Story at a glance

  • Six people who advised President Biden during his transition into office wrote three opinion articles published in a medical journal.
  • The articles call for a national strategy with a focus on life with COVID-19 as the “new normal.”
  • The health experts also discuss testing, surveillance, vaccines and therapeutics.

On Thursday, the Journal of the American Medical Association (JAMA) published three opinion articles by six former advisers to the Biden administration. They were part of the transition team about a year ago when President Biden took office and include people like Luciana Borio, a former acting chief scientist at the Food and Drug Administration (FDA) and oncologist, and former adviser in the Obama administration Ezekiel Emanuel, who is a medical ethicist and professor at the University of Pennsylvania. 

Each opinion article addresses a different aspect of a national strategy: a “new normal” life with COVID-19, testing and mitigation and vaccines and therapeutics

In the first piece outlining a “new normal,” the authors write, “In delineating a national strategy, humility is essential. The precise duration of immunity to SARS-CoV-2 from vaccination or prior infection is unknown.” 

They continue, “It is imperative for public health, economic, and social functioning that US leaders establish and communicate specific goals for COVID-19 management, benchmarks for the imposition or relaxation of public health restrictions, investments and reforms needed to prepare for future SARS-CoV-2 variants and other novel viruses, and clear strategies to accomplish all of this.” 

The experts write that the goal for a “new normal” is not eradication of SARS-CoV-2 and COVID-19, or what other countries are calling "zero COVID." They call for the recognition that this coronavirus is one of many types of viruses that circulate regularly in our population, saying we should focus instead on “the aggregate risk of all respiratory virus infections.” 


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In the JAMA piece about testing, surveillance and mitigation strategies, the experts call for the Centers for Disease Control and Prevention to "collect and disseminate accurate real-time, population-based incidence data on COVID-19 and all viral respiratory illnesses.” 

They say the U.S. needs a comprehensive testing and reporting system and needs to be linked to sociodemographic, vaccination and clinical outcomes data. The authors also point out the need for low-cost testing, such as rapid at-home antigen tests. The Biden administration does have plans to distribute 500 million of these, but experts question whether it will be enough and if the process for getting the tests will be clear and equitable. 

Regarding surveillance, the experts highlight the need for environmental surveillance with wastewater and air sampling. They also call for more genomic surveillance to monitor for new variants.

“The US needs to establish a real-time, opt-out digital surveillance system to monitor all vaccinated individuals for the frequency and severity of adverse effects, postvaccination infections, and waning immunity,” write the authors. “Two years into the pandemic, the US is still heavily reliant on data from Israel and the UK for assessing the effectiveness and durability of COVID-19 vaccines and rate of vaccine breakthrough infections.” 

The former advisers think that updated vaccines will eventually be necessary, but they also say that the government will need to do more for the development and efficient deployment of them.

“Achieving 90% population vaccination coverage will require mandates” write the authors. “Few countries have ever achieved such levels of coverage of any vaccine without vaccination requirements.” 

These JAMA opinion articles were shown to White House officials before they were published, and the authors say that they wrote them partly because discussions with them had not led anywhere, according to The New York Times

Borio said, according to the Times, “From a macroperspective, it feels like we are always fighting yesterday’s crisis and not necessarily thinking what needs to be done today to prepare us for what comes next.” 


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Published on Jan 08, 2022