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Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts. |
Politics
Thank goodness that is over.
One of the few political biases I will admit to is being a traditionalist. Most people find the funny hats, streamers and band music of political conventions annoying. I love it.
It is one of the few times left in this country where on the same nights in the same place you will find barbers, lawyers, secretaries, farmers and college students; city people and country folk; young and old; white, Black and every shade in between all rooting for democracy.
My favorite part is when each state is called to cast their vote for the nominee. The lead delegate screams at the top of his/her lungs, "THE GREAT STATE OF TENNESSEE…" before proceeding with the allocation of nominating votes.
To me anyway, it evokes the essence of the American political system like nothing else; sovereign states joined for a common purpose.
This year’s conventions looked more like infomercials and not very good ones at that, especially if you are interested in policy.
Republicans’ health policy has always promised excitement but delivered disappointment - kind of like when your nerdy brother, the biochemistry grad student, dated the cute pharmaceutical salesperson… for a week. Despite health care being listed at the top of most polls inquiring into Americans’ major concerns, Republicans have struggled to come up with a cogent policy they can articulate with some conviction.
Of course, the president mentioned his top issues: the pharmaceutical industry, price transparency and surprise billing. Other speakers spoke about cancer treatment and telemedicine. COVID-19 came up as well, but that stopped being a health matter and became a political issue a while back.
What was noteworthy is the Republican’s infomercial did not have a role for the Affordable Care Act. There was one mention of “Obamacare” but otherwise the mantra on every Republican’s lips from 2010 through 2017, “repeal ‘Obamacare’” has vaporized.
Have they moved on? Surely that has something to do with it but perhaps America has as well. After some dramatic adjustment, health insurance premiums have stabilized in the individual and small group markets. People have adjusted and learned to enjoy a number of the law’s benefits including mandates on preventive services, insurance coverage for children up to 26 years old and guaranteed issue, the one aspect of the law the Trump White House has committed to in the event of positive outcome for them at the Supreme Court.
Perhaps also, in an era of pandemic, heightened geopolitical risk and economic Armageddon, there are simply more important things to worry about.
Policy
Hanging over the Republican convention, and getting a few mentions, was the development of a vaccine for SARS-CoV-2. The administration has cause to be optimistic as there are several promising candidates.
The speed at which vaccine development, approval, and widespread availability are moving is raising a few questions about safety and efficacy. Those concerns may be valid, but they could also be a result of the lead foot the Trump administration has on science and medicine’s gas pedal which has proven disorienting for many of us.
A sequential process of discovery, development, trial, manufacturing, distribution and administration has been transformed in a matter of weeks into a parallel process, aided by liberal use of the U.S. Treasury. Specifically, supplies of the two leading candidates are being manufactured before Food and Drug Administration approval or issuance of an Emergency Use Authorization.
Manufacturing the vaccine means there also needs to be plans for distribution and administration. Under normal circumstances, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices would await FDA approval and make its recommendations on priority populations, distribution, storage and administration procedures.
These are not normal circumstances.
ACIP met last week and began developing its recommendations for the COVID-19 vaccine. Their preliminary work assumes the approval of one or two vaccines. One labeled “A,” presumably Pfizer/BioNTech’s candidate and one labeled “B,” likely MRNA’s mRNA-1273. They are also assuming approximately 35 to 45 million doses will be available if both possibilities are approved at the end of December.
The dosage supply assumptions used by ACIP is lower than the 100 million expected by the White House but given the necessity of planning for supply constraints, probably appropriate.
There are several unknowns, not the least of which is data on the vaccines themselves, but ACIP appears to be moving toward recommending distribution priority in this order:
- Health care personnel
- Essential workers including food and agriculture, transportation, education, energy, water and law enforcement
- People with high risk medical conditions
- Older adults
For the initial roll-out, the vaccine distribution will be highly targeted. In other words, it will be military style with MCK handling the actual movement of supplies. Don’t plan on getting your vaccine shot for Christmas.
When vaccine supply is enough to meet demand, probably in the first half of 2021, administration will broaden to include pharmacies, physicians’ offices, public health clinics and Federally Qualified Health Centers. As is the case with distribution of Remdesivir ® today, supplies are going to be heavily regulated with the intent of focusing on access for the critical populations and limiting hoarding.
Nonetheless, approval of a vaccine and its initial roll-out will be a welcome development and the wheels of the bureaucracy are turning to limit delays and broaden access.
Power
When trying to guess what precisely would be the last straw for Americans tired of economical ruin and social isolation caused by the COVID-19 outbreak, I would not have chosen football. Yet, the Friday night lights are proving to be more compelling than the president of the United States, quite a few Governors and a lot of pediatricians and mental health professionals.
Since March, the dominant political narrative about COVID-19 has shifted multiple times. Initially, cessation of commercial activities and assembly were justified in order to prepare the health care delivery system.
That narrative quickly morphed into the need to flatten the epidemic curve and limit infection and disease.From there we moved on to eradication, or nearly so, as the new benchmark, presumably coincident with the availability of a vaccine.
The passage of time and the shifting narrative has taken its toll on public support. Until the past week or so, lack of support was not translating into objection, at least not in a nonpartisan, nonpolitical way. On Thursday, eight University of Nebraska football players sued the Big 10, asking for a reversal of Commissioner Warren’s suspension of the fall 2020 season. The incoherence of America’s COVID-19 response means, to the dismay of eight Cornhuskers that of the 130 FBS teams, 77 are playing fall seasons, but not in Nebraska.
Here in Nashville, parents are planning to protest Monday evening Mayor John Cooper’s delay of fall sports until schools fully reopen, which is rumored to be January.
Meanwhile, all the private schools in town and each of the surrounding counties have returned to fields and balls of one sort or another, with all the precautions you would expect.
The story is being repeated throughout the country. Unlike debates about opening bars and restaurants, where the profit motive is no match for public health priorities, demanding a return of school sports has a certain selflessness about it. The absence of conflict and the presence of purity may finally be the force to bring balance back to the COVID-19 response.
Football. Never would have guessed it.
