The decision, which has not yet been finalized amid more immediate efforts to manage a recent spike in Covid cases, would trigger a complex restructuring of major elements of the federal response — and set the stage for the eventual shifting of greater responsibility for vaccines and treatments. to the private market. It would kickstart a transition away from the White House-led crisis operation and towards treating the virus as a continuous long-term threat.
And for President Joe Biden, who campaigned on eliminating the virus, it would symbolize a measure of progress towards an early pledge that has proven far more difficult than anticipated to keep.
“The challenge we have is there’s no clear roadmap to say where we’re at,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said of the pandemic’s trajectory. “We just have to accept the uncertainty.”
Under the current tentative plan, health officials will quietly renew the emergency declaration for another 90 days before its scheduled expiration on Wednesday. That would give the administration until early February to alert states and health industry representatives that it plans to end the designation.
The timeline means Covid’s crisis stage could be declared over as early as April, although the people with knowledge of the matter cautioned the administration could still issue additional short-term extensions if it needs more time to manage the transition — or grapple with the emergence of yet another variant.
“All the signs around them are that we’re going to be battling episodic surges,” said Lawrence Gostin, a Georgetown University public health professor who has informally advised the White House. “It’s going to be déjà vu all over again.”
A spokesperson for the Health and Human Services Department said in a statement that no decision on ending the public health emergency has been made, “and as HHS committed to earlier, we will provide a 60-day notice to states before any possible termination or expiration .”
In an interview, White House Covid response coordinator Ashish Jha said his team is focused on more urgent priorities like tamping down the latest surge in Covid cases and safeguarding vulnerable Americans from the virus.
The rising post-holiday caseload “has compelled us to work even harder to try to make sure that, particularly, older Americans are getting vaccinated,” he said.
Nearly two years since Biden took office, widespread vaccinations and the development of new therapeutics have sharply cut the risk of severe disease, allowing the vast majority of Americans to resume their everyday lives. Businesses and schools are open, and the economy has rebounded from its Covid-induced depths.
Yet the internal planning for the end stage of the crisis also amounts to an acknowledgment that the White House is more limited than ever in its ability to keep up the fight.
There is little federal funding left to fuel its vaccination campaign after Congress refused to allocate more money at the end of last year, and there is even less hope that a GOP-led House will entertain future requests. State leaders who were once enthusiastic partners have dropped their Covid precautions and shifted their attention to other matters.
As for the broader population, officials said they recognize that much of America has moved on.
Even as Covid hospitalizations and deaths climb once again, Biden officials privately concede the administration sees dwindling benefits in justifying the continuation of the health emergency — especially for a public that’s largely learned to live with the virus.
“There’s still a lot of passion in the administration on Covid – they understand how important it is,” Gostin said. “But I think people recognize there aren’t a lot of new ideas and there isn’t a lot of money.”
Biden health officials stressed that the Covid response would remain a top priority for the administration no matter the status of the emergency designation. The president has continued to urge aides to do whatever is necessary to keep control of the virus, seeing it as integral to the health of both the nation and his own presidency.
But alongside efforts to make vaccines and treatments more widely available, officials have focused on building out a sustainable response that can eventually be managed largely under the sprawling umbrellas of HHS and the Centers for Disease Control and Prevention. As part of that, aides are weighing whether to begin a wind-down of the White House Covid team in the spring or summer months following the anticipated end of the health emergency, or keep it intact through the end of the year, two people with knowledge of the said matter.
Either way, the White House is not expected to replace staff who leave the team in the interim — a sign that officials anticipate transitioning increasingly more responsibility back to the health department. Similarly, Biden is not expected to name a new White House chief medical adviser, following the departure of Anthony Fauci at the end of last year.
Biden’s Covid team in the meantime has spent the first days of the new year trying to clamp down on a new threat, in what officials characterized as a stark reminder that the virus still poses a danger to vulnerable Americans.
A new Covid subvariant, XBB.1.5, spread rapidly throughout the US over the last few weeks, quickly accounting for more than a quarter of all cases, according to CDC estimates. The strain, which appears to be the most immune-evasive one yet, has sparked renewed efforts to convince Americans to stay up to date with their vaccines — a challenge hampered by widespread pandemic fatigue and a lack of federal funds.
“We’re doubling down on our efforts here to do more,” Jha said. “But we’re doing all this with a fraction of the funding we had last year because Congress failed to do its duty of funding an effective vaccination program.”
The Biden administration is planning to roll out a series of new initiatives in the coming days targeted at older Americans, Jha added, to reach those most at risk from the virus.
Just 38 percent of seniors have received their most recent booster, according to the CDC, a sluggish rate that has alarmed health experts inside and outside the administration. As an alternative, officials are also planning to step up their push for people to seek out treatments like Paxlovid that are capable of keeping Covid patients out of the hospital — but have not been nearly as heavily politicized as vaccines.
“There’s so much disinformation about these vaccines,” Jha said. “Unfortunately that disinformation is deadly, and we’re not just fighting a virus but fighting people who are actively trying to leave people vulnerable to the virus.”
The rising caseloads have also added to the sense of urgency behind developing a long-term blueprint for a coronavirus response that can outlive the White House Covid team — and likely the Biden presidency.
Health officials have spent the last several months plotting to transfer responsibility for distributing most vaccines and treatments to the private market, in a move that is expected to occur later this year. The administration is also exploring new policies aimed at protecting access to those tools for the uninsured, and working with states and health companies to smooth the unwinding of sweeping policy changes imposed by the emergency declaration.
Yet despite that intensifying planning, health officials allowed that ending the public health emergency would only go so far towards closing this chapter of the pandemic. As the administration has been reminded several times before, the rest will be up to the virus.
“People’s memories are short as to how bad things actually were, and that’s a testament to the miracle of science with these vaccines,” said Krutika Kuppalli, an infectious disease physician and chair of the Infectious Diseases Society of America’s global health committee. “We need to think about what coming out of the acute phase of the pandemic is going to look like, but obviously we’re not out of it when we have over 100,000 new infections a day.”