a week looked good on paper — until they were compared to the 30 million a day that some experts say are needed. The administration then tried to justify why more tests weren’t needed. Remember Trump saying that “tests create cases” or the CDC issuing nonsensical testing guidance?
When that didn’t work, Trump officials deflected blame to the states. Never mind that there should have been a national strategy or that states didn’t have the resources to ramp up testing on their own. It was easier to find excuses than to admit that they were falling short and do the hard work to remedy it.
Instead of muddying the waters, the federal government needs to take three urgent steps. First, set up a real-time public dashboard to track vaccine distribution. The public needs to know exactly how many doses are being delivered, distributed and administered. Transparency will help hold the right officials accountable, as well as target additional resources where they are most needed.
Second, publicize the plan for how vaccination will scale up so dramatically. States have submitted their individual plans to the CDC, but we need to see a national strategy that sets ambitious but realistic goals.
Third, acknowledge the challenges and end the defensiveness. The public will understand if initial goals need to be revised, but there must be willingness to learn from missteps and immediately course-correct.
I remain optimistic that vaccines will one day end this horrific pandemic that has taken far too many lives. To get there, we must approach the next several months with urgency, transparency and humility.
Crafting successful public health measures depends on the ability of top scientists to gather data and report their findings unrestricted to policymakers.
State of play: But concern has spiked among health experts and physicians over what they see as an assault on key science protections, particularly during a raging pandemic. And a move last week by President Trump, via an executive order, is triggering even more worries.
What’s happening: If implemented, the order creates a “Schedule F” class of federal employees who are policymakers from certain agencies who would no longer have protection against being easily fired— and would likely include some veteran civil service scientists who offer key guidance to Congress and the White House.
- Those agencies might handle the order differently, and it is unclear how many positions could fall under Schedule F — but some say possibly thousands.
- “This much-needed reform will increase accountability in essential policymaking positions within the government,” OMB director Russ Vought tells Axios in a statement.
What they’re saying: Several medical associations, including the Infectious Diseases Society of America, strongly condemned the action, and Democrats on the House oversight panel demanded the administration “immediately cease” implementation.
- “If you take how it’s written at face value, it has the potential to turn every government employee into a political appointee, who can be hired and fired at the whim of a political appointee or even the president,” says University of Colorado Boulder’s Roger Pielke Jr.
- Protections for members of civil service allow them to argue for evidence-based decision-making and enable them to provide the best advice, says CRDF Global’s Julie Fischer, adding that “federal decision-makers really need access to that expertise — quickly and ideally in house.”
Between the lines: Politics plays some role in science, via funding, policymaking and national security issues.
- The public health system is a mix of agency leaders who are political appointees, like HHS Secretary Alex Azar, and career civil servants not dependent on the president’s approval, like NIAID director Anthony Fauci.
- “Public health is inherently political because it has to do with controlling the way human beings move around,” says University of Pennsylvania’s Jonathan Moreno.
Yes, but: The norm is to have a robust discussion — and what has been happening under the Trump administration is not the norm, some say.
- “Schedule F is just remarkable,” Pielke says. “It’s not like political appointees editing a report, [who are] working within the system to kind of subvert the system. This is an effort to completely redefine the system.”
- The Center for Strategic and International Studies’ Stephen Morrison says that the administration has been defying normative practices, including statements denigrating scientists, the CDC and FDA.
The big picture: Public trust in scientists,which tends to be high, is taking a hit, not only due to messaging from the administration but also from public confusion over changes in guidance, which vacillated over masks and other suggestions.
- Public health institutions “need to have the trust of the American people. In order to have the trust of the American people, they can’t have their autonomy and their credibility compromised, and they have to have a voice,” Morrison says.
- “If you deny CDC the ability to have briefings for the public, and you take away control over authoring their guidance, and you attack them and discredit them so public perceptions of them are negative, you are taking them out of the game and leaving the stage completely open for falsehoods,” he adds.
- “All scientists don’t agree on all the evidence, every time. But what we do agree on is that there’s a process. We look at what we know, we decide what we can clearly recommend based on what we know, sometimes when we learn more, we change our recommendations, and that’s the scientific process,” Fischer says.
What’s next: The scientific community is going to need to be proactive on rebuilding public trust in how the scientific process works and being clear when guidance changes and why it has changed, Fischer says.