Erin BancoSun, 14 February 2021, 4:34 am
In the morning hours of Jan. 5 in the remote woods of Maryland’s Catoctin Mountain Park, senior political advisers leading President Donald Trump’s vaccine effort gathered for a colloquium at Camp David.
There were just over two weeks left in the administration and the sprawling presidential retreat— where President Franklin Roosevelt and British Prime Minister Winston Churchill discussed the Allies’ invasion of Europe and where President Dwight Eisenhower met Nikita Krushchev— seemed like the perfect setting to mark the end of their work on Operation Warp Speed, or what attendees described as their “Manhattan Project.”
To those who gathered in the woods that day, four of whom spoke to The Daily Beast for this story, Operation Warp Speed, the Trump administration’s effort to fast-track a COVID-19 vaccine within the span of a year, had been a resounding success, their job was nearly done, and any shortfalls on the ground were largely the responsibilities of others, primarily state leaders.
The conversation at Camp David foreshadowed the problems the Biden team would later struggle to address—and underscored the extent to which the Trump administration had fallen short of reconciling the gap between the federal government’s work on developing and shipping the vaccine and the state’s efforts to distribute and administer it. That disconnect would later consume Biden officials in the first days of the administration as they attempted to locate millions of vaccine doses and streamline the distribution process.
On that day at Camp David, officials got together for a “recognition,” as some attendees described it, of all the team had accomplished with the vaccine. The meeting “felt like an exhale,” one former official said. “There were a lot of congratulations and thank yous.”
“This has to be the most spectacular mobilization of the U.S. industry since World War Two,” Paul Mango, the former policy lead at the Department of Health and Human Services (HHS), said during a recent interview, referring to Operation Warp Speed. “Relative to every other country in the world, it’s been a spectacular success story.”
Other officials who participated in the meeting said it was more than a pat-on-the-back soiree. If anything, the discussion was primarily a “a post-mortem”—a reflection of what the team could have done better as well as a calculation of what was not going as planned.
There was plenty to talk about. After several weeks of the vaccine rollout, just over 15 million doses had been shipped to states but only two-thirds of those doses had been administered, according to data from the Centers for Disease Control and Prevention. The vaccination rate across the country was low, and states such as Florida and California threatened to punish hospitals with fines and reduction of supplies if they did not administer the doses within a week. Meanwhile, health-care workers across the country told hospital executives they did not want to sign up to get the shot. At one hospital in Essex County, Massachusetts, which experienced a massive uptick in cases after Thanksgiving, more than one third of the health-care workers said they did not want to get the vaccine, according to a hospital administrator. Meanwhile, state health officials had placed calls to the federal government about changing the dosing schedule as a way to immunize more people more swiftly. The Federal Drug Administration promptly shut those suggestions down, saying changing the dosing intervals could impact effectiveness of the vaccine.
Officials at the Camp David meeting said they were concerned that unused doses would expire on the shelves and that the data the CDC had collected on the vaccine rollout was incomplete and limiting. One official said they worried that new mutations of the virus would seriously complicate vaccination in the following months.
For all the focus on the issues surrounding the vaccine rollout, particularly on the fact that the nationwide vaccination rate was distressingly low, officials in the meeting said they believed the problems on the ground were due in large part—or almost entirely—to mismanagement at the state level and it was up to governors to reverse course.
“To this day, I remain with one question: Why did health authorities tell us where to send the vaccine, say, to a particular health center, and not have a plan to immunize people with those doses?” said Moncef Slaoui, the former chief scientific officer of Operation Warp Speed who also attended the Camp David summit. “Someone needs to go in and dissect what happened. At the time we shipped 11 million doses to 14,000 different sites. At the county level, at the state level, they did not plan enough to immunize. If you have the information to say ship me 2,000 doses here that same information should be telling you, ok, well, then I need enough people to use 2,000 doses.”
“The distribution, for me, is the physical shipment of vaccines,” Slaoui added. “Immunization, inoculation, administration is where we fail. Not in the distribution. Distribution, frankly, has worked perfectly.”
While Trump officials promoted their efforts to fast-track the vaccine and set up a reliable system to ship the vaccine to states, there was very little attention paid behind the scenes to the administration of the vaccine—to overseeing states’ efforts to get shots into arms. Operation Warp Speed officials say that portion of the process was never supposed to fall to them. It was the CDC, they said, that had taken on the task of reviewing state vaccines distribution plans and overseeing their implementation. Even with the CDC’s guidance, officials who spoke to The Daily Beast for this story conceded there was no formalized plan or accountability system discussed at the task force level that would ensure jurisdictions promptly accounted for the doses arriving at the delivery points and when and how many doses moved into people’s arms. That’s because officials said they viewed the administration of the vaccine as a local issue.
In a recent interview with The Daily Beast, Dr. Anthony Fauci, Biden’s chief medical officer, said the Trump team had ultimately failed in its efforts to bridge the communication gap between the federal government and states.
The problems went deeper than a failure to communicate. According to a report by Stat News, Trump officials, including Mango, actively lobbied Congress to deny states aid they needed for the vaccine rollout, arguing that governors had still not used money allocated to them earlier in the year.
“There was a system in place to get the vaccines from point A to point B but there was no planning on that last mile step … on how to make sure that these doses were getting into people’s arms,” one Biden official said.
A former senior administration official, defending the Trump administration’s planning on vaccine distribution, said while some states took longer to ramp up vaccinations because they “had data issues or got too caught up in the … recommendations and overly restricted access to hospitals” other states were well-prepared and “got a high percentage of shots delivered into arms quickly.”
None of the notes from the Camp David meeting made their way to the transition team, according to two individuals with direct knowledge of the matter. One senior official working on the federal government’s response to COVID-19 said even if the Biden team had received notes from the Camp David meeting, it is not clear they would have helped the new administration fix what it saw as a fundamentally broken relationship between the federal government and states.
Biden’s COVID-19 transition team understood that regaining the trust of the nation’s governors would be crucial to a smooth vaccine rollout. In the weeks before he took office, then president-elect Biden and his top aides communicated with health-care leaders and state officials behind the scenes, promising a return to normalcy once he took over. But the level of mistrust among state officials may be more difficult to repair than previously thought, Biden officials told The Daily Beast.
“I think the Biden team is going to learn that if you attempt to micromanage thousands of vaccination sites, a team of people sitting in a conference room in Washington, D.C., won’t be able to do that effectively given the incredibly diverse needs of various communities around the country,” said the former senior administration official. “Shots in arms is ultimately an intensely local effort. What works in rural Montana might actually create distrust in urban Philadelphia. Using the existing infrastructure and people trusted in the local communities or pharmacies where Americans are used to getting medicines is how this is going to get done successfully, and that requires more granular awareness than you typically have in D.C.”
Over the last two weeks, senior Biden officials have held dozens of phone calls with state leaders only to find a hodgepodge of rollout strategies, each distinctly different from the next, with varying levels of efficiency.
In their conversations with state leaders during the first days of the administration, Biden officials met with widespread frustration among governors, many of whom said they needed more guidance and financial support from the federal government for vaccine distribution.
That frustration is in part a reaction to the Trump administration’s thinking that states were not taking on enough of the burden of helping slow the spread, curb deaths, and vaccinate their people. During the course of 2020, President Trump made it a practice of calling out specific governors, including New York Gov. Andrew Cuomo, chastising their decisions around how to respond to the virus. He also pitted blue states against red states, saying in a September press conference that the COVID-19 death toll was “very low … if you take the blue states out.”
Over granola bars and other small snacks, participants of the Camp David meeting discussed the extent to which states were “failing in their vaccine rollout,” one attendee told The Daily Beast. After all, they said, the federal government had done its job.
The team had helped shepherd the vaccine’s development with extra funding, stood up dozens of manufacturing facilities to scale production, used the Pentagon’s aircraft to ship much needed equipment from Europe, and set up a system that would pull doses off the line and send them directly to hospitals and other vaccine distribution points. By the first week in January the U.S. had readied two efficacious vaccines—developed by Pfizer and Moderna—and the federal government had delivered millions of doses to states and territories so Americans could begin to get vaccinated. But it soon became clear that doses were not moving from the freezer into people’s arms.
Mango said the federal government didn’t have any intention of getting involved in the administration of the vaccine, or attempting to meddle in states’ strategizing, primarily because the plans they had submitted to the CDC were comprehensive but also because “you never want your reach to exceed your grasp,” Mango said.
“We understood what the government could do extraordinarily well, and we understood what it couldn’t,” he added. “And one of the things that we couldn’t do extraordinarily well is understand how to vaccinate people at the corner of Fifth and Vine. It’s way too local. It’s way too local for us to intervene. What we couldn’t do is understand the very different situations that each of the jurisdictions was facing.”
Despite that lack of understanding, officials at the Camp David meeting made a decision that would have far-reaching consequences for every state. They publicly recommended that states expand the population of those who could receive the vaccine to everyone 65 and older, Mango said. After the Camp David meeting, Operation Warp Speed board members, including Jared Kushner, held a series of meetings about the new recommendations which Health and Human Services Secretary Alex Azar would later make public in a Jan. 12 press conference. The idea, according to Slaoui, was to ensure doses did not expire on the shelf.
“I think the worst thing is to have vaccine doses in a fridge waiting. From that standpoint, widening the pool meant having more people immunizing and therefore more people immunized,” Slaoui said. “Failing to use vaccines after you spent so much effort to discover, develop and produce them is a failure.”
In order to improve the vaccination rate, Mango said the administration gave states an ultimatum.
“We said ‘guys, we’re gonna give you a couple of weeks, but two weeks from now, if you’re not ordering and if you’re not administering, guess what? We’re gonna send these doses to the places that are being starved, not the places that are not using them,’” Mango said. “I think the governors got their butts in gear and started reporting better and harder.”
While the vaccine supply has increased and vaccine rates are improving nationwide, state leaders say they have over the last several weeks struggled to understand exactly how many doses they should expect to receive and when they should expect to receive them. And once states began to expand the pool of who was eligible for the vaccine, demand spiked. States had to cancel hundreds of appointments because they said they ran out of vaccine doses. Governors called on the Biden team to send more. But Biden officials working on the administration’s COVID-19 response pushed back on those calls, saying the data the federal government had collected showed there were still millions of doses available for use. Biden officials later said some states had chosen to hold some of the doses distributed to them for second-dose shots rather than dole them out as soon as they got them.
The back and forth underscored the fact that the system through which the CDC collected its data on vaccine distribution and administration was flawed, officials said. Over the past two weeks, state officials have raised the issue directly with the federal government, claiming the CDC vaccination tracker was misleading and that their states had actually administered more doses than was being reflected on the agency’s website.
Officials in the Camp David summit had also raised the issue of how inaccurate data was limiting the federal government’s visibility into the vaccine distribution. It wasn’t the CDC’s fault, Mango said. (The CDC publishes data on how many doses have been allocated, distributed and administered across the country.) As was the case with other lockjams, attendees of the Camp David meeting who spoke with The Daily Beast said the problem most likely stemmed from states and the speed with which they were required to report their vaccine numbers to the federal government.
“The CDC had a standard before COVID of states having to report any vaccination for any disease within 30 days. What we talked about was [former CDC director] Dr. [Robert] Redfield changing the standard to three days. State reporting systems could not move on that diet,” Mango said. “We talked about, what is it that we could do? I think what we learned was that the states weren’t paying much attention to the data. And once we brought it to their attention, and they saw, wow, you mean, Connecticut is at 80 percent and I’m at 20 percent? Governor’s don’t like to hear that if they’re at 20 percent.”
“Part of it was just shining a spotlight on the variation,” Mango added. “What we decided was we’re just gonna start posting the data publicly and then maybe that’ll help people get on the horn and start reporting better.”
Biden officials have drafted various plans to help states with vaccine distribution, including sending federal officials to work with state health agencies to help in the planning and administering of the vaccines. They have also discussed sending federal officials to help states better track the doses allocated to them. Additional funding states say they need to help bolster the vaccine rollout is currently held up in negotiations around President Biden’s $1.9 trillion stimulus bill. A group of moderate Democrats have called on House Speaker Nancy Pelosi (D-CA) to consider breaking off and passing a vaccine package so states could more swiftly scale distribution.
Vaccine distribution and administration has improved in recent days. And Biden’s COVID-19 task force has committed to increasing supply to states from 10 to 10.5 million per week for the next three weeks. Still, states say the supply does not meet demand.
“I feel very sorry for people waiting in line. But, you know, it’s the reality,” Slaoui said. “Imagine there is a restriction in food. We don’t have meat. And then you hear okay, well, we know we were able to slaughter 500 cows, we now have meat. It’s enough for 1000 people but we have 10,000 people waiting in line. I think it’s the same principle. People were afraid of the vaccine. But once you have a vaccine and it’s 95 percent efficacious, I could hear people get angry, saying ‘I want to see my grandchildren, I want to get out of my house, I want to have my life again, and therefore I’m going to take a line and stand there.’”
“I think the average American understands that this was unprecedented in terms of mobilizing U.S. industry, but the political narrative is trying to disparage what is, again, something that you can compare to Apollo or a Manhattan Project,” Mango said. “If I were on the Biden team, I would have said, ‘these guys handed us something very special and we’re gonna make it even better.’ That’s why we went out to Camp David, because … we were trying to figure out what we could do better. We realized we couldn’t get everything 100 percent perfect on day one. Sure, the Biden administration is going to be smarter than we were three weeks from now and they ought to make some changes. But that’s a lot different than saying ‘we were handed a mess.’