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How Biden Distributes the Vaccine Will Define His Presidency

He needs to prove that he is serious about breaking the policies of inequity and favoritism that flourished under Trump.

Jim Watson/Getty Images

As the president who will be in charge of the rollout of the Covid-19 vaccine for almost all Americans, Joe Biden could preside over the greatest public health victory in our nation’s history. Or the new president could become a victim of what might be called the Gavin Newsom Syndrome.

Last month, the California governor violated his own health guidelines by attending a 12-person dinner with lobbyists at the exclusive and expensive restaurant the French Laundry, in Napa Valley. Newsom initially claimed that he had eaten outside, but photographs later made clear that he was inside with only a sliding door (that may have been closed) for ventilation. Newsom finally hit the right note with his apology: “I need to preach and practice, not just preach and not practice.”

But many Democrats are now following his lead—preaching but not practicing. San Francisco Mayor London Breed also attended a group dinner at the French Laundry that was mostly indoors. The chutzpah prize goes to Steve Adler, the mayor of Austin, Texas, who recorded a YouTube video stressing that residents “need to stay home if you can.” Adler made his appeal while in Mexico, celebrating, in the aftermath of his daughter’s wedding.

Biden is, of course, not responsible for the hypocrisy of other Democrats. But the credibility of his vaccination program depends on Americans believing that the initial, limited supplies of doses will be allocated fairly—to those who need them most, rather than those with the most clout. Unless Biden works to break the inequities of the current health care system with his mass inoculation program, he will send a powerful signal that life will remain a rigged game no matter who resides in the White House.


Until now, most of the public concern about the vaccine has been focused on right-wing anti-vaxxer sentiment and the spread of Trumpian misinformation on social media. But there remains the hope that some of this resistance to science will crumble once it becomes clear that vaccinations are the best way for Americans to resume their normal lives.

Equally threatening for Biden is the free-market free-for-all over who will get the early doses of the vaccine that has already developed under Trump’s laissez-faire leadership. White House staffers jumped to the front of the line just hours after the first shipments of the vaccine left the Pfizer plant in Michigan. In all likelihood, junior press aides, whose only job is to lie about the election, will get inoculated before most frontline doctors. Membership in Mar-a-Lago may also give Trump’s wealthy cronies an early line on the vaccine.

But the race to jump the queue extends well beyond Trump World. The National Hockey League has reportedly been trying to line up a private supply of the vaccine for its players, who are considered high risk only for dental work. The American Bankers Association has been lobbying the CDC to have bank employees defined as “essential workers,” presumably because they monitor the health of your finances. In California, Uber wants Newsom to give priority to its underpaid drivers when it comes to allocating the scarce vials of vaccine. Influence talks when it comes to deciding who will be vaccinated in January instead of July or August, when the final dosages are expected to be distributed.

Until now, Trump and his friends have followed the path blazed by Trump’s legal mentor, Roy Cohn, who in the mid-1980s wormed his way into an early clinical trial of the AIDS drug AZT, even as he was claiming that he had liver cancer. The message from the White House on Covid-19 feeds the cynical assumption that the first lifeboats are always reserved for VIPs. Rudy Giuliani, a private citizen, received a cocktail of nearly impossible to obtain drugs when he was hospitalized last week for the virus. Gushing about how he had received the same treatment Trump had, Giuliani told WABC Radio, “The minute I took the cocktail … I felt 100 percent better.” Chris Christie, when he was stricken with Covid, had the same good fortune, immediately gaining access to much better treatments than those available to a typical ICU patient in, say, El Paso, Texas.

This is how the game is always played when it comes to health care. In rarefied social circles in New York, making a large donation to Memorial Sloan Kettering Cancer Center is known as purchasing “cancer insurance.” There is a similar reason why the names of billionaires like Henry Kravis adorn heart treatment centers in Manhattan. It is easy to imagine that a 38-year-old hedge fund director, who runs ultramarathons and has plans to climb Everest, has already made arrangements to be vaccinated before most frontline nurses get their turn.

Americans are not naïve about how power and money assert themselves during the pandemic. An AP-NORC poll, conducted earlier this month, found that only 20 percent of Americans are “extremely or very confident” that the vaccine will be distributed fairly. And 39 percent seriously doubt that fairness will play a role in deciding who is inoculated first.

As a result of the Trump administration’s ineptitude, Biden will inherit a vaccine distribution network in which states and local jurisdictions are making many of the key decisions about the vaccine. The political problem with this shared responsibility is that Biden, even though he will lack full control, will be blamed if anything goes awry.

But Biden can demonstrate the power of moral example and use his bully pulpit to call out anyone who elbows his or her way into line. If governors and mayors emulate Gavin Newsom or Steve Adler, Biden could choose to chastise them himself. And Biden will have the power to prevent the CDC from defining globe-trotting financial titans or movie stars as essential workers. Appeals by, say, the NFL to safeguard the Super Bowl should be laughed off the field. Obviously, the incoming 78-year-old president and those staffers and Cabinet officials who see him on a daily basis would need to be vaccinated immediately. But junior White House speechwriters and assistant secretaries of commerce should wait to be inoculated as any ordinary citizen would.

Americans in the AP-NORC poll demonstrated a sensible set of priorities about who deserves to be at the front of the line for early doses of the vaccine. More than 80 percent of those polled believe that health care workers; nursing home residents; those with high-risk medical conditions; and first responders, such as the police and firefighters, deserve the first doses. At the bottom of the list are elected officials (15 percent) and athletes (5 percent).

At a time when too many reality-defying Trump true believers question Biden’s legitimacy as president, it is vital to resist any whiff of cronyism and political favoritism surrounding the mass inoculations. The closest analogy is rationing on the home front during World War II. It would have been morally intolerable and injurious to the war effort if Cabinet officers routinely bought steak off the black market. Or turned a blind eye as their sons and daughters went joyriding with counterfeit gasoline ration coupons.

Trust is a precious commodity for Biden as the forty-sixth president. That is why the message that accompanies the vaccination program that will define the first year of a Biden presidency has to be, “We’re all in this together as Americans.”