On Jan 20, 2021, Joe Biden was inaugurated as the 46th President of the USA. With over 430 000 deaths from COVID-19 (1314 deaths per million of the population), the country has been one of the worst hit globally, and the previous Trump administration was heavily criticised for its pandemic response. However, there is a sense of hope with the arrival of the new Biden administration, who have promised progress in managing the pandemic, as well as in environmental and health policy.
On his first day as President, Biden re-joined the Paris Agreement, withdrew a permit for the Keystone XL pipeline, re-joined WHO, and initiated proposals to regulate methane emissions. The climate change taskforce, appointed by Biden, is highly experienced both in terms of their environmental and international relations expertise. While Biden has been vocal about making climate change a top priority, the USA has the highest CO2 emissions per capita in the world. Wildfires across the west of the country have been at their most severe in recent years, adding to the problem of climate change, and negatively affecting respiratory health. Biden will face an uphill struggle to ensure meaningful and lasting change to reduce the environmental and health burdens attributable to climate change.
The most crucial and pressing hurdle for the new administration to address is the COVID-19 pandemic. A US$1·9 trillion investment from the US Government will help to guide the country out of the pandemic, with $400 billion directly dedicated to COVID-19 relief, including a national vaccination programme, and $1400 stimulus cheques being distributed to qualifying Americans. Measures such as improved ventilation will also enable schools to reopen once the R number is under control and vaccine rollout programmes have been more fully implemented, and paid emergency leave will permit people to stay at home when needed. Biden's ambitious plan to vaccinate 100 million Americans in 100 days is welcome, and he has taken steps to achieve effective distribution and administration. Unfortunately, some US states are running out of vaccine stocks and shortages are likely to be an ongoing problem. There have also been large disparities in distribution by local regions and states, some with more effective policies than others. A flexible approach that enables a quick response to these challenges will be needed if the vaccination programme is to succeed in quickly reducing mortality rates and easing pressure on US health systems.
A robust effort to tackle misinformation about the perceived dangers of vaccination, to communicate clearly on the question of vaccine safety, and to understand and address vaccine hesitancy in some communities is also needed. There has been an unexpectedly poor uptake of the vaccine among US health-care workers, according to one cross-sectional study, with the majority (56% of 3479 responses) indicating that they would rather wait for more data to become available. Less than a fifth of black health-care workers would choose to have the vaccine, and acceptance in other minorities is worryingly low. Addressing vaccine hesitancy among Black and minority ethnic groups should be a priority for the new administration. Minority populations generally have less access to health care, are more likely to have chronic conditions, are less educated, have poorer housing, and are more likely to be essential workers—all of which contribute to increased risk of COVID-19 and worse outcomes. 70–75% of health-care workers were concerned about the safety and efficacy of vaccines, and the speed with which they were approved. It is the responsibility of leaders in health care to reassure their employees that despite the unprecedented speed of vaccine development and approval, all the required protocols and safety checks were completed.
The Biden administration has promised to confront health disparities, extending the Affordable Care Act and establishing a public option plan (similar to Medicare) to make affordable health care available to all, including those with pre-existing medical conditions. This is a huge step in the right direction for those with chronic respiratory conditions.
“Science will always be at the forefront of my administration”—an encouraging statement from Biden, which gives a sense of hope that the new administration will take full advantage of existing and emerging knowledge to tackle health inequality, to collaborate globally on environmental and health frontiers, and to gain control over the COVID-19 pandemic. Only time will tell whether this promising start will be maintained throughout the next 4 years to promote the health of all Americans.
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