An uncomfortable disagreement with Michigan has handed President Joe Biden his most controversial and politically unpalatable moment yet since assuming responsibility for the US' response to the pandemic.
His administration's blunt rebuff of a plea by his ally and Michigan's Democratic Gov. Gretchen Whitmer for an increased supply of vaccines to combat a Covid-19 spike represents the kind of tough decision the President and his team will increasingly face on the exit road from the crisis.
As a case in point, the Centers for Disease Control and Prevention and the Federal Drug Administration on Tuesday ordered a pause in the administering of the Johnson & Johnson vaccine following six reported cases of a rare blood clot among 6.8 million US recipients. The move is unlikely to seriously set back the US vaccine drive since most doses going into US arms are from other manufacturers. But it underscores how sensitive the administration is to any incidents that harm public confidence in vaccines.
Agonizing trade-offs have long characterized the emergency, none more so than the one between public health and economic well-being that was crushed by the lockdowns needed to stem successive tides of infection. But the speeding vaccine program that has become a political shield for the President will not spare him from possibly damaging dilemmas like the one involving a swing state that helped pave his way to the White House.
Whitmer has made several direct appeals to the White House for a vaccine surge -- including in a 20 to 30 minute call with the President last week, CNN's Kaitlan Collins reported on Monday. Her inability to convince the White House to supplement the state's vaccine stocks could expose a governor, who was on the short list to be Biden's running mate last year, to fresh attacks from Republicans who spent months slamming her business restrictions and mask mandate.
The White House sought to downplay tensions with Whitmer on Tuesday. When asked about the conflict by CNN's Phil Mattingly, White House press secretary Jen Psaki gave a long answer praising the Michigan Democrat.
'She has been steadfast in her commitment to keeping the people of the state of Michigan safe and a tremendous partner in the fight against Covid,' Psaki said. 'And if you go back more than a year ago, she led that fight to make sure first responders in the state had PPE they needed when cases took off. And she pushed for more testing when the federal government told governors that they were, frankly, on their own.'
Psaki continued, 'She had to endure not just a public health crisis and a hostile state legislature, but friends who have passed from the virus, armed aggression in the state capitol and threats against her life. She's also had to coordinate a disaster response to a faulty dam burst, all while doing all of this, and a devastated Michigan community. So, we feel she's shown some serious grit, fight and resolve. We are going to continue to work with her on how we can help address the uptick in her state and help deploy the resources we have available.'
The political dimension of this episode, coupled with fierce debate about the wisdom of a vaccine surge as hospitals fill up, mean the Great Lakes State's plight has become the most discordant moment in Biden's so far smooth steering of the US assault on the virus.
Michigan's suffering also offers a glaring warning of the capacity of a pernicious viral variant first discovered in the United Kingdom to exploit fatigue with social distancing and businesses' desire to escape commerce-choking restrictions. Michigan has reported more than 9,600 cases of Covid-19 on Sunday and Monday, according to the state Department of Health and Human Services.
But despite its dire situation, US Centers for Disease Control and Prevention Director Rochelle Walensky explained in frank terms that the time vaccinated patients need to build immunity requires the rejection of Whitmer's pleas.
'If vaccines go in arms today, we will not see an effect of those vaccines, depending on the vaccine, for somewhere between two to six weeks,' Walensky said at a White House briefing on Monday.
'So when you have an acute situation, an extraordinary number of cases like we have in Michigan, the answer is not necessarily to give vaccine. In fact, we know that the vaccine will have a delayed response.'
'Close things down'
Walensky's alternative prescription for quelling the new wave of virus was likely to be even more unwelcome for Whitmer, who endured months of intimidation and even a kidnap plot as conservatives demanded she open her state. Over the weekend, the governor -- who faces reelection next year -- asked Michiganders to voluntarily observe two weeks of voluntary restrictions on activities like indoor dining and youth sports in a sign that new lockdowns are politically unsustainable for her.
But Walensky suggested that Michigan should 'really close things down, to go back to our basics, to go back to where we were last spring, last summer, and to shut things down, to flatten the curve, to decrease contact with one another.' While it is not surging vaccine to Michigan, the White House is sending therapeutics, more testing materials and medical professionals to more efficiently administer its existing vaccine allocation.
While advice to shutter states may be scientifically justified, they are now even more likely to be in vain given widespread public Covid-19 fatigue, and the fact that millions of vaccinated Americans are already beginning to reclaim their freedoms. The kind of central government ordered shutdown lasting months from which the UK is beginning to emerge, for instance, has long seemed incompatible with the American creed of individualism and personal freedom -- even in Democratic-run states.
Many state governors, like the Republicans who run Texas and Florida, have long chafed at CDC recommendations and responded to an easing of the winter Covid-19 case load by swiftly opening for business. They are showing no sign of changing their minds even as Washington's warnings of a surge in cases of more infectious new variants materialize.
The unequivocal message from Walensky does validate one promise Biden made on assuming the Oval Office: to depoliticize the fight against the pandemic. It's not clear whether Donald Trump would have made a similar decision given his track record as a President who loved to bestow favors on swing states and political friends, and then claim the credit.
The case against surging vaccines to Michigan is not just rooted in the maximum six-week delay until people acquire full immunity. The current population-based vaccine strategy is designed to ensure fairness for all states and to tackle the virus across the nation. If the administration cedes to Michigan's appeals, it will inevitably receive similar calls from other states that that could splinter the coherence of the national vaccine effort. And Biden could soon find himself accused of playing favorites with vaccine stocks.
'We have to remember the fact that in the next two to six weeks, the variants that we've seen in Michigan -- those variants are also present in other states,' Andy Slavitt, White House senior adviser for Covid response, said Monday.
'So our ability to vaccinate people quickly in each of those states, rather than taking vaccines and shifting it to playing whack-a-mole, isn't the strategy that public health leaders and scientists have laid out.'
Debate over future vaccine strategy
Michigan's request and the federal response represents the classic tug of war between the national and local interests that are baked into the US system and often complicate public health and disaster relief efforts.
But unlike many of the steps taken by Biden since taking office and deploying presidential authority to a pandemic of which Trump had long tired, there is no medical consensus on his decision on Michigan.
'A core principle of public health is to target resources to where they are needed the most,' Leana Wen, a former Baltimore Health Commissioner, said on CNN's 'New Day' on Monday.
'That's the kind of plan we need coming into the summer and fall where we are going to see these localized, regionalized outbreaks and the federal government is going to have to come up with a plan to surge the resources, including vaccine allocation,' Wen said.
Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration under Trump, said the scale of the current crisis required new thinking.
'We're not going to see a confluent epidemic, but we'll see these hotspots, so we need to get in the habit of trying to surge resources into those hotspots to put out those fires of spread,' Gottlieb said on CBS' 'Face the Nation' Sunday.
Medical experts who disagree with the idea of the a surge, however, argue that the B 1.1.7 variant is so prevalent that it will be cascading across the nation in the coming weeks anyway, so isolated vaccine targeting will not make much difference.
'If they divert vaccines to Michigan, then the outbreak could be in another state next week,' Brown University professor and Emergency Room Physician Dr. Megan Ranney said on CNN's 'Newsroom' on Monday.
Circumstances could change. Officials say that given the efficiency and growing capacity of the vaccine rollout, supply could outstrip demand in the coming weeks. So it's not impossible the calculation on the wisdom of vaccine surges may shift simply because vaccines might otherwise go to waste.
Biden has enjoyed broad public support for his management of the pandemic since taking office nearly three months ago. That is no doubt partly owing to the contrast with the denial and neglect of the Trump administration.
But the White House has also achieved significant success in accelerating the deployment of vaccines. More than 120 million Americans have now had an injection. More than 72 million have been fully vaccinated. Some 78% of seniors have had at least a first shot and 28% of US adults are now fully vaccinated, according to Slavitt, who updated inoculation figures at Monday's briefing.
But with a return of a semblance of normal life hopefully approaching this summer, the White House's ability to maintain the balance between Covid-19 mitigation measures and resurgent commercial activity and gatherings will likely ebb even further.
Public approval with Biden's management of the pandemic will also be tested by key decisions -- for instance the issue of when to resume normal international flights -- a huge consideration for business but a shift that may be months away given lower vaccine rates abroad.
The possibility of new surges of infection in the fall could meanwhile revive the dilemma over whether to urge local jurisdictions of states to shut down again, especially if the administration is not successful in convincing vaccine skeptics -- including many Republicans -- to take their shots.