More federal support is key to smoothing out problems

Biden’s answer to Covid-19 and vaccination efforts is, in some ways, simple: more federal support.

If you look at what’s going wrong with vaccines in the US, it can seem like a bunch of different issues from place to place. But many of these issues are rooted in a lack of federal support for notoriously underresourced public health agencies.

To put it another way: If you asked a bunch of underfunded public health agencies to do a big task in a large, diverse country, then refused more support to help them carry out this task, you would actually expect a lot of different problems to arise by virtue of the country being a big, diverse place. The root problem is a lack of federal support, but how that problem looks in different places will vary widely based on geography, demographics, local and state political environments, and more.

“States aren’t totally off the hook, but what we are seeing is the result of lack of resources and strong guidance (and the historical way in which public health is organized and delivered in the US),” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me.

That helps explain why such a variety of problems have appeared throughout the vaccine effort, from vaccine doses going unused to some equipment breaking down to long lines to insufficient staffing at vaccination sites. These problems are rooted in insufficient resources or guidance; whether one state experiences them while another doesn’t can come down to even hyperlocal variables.

Biden’s announcements on Tuesday chip away at some of these problems. For one, they make it clear that the federal government will supply more vaccine doses — promising to alleviate some of the supply constraints. But they also help states coordinate their efforts: By providing more guidance on how many vaccine doses states can expect to get weeks earlier, state officials can actually plan with those numbers of doses in mind.

But administration officials acknowledged these actions are only a start. They called on Congress to pass Biden’s $1.9 trillion economic relief package, which includes a $400 billion Covid-19 plan and $20 billion for vaccine efforts in particular. That kind of funding, along with the $8 billion Congress approved in December, could go a long way to giving states the resources they need to roll out vaccines.

None of this is particularly groundbreaking. But it’s the kind of thing that the Trump administration resisted doing, as it took a leave-it-to-the-states approach to vaccine distribution and even characterized more support to the states as a federal “invasion.”

Biden has promised a much more involved federal approach. Tuesday’s actions are a small part of how that might work in practice.

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